Its purpose is to settle administrative disputes between a user and a French Social Security fund out of court. Disputes must first be submitted to this board before any litigation can be brought before the court of law "Tribunal judiciaire".
FR Commission de recours amiable (CRA)Under French legislation, when Puma (Universal Health Care Coverage) was rolled out on January 1st, 2016, beneficiary status ceased to exist except for minors who:
-are dependents of a French-insured individual,
-are not employed,
-have not applied for membership in their own right (possible from age 16 and up).
Benefits in kind are the total or partial refund of the insured individual’s or his/her beneficiaries’ medical, paramedical, and hospitalization expenses.
FR Prestations en natureThe amount that is taken into account when calculating family benefits. As an example, family benefits due for 2 children amount to 32% of the BMAF. The BMAF is uprated on April 1st of each year, in accordance with that year’s forecast average consumer price trend not including tobacco.
FR Base mensuelle de calcul des allocations familiales (BMAF)Services provided to workers or pensioners residing in a State other than the State of employment or other than the State paying their pension.
FR Soins liés à la résidenceCash benefits are the replacement income that is paid to an insured individual to compensate for a loss of earned income during medical leave due to illness, maternity, or an industrial accident.
FR Prestations en espècesThe concept of circumstances treated as employment is defined in Decision No. F1 of June 12, 2009, of the Administrative Commission for the Coordination of Social Security Systems. This term refers to a period of temporary suspension of employment on the basis of illness, maternity, paid unemployment benefits, or unpaid leave that has been taken in order to raise a child (parental leave).
FR Situation assimilée à une activité professionnelleAn internship is a period completed by students in secondary or higher education as part of their program of studies as an extension of the formal education they are receiving at their institution of learning. As a general rule, a company internship is an addition to their training that provides a hands-on opportunity to apply what they have learned. A distinction is made between interns and members of the following categories:
French law No. 2014-788 of July 10, 2014, stepped up oversight of internships and the protection of intern status, in particular by introducing the following measures:
An internship cannot last for more than 6 months, except as part of certain specific training programs.
FR Stage en entrepriseInstitution with which the person concerned is insured at the time of the application for benefit.
FR Institution compétenteMember State under whose social security system the patient concerned is insured at the time of the cross-border treatment.
FR Etat membre compétentThe total amount of all pay components that are taken into account when calculating a customer’s social contributions.
FR Assiette de cotisationsMaximum amount above which contributions are no longer calculated. The social security ceiling is a contribution ceiling. As an example, in France there is no ceiling for health insurance contributions: there are calculated on the basis of the member’s total earnings.
FR Plafond de cotisationsA set out-of-pocket amount which will not be covered by the national health service/statutory health insurance, but which the insured will have to pay him or herself (i.e. the patient’s share of the medical costs).
FR Ticket modérateurThis is France’s highest court. Its role is to examine whether the law has been correctly applied by the country’s lower and appeals courts and thus to ensure that the law is interpreted in a uniform manner.
FR Cour de cassationAgreement to promote the development of cross-border health cooperation between neighbouring States with a view to ensuring better access to high-quality health care for the population around the border, guaranteeing continuity of care and the fastest possible recourse to emergency aid, by promoting the pooling of knowledge, practices, human and material resources.
FR Convention transfrontalière de coopération sanitaire ou médico-socialeCross-border healthcare refers to medical treatment outside the patient’s country of residence, where s/he is entitled to public healthcare (whether or not under the social security legislation of another Member State). The treatment is considered to be cross-border when received in any another EU/EEA Member State or Switzerland, without the prerequisite of sharing a geographical border with the country of residence.
FR Soins de santé transfrontaliersPrescription for medicines or medical devices issued by a health professional legally authorised to prescribe in the Member State in which the prescription is issued.
FR Prescription transfrontalièreUnder the European Social Security coordination regulations, cross-border worker refers to any individual engaged in salaried or self-employment in one member State while residing in another member State, where s/he is expected to return every day or at least once a week.
FR Travailleur frontalierThe ECJ has ruled that CSG and CRDS go to finance the French Social Security system. They cannot be withheld from the employment and replacement income of individuals who are tax residents of France but are not covered by the French social security system. An individual drawing a pension from only one EU-EEA member state or Switzerland and residing in France only pays CSG-CRDS if the following two requirements are met: being a tax resident of France and having compulsory membership in the French health insurance system.
FR CSG - CRDSAlso referred to as cash benefits, the daily benefits paid by France’s health-maternity insurance system are intended to replace income (such as wages, salary, or unemployment benefit) that has been suspended due to sick or maternity leave.
