If you are a member* (or the beneficiary of a member) of a French social security scheme, you may qualify for coverage of your healthcare expenses when you go to another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member state in order to receive medical treatment.
In order to be covered for certain types of scheduled care (particularly extensive treatment) in another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member State, prior authorization from the French health insurance fund is required.
* Salaried or self-employed worker, unemployment benefits recipient, resident, pensioner, etc.
Before you leave, you must apply for prior authorization of coverage for care requiring at least a one-night hospital stay or the use of highly specialized and costly medical equipment or facilities.
Treatments subject to prior authorization are as follows:
The portable S2 certificate, « Entitlement to scheduled treatment », authorizes you to travel to another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member state 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 (doctor registered in France or doctor registered in the EU/EEA/Switzerland), specifying:
- your medical condition,
- the type of care you intend to receive,
- the medical reasons for which you intend to seek care elsewhere in Europe,
- the country and the facility in which you will receive care,
- the expected beginning and end dates of your course of treatment.
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.
However, if the patient requires urgent care which can neither be postponed nor performed in France, prior authorisation may be issued retrospectively when the patient was prevented from requesting such authorisation before his departure or could not wait for the decision of the competent institution.
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 healthcare 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.
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.
Coverage of other scheduled care, particularly standard ambulatory care, is not subject to prior authorization from your local French health insurance fund, but this care must be part of the benefits to which you are entitled in France. Otherwise, no reimbursement is allowed.
However, certain types of care or treatment may be subject to prior authorization from the French system:
Before you leave, you need to inquire whether the care or treatments you plan to receive will require prior authorization from the Health Insurance Fund in order to be covered. If so, prior authorization will be also required for coverage of scheduled care in another State.
Your designated primary care provider must fill out the request for prior authorization of coverage and give it to you. You must then complete it and send it to the medical Service of your local Health Insurance Fund in France. You must also send the prescription (original or copy) for care or procedures performed by allied health professionnals (physical therapists, speech therapists, othoptists), for travel expenses for medical purposes, for lab exams or for medical equipment along with your application.
You will receive notice of prior authorization or refusal of coverage from your Health Insurance Fund within period of 15 to 21 days of receipt of your application, depending on the nature of the care. If you receive no response within this timeframe, your application has been approved.
If you request for prior authorization has been denied, the decision must be reasoned and include instructions on the appeals procedure.