If you travel to Switzerland while pregnant

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Important:

  • If you are a Swiss cross-border worker who has opted for membership in the French health insurance system, special provisions have been adopted to guarantee continuity of care in Switzerland under certain conditions.
  • Directive 2011/24/EU on patients' rights in cross-border healthcare, which incorporates EU Court of Justice legal precedent on the free circulation of services (including the Kholl and Decker rulings), is not applicable in this country. This means that standard (non-emergency) ambulatory care cannot be covered.

This section applies if you are pregnant and a member or the beneficiary of a member of the French health insurance system. If you travel to Switzerland, you may be eligible for coverage of any medical care related to your pregnancy, regardless of your circumstances (salaried or self-employed worker, unemployment benefits recipient, resident, pensioner, etc.).

However, your coverage will differ depending on the reasons for your travel to these countries: exclusively medical reasons or non-medical reasons.

I – Travel for exclusively medical reasons

Before you leave, you must apply for prior authorization of coverage (S2 form).

The following types of care are subject to prior authorization:

If approved, you will receive a portable S2 certificate for coverage in the country you are visiting. If you pay all or part of your medical expenses upfront, you can apply to your local health insurance fund for a reimbursement when you return to France.

The portable S2 certificate

Legal framework:

The portable S2 certificate, "Entitlement to scheduled treatment,"authorizes you to travel to another EU or EEA member state or to Switzerland to receive medical care. It means that your care will be covered as provided by local law and according to local rates. Indeed, you will receive the same care as members of the local social security system.

You will need to apply for this document (S2 form) from your local health insurance fund in France. Your application must be sent along with a detailed medical certificate issued by your designated primary care physician specifying:

You will receive notice of prior authorization or refusal of coverage from your health insurance fund within 14 days of receipt of your application. If you receive no response within this timeframe, your application has been approved.

You must apply for your authorization far enough in advance so that your local health insurance fund can process it before you leave.

Your authorization will not be granted automatically. Indeed, the following conditions apply:

If your application is approved, you will be issued with an S2 certificate you will need to show in the Member State you are visiting either to one of the local health insurance fund or directly to your health care provider so that your care is covered locally pursuant to local law.

If your request for prior authorization has been denied, the decision must be reasoned and include instructions on the appeals procedure.

SPECIAL CASE:

If you are not a resident of the competent State, you will need to apply for authorization of scheduled care through the institution of your place of residence, which will immediately forward your application over to your fund of membership (competent institution). In this case, authorization can be granted:

If you need critical emergency care and prior authorization cannot be denied (the care is covered domestically by the member State of residence and cannot be provided within a reasonable timeframe from a medical standpoint), you will be granted authorization by the health insurance fund of your place of residence on behalf of your fund of membership.

If you or your family members are residing in a State that has opted for the reimbursement of care on a lump-sum, the competent institution to issue the prior authorization will be the health insurance fund of your place of residence as that is the fund that will cover the cost of your scheduled care.

Coverage of transportation expenses:

When the medical service processes an application for prior authorization of scheduled care, it must also process any request for coverage of related transportation expenses at the same time, using the criteria set forth by French regulations (submission of an application for prior authorization valid as a medical prescription).

Transportation expenses must have been medically prescribed to the patient and are reimbursed on the basis of the least expensive itinerary and means of transportation that are compatible with the patient's state of health.

Requesting reimbursement of your health expenses

II – Travel for another reason (non medical), during which you received necessary care

Legal framework:

As a member or beneficiary of a member of a French social security scheme, you are entitled to coverage of care which becomes medically necessary during a temporary stay in another European Union or European Economic Area country (e.g. during vacation, business trips, or foreign-language programs). This care is covered by your European Health Insurance Card (EHIC). The EHIC is proof of your entitlement to coverage under the French health care system. However, you may still need to pay for your care upfront.

The EHIC covers all care that becomes medically necessary during your stay: all unscheduled or emergency care, including hospital care, regardless of whether it is provided in a public or private facility in the country you are visiting.
If you paid for your care upfront, you will need to submit your paid invoices to your French health insurance fund. The fund will then consider your request for reimbursement as if the care had been received in France.

In particular, the fund will check whether the conditions for reimbursement provided by French law, such as the requirement for a medical prescription, were met.

Where applicable, the fund will reimburse you for your care based on Social Security rates in the country where the care was provided or, if you agree, based on French Social Security rates up to a maximum of actual expenses.