FR Indemnités journalièresThe patient’s out-of-pocket contribution to his/her room and board during a hospitalization.
FR Forfait hospitalierFrom the Latin “Is de cujus successione agitur”, the person whose estate is being discussed. Means the future deceased or person whose estate is being administered.
FR De cujusConcerns the application of cross-border healthcare and aims to guarantee patient mobility and freedom to provide health services in the EU 27, Iceland, Liechtenstein, and Norway but not in Switzerland.
FR Directive n°2011/24/UEAims to facilitate the recognition of cross-boarder medical prescriptions issued in another Member State and provides for the minimum information to be reported on these prescriptions by the health professional.
FR Directive n°2012/52/UEProvision of remote health care services through the use of information and communication technologies (ICTs), e.g. teleconsultation, telemonitoring, telesurgery,...
FR Santé en ligne ou TélémédecinePrescription that is electronically generated, transmitted and filled.
FR Prescription électroniqueEnsures compliance and uniform application of European Union law throughout the EU by checking EU institutions’ actions for legality, ensuring that Member States meet the obligations that ensue from treaties and interpreting European Union law upon request by domestic judges.
FR Cour de justice de l’Union EuropéenneThe European Economic Area (EEA) includes, besides the 27 EU Member States, Iceland, Liechtenstein and Norway.
FR Espace économique européenFree card, issued by the national health service authority/health insurer, that gives the patient access to medically necessary, state-provided healthcare during a temporary stay in another EU/EEA country, in Switzerland, or in the United Kingdom, under the same conditions and costs (free at charge in some countries) as people covered/insured under the national health services or national health insurance scheme of that country.
FR Carte européenne d'assurance maladie (CEAM)Virtual cross-border cooperation platforms, unique and innovative, bringing together specialists in the diagnosis and treatment of complex and rare diseases that require highly specialised treatment and a concentration of knowledge and resources (www.europa.eu/youreurope).
FR Réseaux européens de référence (ERN)They aim to coordinate the various European social security legislations, facilitate the free movement of persons, avoid loss of rights when moving within Europe (EU, Iceland, Liechtenstein, Norway and Switzerland) and ensure continuity of their social protection when they move from one legislation to another.
FR Règlements européens de coordination des systèmes de sécurité sociale (CE) 883/2004 et (CE) 987/2009The European Union (EU) includes following 27 Member States: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden.
EU-law is not applicable in Northern Cyprus (the Turkish Republic of Northern Cyprus).
FR Union européenneFrom a Social Security standpoint, a worker who goes to another country to work is an expatriate if s/he is no longer a member of his/her home country’s social security scheme and has compulsory membership in the local scheme of the State in which s/he is working.
FR ExpatriationUnder European law, the following family benefits are exportable: France’s “allocations familiales” (family allowances) along with top-ups to these benefits and the “forfait familial” (lump-sum payment for each dependent child), the early childhood benefits (the “PAJE” program including a basic allowance “allocation de base”, a shared child-rearing benefit “PreParE” and a supplement for free choice of childcare “complement de libre choix du mode de garde”), the family supplement (“complement familial”), the disabled child’s education allowance (“allocation d’éducation de l’enfant handicapé”/ AEEH), the back-to-school benefit (“allocation de rentrée scolaire”/ ARS), the family support allowance (“allocation de soutien familial”/ ASF), and the daily parental presence allowance (“allocation journalière de presence parentale”/ AJPP).
The following family benefits are not exportable: the birth bonus (“prime à la naissance”), except under special circumstances, and housing benefits (“allocation logement”).
FR Prestations familiales (non) exportablesA flat fee deducted from the reimbursements you receive from your health insurance fund for treatment or diagnostic procedures costing more than a certain amount that you undergo in a non-hospital setting, in a health center, or in a health care facility (hospital or clinic).
FR Forfait acte lourdUnder French Social Security law (article L 161-1 of the French Social Security Code), family member refers to:
-an insured individual’s spouse or domestic partner or the person with whom s/he has entered into a civil union (“pacte civil de solidarité”/ PACS),
-the latters’ minor children,
-an insured individual’s ascendant or descendant who is living at that individual’s home and whose sole occupation consists of household work and of rearing the insured individual’s dependent children.
Under the European Social Security coordination regulations, “family member” is defined under article 1) 1) i of (EC) regulation No. 883/2004.
FR Membre de familleAn out-of-pocket amount deducted from the reimbursements paid by the patient’s health insurance fund for doctor’s appointments and procedures and for radiological exams or laboratory tests.
