If you are insured* (or the beneficiary of an insured individual) under the Social Security system of an EU or EEA (Iceland, Liechtenstein, Norway) member State or Switzerland, you may receive healthcare coverage from your member State of affiliation if you travel to France in order to receive medical care.
* worker, unemployed, pensioner, daily benefits recipient
For detailed information on coverage, please check with your State of affiliation by contacting either your local health insurance fund or your home country's national contact point.
Legislative framework :
The portable S2 certificate, "Entitlement to scheduled treatment" (equivalent to the E112 certificate) authorizes you to travel to France to receive medical care. With this certificate, you are entitled to coverage in accordance with France's regulations and established rates. Indeed, you will receive care under the same conditions as those insured under the French social security system.
You must apply for your certificate early enough so that your local sickness fund has enough time to process your application before your departure.
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.
In France, the organization with the authority to reimburse healthcare expenses and inform the patient on state-registered ("conventionné") doctors, state-registered ("conventionné") or certified healthcare facilities is the "Caisse primaire d'assurance maladie" (CPAM) in metropolitan France or the "Caisse générale de sécurité sociale" (CGSS) in France's overseas "départements" (DOM). You can do a "département"-by-"département" search for the local CPAM or CGSS, based on where you will be staying.
In France, benefits in kind (healthcare) cover medical expenses, pharmaceutical expenses, the cost of dental care and prostheses, hospitalization expenses, the costs of laboratory tests and analyses, and transportation expenses.
Before you see a doctor or dentist, make sure that s/he is state-registered ("conventionné"). "Conventionné" doctors will have one of two statuses:
In either case, your reimbursement by the CPAM or CGSS where the care was provided will be based on state-regulated fees.
You can search for a healthcare professional by location on the French healthcare insurance website Ameli.
If you are insured in another EU member state or Switzerland, the provisions of French law pertaining to the healthcare pathway (appointing a primary care physician, who must be consulted before consulting a specialist) do not apply to you. You must show the (general practitioner or specialist) doctor you see your S2 certificate as proof that the healthcare pathway does not apply to you, and to make sure that you are not charged an extra fee.
You will need to pay the doctor's or dentist's fees upfront: the practitioner will then draw up a "feuille de soins" (medical expense claim form) so that you can be reimbursed either locally or in your State of affiliation.
You can purchase your medication in any pharmacy by showing the prescription written by your doctor. You will need to pay the pharmacist directly, and s/he will draw up a "feuille de soins" (medical expense claim form) so that you can be reimbursed.
You will need to submit your dated and signed "feuille de soins," along with your prescription and a copy of your S2 (or E 112) certificate, either in person or by mail, to the CPAM (or CGSS in the overseas "départements") that covers the location where you received care. Provide your permanent address and your banking information (bank name and address, SWIFT code, and account number with your IBAN or BIC code).
Medical expenses are reimbursed 70% of the rates set by the French Social Security system. The rest is an out-of-pocket expense for the insured. For information purposes, the State-regulated charge to see a general practitioner or a specialist is 25 euros. If you see a general practitioner, you will be reimbursed €16.50 by the CPAM and your out-of-pocket expense will come to €8.50.
Doctor-prescribed laboratory tests and analyses are reimbursed 60% of the rates set by the French Social Security system.
Extensive medical treatment costing 120 euros or more, or procedures assigned a coefficient of 60 or above, are reimbursed 100%. Nevertheless, you will have to pay an 24 euro flat-rate fee per treatment, regardless of its cost. This 24-euro co-payment applies whether the procedure is performed in a doctor's office or at a hospital.
Medications are reimbursed if they are prescribed by a doctor and appear on the list of reimbursable pharmaceutical products. Reimbursement rates depend on the item and are 15%, 35%, 65%, or 100% of the sale price, or of the reference price for certain groups of generic medications:
Legislative framework :
If you have paid medical expenses upfront in France, European law allows you to submit your paid invoices to your local sickness fund in your home country for reimbursement of your health expenses in France. You will be reimbursed according either to French rates or, if you agree, according to the rates set by your member State of affiliation.
If you have a scheduled hospitalization, you will need to show an S2 certificate, "entitlement to scheduled treatment", to the hospital's admissions desk. The S2 certificate means that you will not have to pay your hospitalization expenses upfront. These are directly covered by the French health insurance fund at a rate of 80%, or 100% in certain cases.
Indeed, you will only be responsible for your co-payment:
Some people with 100% coverage may be exempted from paying either or both of these flat fees (those with CMU-C coverage, patients with a long-term illness, a work-related illness, or an occupational accident injury, and pregnant women from the 6th month of pregnancy).
If you are admitted to a private facility, check that it is "conventionné".
The daily benefits (also known as cash benefits) which are paid by France's health-maternity insurance system are intended to replace income (wages, salary, or unemployment benefits) which is suspended due to illness or maternity.
In order to continue receiving cash benefits or daily compensation from your home country's health insurance system, you must have received prior authorization from your sickness fund in your home country before you travel to France to receive treatment.
If you are found unfit for work, you must immediately see a primary care physician to obtain a medical certificate which you will need to submit directly to your sickness fund in your home country by the deadline established by local law.
Your cash benefits or daily compensation will be granted and paid directly by the fund in your member State of affiliation