FR Participation forfaitaireHealthcare that may be required as a result of treatment or medical intervention with the purpose of providing aftercare or surveillance to ensure a good recovery.
FR Suivi médicalAn independent public authority in France that helps to regulate the health system through quality. Its work involves evaluating health care products, professional practices, the organization of care, and public health.
FR Haute Autorité de Santé (HAS)A public authority in France that is tasked with setting up free, fast, and out-of-court compensation for medical accident victims.
FR Office National d’Indemnisation des Accidents Médicaux, des Affections Iatrogènes et des Infections Nosocomiales (ONIAM)Each agreement specifies the regions, counties or towns to which the agreements apply.
FR Champ d'application géographiqueHealth services provided to patients by health professionals to assess, maintain or restore their health, including the prescription, dispensation and provision of medicines and medical devices.
FR Soins de santéComprehensive, ongoing, and locally-based care for patients. The aim is to bring prevention, health care, and social welfare services together in such a way as to provide coordinated, locally-based care throughout the patient’s illness, near his or her home.
FR Parcours de soinsThe healthcare professional card (CPS) is a smart card used in France to ensure confidentiality of access to personal data in the context of electronic health services. It is issued by the Agence du numérique en santé to each healthcare professional.
FR Carte de professionnel de santéMeans any natural or legal person or other entity legally providing health care on the territory of a Member State.
FR Prestataire de soins de santéThe results of programs that are conducted to improve the quality and safety of care in health care facilities in order to meet patient and user demands. Public and private health care facilities are required to make the results of the indicators available to the public each year: for France, the website of the French Health Authority (« Haute Autorité de Santé » / HAS) provides access to each health care facility’s individual results (QualiScope).
FR Indicateurs de qualité et sécurité des soinsStatutory social security scheme financed by tax or social contributions and which covers health care in the event of illness or accident.
FR Assurance maladieHealth networks aim to improve access to care, coordination, continuity or interdisciplinarity of care. They provide care adapted to the person's needs in terms of health education, prevention, diagnosis and care.
FR Réseaux de soinsCan be defined, in an EU/EEA/Switzerland country, as all the organisations, institutions and resources that aim to improve health.
FR Système de santéHealth technology assessment (HTA) summarises information on the medical economic social and ethical issues related to the use of a health technology such as drugs medical equipment or in vitro diagnostics.
FR Evaluation des technologies de la santéTreatment requiring the patient to stay in hospital or another health facility.
FR Traitement hospitalierInstitution which is competent to provide benefits in the place where the person concerned resides.
FR Institution du lieu de résidenceInstitution which is competent to provide benefits in the place where the person concerned is staying.
FR Institution du lieu de séjourPerson or family member of a person who is subjected to the social security legislation of one or more of EU/EEA Member States.
FR Personne assuréeBody composed of representatives of both States’ ministerial competent authorities. This committee is tasked with overseeing the application of the cross-border agreements, sorting out any difficulties with their application, and proposing amendments if needed.
FR Commission mixteServices in the field of long-term care the purpose of which is to support people in need of (non-medical) assistance in carrying out routine, everyday tasks, for example nursing homes
FR Soins de longue duréeEach agreement specifies the types of affection/pathology covered under the agreement or the type of care and support provided to disabled persons.
FR Champ d'application matérielTheir purpose is to provide arbitration to resolve disputes between patients and healthcare professionals in France, as well as to award compensation by facilitating the out-of-court settlement of disputes related to medical accidents, iatrogenic conditions, and hospital-acquired infections.
FR Commissions de conciliation et d’indemnisation des accidents médicaux (CCI)An out-of-pocket amount that is deducted from the reimbursements you receive from your health insurance fund for pharmaceuticals, ancillary medical procedures, and medical transport.
FR Franchise médicaleServices provided to tourists, pensioners, posted workers, or students who need medical care during a temporary stay in another country.
FR Soins urgentsTreatment that cannot be postponed and must be provided in order to prevent the patient from having to return home before the end of the planned duration of the stay abroad (work, study or leisure).
FR Soins médicalement nécessaires (inopinés ou urgents)Paper or electronic record of a patient containing diagnoses, test results, treatment results, list of medications administered, and post-operative results.
FR Dossier médicalTreatment including medical diagnosis, medical treatment and prescription of medicines or medical devices.
FR Traitement médicalMember State where the cross-border treatment is provided, or in the case of telemedicine, Member State where the healthcare provider is located.
FR Etat membre de traitementIn France, this term refers to an individual who is drawing pensions from several basic retirement pension schemes due to a varied work history.
FR Polypensionné (ou pluripensionné)Salaried or self-employment activities conducted either simultaneously or on an alternating basis in two or more EU-EEA member States or Switzerland (European regulations only).
FR PluriactivitéBodies designated in each EU/EEA Member State to provide patients with information on all aspects of cross-border healthcare.
FR Point de contact national (PCN)Health care rates have been set by agreements between France’s health care professionals and the social security system. If a doctor’s rates exceed the nationally agreed amounts, he has added a surcharge (« dépassement d’honoraires »).
FR Tarif conventionnelAllocation and acccess to organs for organ transplants (with the exception of surgery for the transplantation itself).
FR Transplantation d'organesThese are used in the diagnosis, prevention, and treatment of rare, fatal, or very serious illnesses. These drugs are limited in their development and rollout because they are targeted at a small number of patients suffering from very rare symptoms.
FR Médicaments OrphelinsTreatment of the patient in a health care facility, excluding a full stay, or treatment in town by a private health professional.
FR Soins ambulatoiresUnder French labor law, parental leave is a legal entitlement and is granted to all employees with a given length of seniority on the date their child is born. Parental leave results in a limited-time suspension of the employment contract, during which some rules continue to apply. This means that the employment contract is not terminated. Due to this ongoing relationship with the company, the individual is treated as a worker even though s/he does not draw a salary while on leave.
FR Congé parentalEach health care facility is required to set up a comprehensive policy designed to ensure compliance with patients’ rights, which is an essential part of quality. These rights include: choosing a health care provider, informed consent, equal treatment, protection of privacy, access to medical records, an appeal and compensation procedure, and information on the cost of care.
FR Droits des patientsRefers to any information relating to an identified or identifiable natural person, that is one who can be identified, directly or indirectly, in particular by reference to an identification number or to one or more factors specific to his physical, physiological, mental, economic, cultural or social identity.
FR Données personnellesEach agreement mentions the health insurance schemes covered by the agreement.
FR Champ d'application personnelUnder the European coordination regulations, this is a document intended for the insured individual to keep as proof of his/her circumstances or entitlements when traveling within the EU/EEA. It has replaced the old E-series forms as from 2010 and the entry into force of the EC coordination regulations Nos. 883/2004 and 987/2009. It is generally issued upon request from the social security institution to which the individual belongs.
FR Document portableFrom a Social security standpoint, posting refers to the continuation of a salaried or self-employed worker’s membership in his/her home country’s social protection system during a set period of salaried or self-employment in another country.
FR DétachementPrescription for medicines or medical devices issued by a member of a regulated health profession who is legally entitled to prescribe in the country where the prescription is issued.
FR Prescription ou ordonnanceThe primary care physician you choose plays a central role in your overall care. This is the doctor you generally see but s/he also coordinates your care, provides referrals as part of the healthcare pathway (« parcours de soins »), manages your medical file and provides personalized prevention.
FR Médecin traitantProcedure consisting of applying to the French health care system « Assurance maladie » for approval or denial of coverage before undergoing certain medical treatments and procedures.
FR Accord préalableAuthorisation that patients must obtain from their health insurance fund before seeking crossborder care and be able to get reimbursement for this care.
FR Autorisation préalableHealthcare provider who is working in the private health sector, is not contracted to the statutory health insurance scheme and whose care will not be reimbursed by the social security system.
FR Prestataire de santé privéThe professional associations have special prerogatives, most importantly those of determining how the profession is organized, of applying rules, particularly with regard to discipline, and of representation before the public authorities.
FR Ordres professionnelsHas the same function as the EHIC and is issued in the event of forgetting, loss, theft or non-possession of this card. This certificate shall be issued for a limited period of validity (3 months for certificates issued by France).
FR Certificat provisoire de remplacementAn authority tasked with advising the Ministry of Health by drafting reports on health in France and making recommendations (drawing up and following the nationwide health strategy, managing health risks, and designing and evaluating prevention and health safety policies and strategies).
FR Haut Conseil de la santé publique (HCSP)Health care provider who is contracted to the statutory health insurance scheme and is entitled to provide benefits covered by that scheme.
FR Prestataire de santé publicPublic programmes of vaccination against infectious diseases which are exclusively aimed at protecting the health of the population on the territory of a Member State and which are subject to specific planning and implementation measures.
FR Programmes de vaccinationRequired period of membership in a social security scheme or fund in order to be eligible for or to draw a benefit.
FR Condition de stageIt is defined in the European Union (EU) as a disease affecting less than 5 in 10,000 people in the general population. About 80% of them are genetic in cause.
FR Maladie rareFrench public administrative authorities in charge of implementing health policy in each region, coordinating prevention, care, and patient support. They ensure that resources are managed in a coherent way to guarantee all patients equal access to continuous, high-quality, and safe care.
FR Agences régionales de santé (ARS)Repayment of the patient by his health sickness fund of healthcare costs on the basis of applicable liability rates.
FR RemboursementThe concept of “member State in which they reside (…) refers to the State in which the persons concerned habitually reside and where the habitual centre of their interests is to be found. In that context, account should be taken in particular of the employed person's family situation; the reasons which have led him to move; the length and continuity of his residence; the fact (where this is the case) that he is in stable employment; and his intention as it appears from all the circumstances.” (ECJ, Swaddling, February 25, 1999, case C-90/97).
FR RésidenceDocument showing prior authorisation to travel to an EU/EEA/Switzerland Member State for medical treatment.
FR Formulaire S2Travel to an EU/EEA/Switzerland country for the purpose to receive medical treatment appropriate to your health condition. This type of care may require prior authorisation from the health insurance fund.
FR Soins programmésAccording to the contribution liability rules that apply to internships completed in France (article D 136-1 of the French Social Security Code), amounts of up to 15% of the hourly social security ceiling that are paid to the intern (wages or gratuities) are not liable to contributions.
FR Franchise de cotisations socialesThe Social Security ceiling is an amount that is set each year by decree and is used to calculate certain social charges (including a portion of a member’s old-age insurance and supplementary pension contributions) as well as certain Social security benefits.
As regards basic old-age insurance contributions, the social security ceiling is the maximum (gross) salary beyond which no employee’s contributions are due. In other words, the portion of the member’s salary that exceeds the Social Security ceiling is not included in his/her contribution basis.
FR Plafond de la sécurité sociale (PSS)These documents are used as part of European social security coordination. They contain information on cross-border records that are intended to be exchanged electronically between Social Security institutions using the secure network EESSI (Electronic Exchange of Social Security Information).
FR Document électronique structuré (DES ou SED)The concept of the supplement comes under article 68 of EC regulation No. 883/2004. When each parent is working in a different European Union - EEA member State or Switzerland, the competent institution to pay family benefits by priority right is the institution of the State in which the children are residing. The other State is competent to determine entitlement to any supplement. Indeed, if the amount of family benefits as provided by the legislation of the State paying benefits by priority right is lower than the amount of benefits as provided by the legislation of the State in which the other parent is working, the latter State pays a supplement that is equal to the difference between those two amounts.
FR Complément différentielThis concept applies under domestic French legislation. Family benefits from the French social security scheme cannot be paid at the same time as child benefits paid pursuant to international treaties, conventions, or agreements which France has signed. When foreign benefits or family-related entitlements are paid on the basis of employment abroad or with an international organization, only a supplementary allowance may be paid to an eligible family residing in France (article L 512-5 of the French Social Security code). This supplementary allowance amounts to the difference between the entitlements that are due under French domestic legislation and those being paid under foreign legislation. Foreign schemes may also provide for a supplementary allowance if eligible children are residing in that country if it exists under the legislation being applied.
FR Allocation différentielleRefers to the direct payment of the healthcare provider by the competent national health service/health insurer. As a result, the patient enjoys treatment free of charge and only has to pay the patient’s part of the costs (co-payment).
FR Tiers payantA three-party agreement must be signed by the intern, the host company, and the teaching institution and must:
Treatment subject to prior authorisation by the Member State of affiliation in the event of hospitalisation or use of heavy equipment (for France, see : decree of 27 may 2014)
FR Soins soumis à autorisation préalablehas jurisdiction to decide disputes relating to general and technical social security affairs litigation as well as social aid eligibility disputes.
FR Tribunal judiciaire (TJ)Puma was introduced by article 59 of France’s Social Security financing law for 2016. It entitles all individuals working or residing in France on a legal and ongoing basis to coverage of health care expenses (reimbursement of health care expenses not including cash benefits), without having to complete any special paperwork.
FR Protection universelle maladie (Puma)The CRUQPC liaises between a health care facility and its users in France. It plays a crucial role in the implementation of measures designed to improve patient and family member intake as well as patient care. It is also in charge of compliance with patient rights. Its tasks also include examining patients’ formal and informal complaints.
FR Commission des relations avec les usagers et de la qualité de la prise en charge (CRUQPC)Period that elapses between eligibility for a Social security benefit and the actual payment of that benefit.
FR Délai de carence