July 3, 2010

Moving to France Tutorial - Part Five

I know it's been a couple of months since my last Moving to France post, but this one was a bit of a challenge to put together.  

(Update: Check out this article)

Once you arrive in France and get your Carte de Séjour sorted out, you will want to join the fabulous French health system.  Actually you must join the French health system.  All permanent residents in France are obliged by law to have national health insurance, which comes in the form of a little green card, the Carte Vitale.
The information on this topic is rather extensive, so in the end, instead of painstakingly re-wording the material from the French government websites, I have simply copied the relevant sections of the Sécurité Sociale guide.  

So, without further ado...how to join the French health system.

As it states in the Livret de Santé:
"In France, everyone is entitled to health insurance to cover the cost of medical care. It is preferable to apply for it before becoming ill. The first step is to apply for “basic” public health insurance, which can be extended by paying for private supplementary insurance ("mutuelle"). For people with a low income, supplementary insurance is available free of charge and is known as supplementary universal medical cover (CMU-Complémentaire).

Who is entitled to “basic” public health insurance?
“Basic” public health insurance (including “basic” CMU) is an entitlement for anyone legally residing in France for at least three months before the request for healthcare (except asylum-seekers who are exempt from this condition).

Where should I apply for public health insurance?

Go to the public health insurance centre in your neighbourhood (ask for the address from the Town Hall’s CCAS, or social assistance centre). If you are using a government-assigned address, go to the public health insurance centre whose address is listed on your certificate of domiciliation.

Documents required:
- Identity: the preferred document is birth certificate, otherwise a passport, identity card or certificate of registration with the OFPRA (French Office for the Protection of Refugees and Stateless Persons) for asylum-seekers or any other document giving proof of your identity;
- Address: certificate of accommodation (with receipt for rent or EDF bill) or government-assigned address registered with an approved organisation. Important: make sure that letters actually reach this address;
- Legal residency in France: any valid residency document issued by the Prefecture: residency card, temporary stay card, proof of receipt of application, temporary approval for stay, appointment/summons, asylum notice, etc.;
- Income: written proof of all income received from January to December of the previous year (wages, welfare benefits, etc.).

Using the Public Health cover System
As a general rule, the public health insurance system reimburses two-thirds* of your healthcare expenses (except on glasses and dentures), but the patient must pay the entire sum first. In healthcare centres, hospitals and certain doctors’ offices and pharmacies, patients may pay only one-third of the expenses (known as the “ticket modérateur”), by showing their health insurance card (paper certificate or Vitale Card). Supplementary CMU insurance or mutual and private insurance companies cover the additional amount.
Important: the “100%” is not free in all cases: those with certain chronic illnesses can be exempt from paying the ticket modérateur, and are considered “100% covered by the public health insurance system”. However, the “100%” applies only to the care received for chronic illnesses."

The French Government Website (in French)

I have to add that the following documents may or may not be asked for (some have already been listed above) but you should have them ready just in case.
  • Passports
  • Details of place of birth (as well as your partner's and children's information)
  • Marriage and birth certificates of all family members
  • Proof of address in France with proof of ownership (deeds) or rental agreement
  • Date of permanent arrival in the departément
  • Proof of residency in France for at least three months (in the form of three months EDF or France Télecom bills, rent statements or mortgage payments or a notarized statement of your home purchase)
  • Proof of income for at least the previous 12 months, whether in France or elsewhere or an avis d'imposition or latest French tax bill.
  • A RIB (Relevé d'Identité Bancaire) provided by your bank
Our Carte Vitale story just goes to show that doing your homework when dealing with French bureaucracy will (sometimes) get you everywhere!

We went to the local CPAM office in Béziers to apply as soon as we got our Cartes de Séjour, as we had been informed to do.  Luckily we had armed ourselves with knowledge of the current law, because even though it had passed a few years before, the powers that be obviously forgot to send the memo down south to the CPAM office in Béziers.
The man behind the desk told us quite confidently that non, we couldn't join the French health system because France had no reciprocity with America, which is true - France and America do not have reciprocity when it comes to medical care.  In turn, we confidently and patiently told him that it didn't matter, because (at the time) the law stated that anyone legally residing in France for at least three months of the year must join the system.
He sat there for a moment, staring at us with a kind of deer-in-the-headlights look, then suddenly grabbed the telephone and made a couple of calls.  When he hung up he looked at us with a smile and said oui, you are correct."
Thirty minutes and a mountain of paperwork later, we were official Carte Vitale carrying residents of France.

*To cover the 30% of costs that are generally not covered by the system, we purchase a Top Up, or mutuelle from a private company.  The price for the two of us is about €130 a month and although many people we know choose not to have the added expense, we like that it gives us the freedom to go to private doctors as well as state doctors.

The next installment of the series will be about obtaining the elusive 10 Year Carte de Résident.  Some of the stories I've heard on this subject have been real doozies and would love to hear from more of you if you want to share your experiences.

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spacedlaw said...

Since I have been living outside France for the past 18 years, I do not have a Carte Vitale and always get shocked looks when I go to a pharmacie to get some medicine.

isabelle said...

I enjoy your blog and especially the "moving to France" tutorial, since we are considering the move ourselves.
However, you'd be doing a great disservice to a lot of potential expats if you do not amend this post.
Your information is based on outdated 2005-6 data. Since then, there have been new rules and laws concerning foreigners integrating into The French Health System.
Unfortunately, the system is running on a deficit, so the new rules are very foreigner-unfriendly. Even for an EU member like myself, the waiting period to join the state system is now 5 years after my first registration in France (EU nationals register, Americans file for Carte de Sejour). The rules for non EU members are even more stringent -(.

Betty Carlson said...

This series looks like an amazing effort. You should put it all together in some sort of PDF or e-book and sell it when it's finished!

Anonymous said...

You need to read this as it is a Q&A on the New Health Law passed 23 Nov 2007. It changes a lot that you have written about.


Jennifer said...

Is there an equivalent card in Italy?

Thanks for your comment.
I don't believe that the data has changed for Americans who arrive in France with visas, as they already have to purchase private health care to get the visa in the first place.
But I'll look into it.

Thanks for the article. It appears that it is geared toward EU nationals and residents of Switzerland, not Americans, which is who these tutorials are written for.

Jennifer said...

It is an undertaking! That is a great idea...

Unknown said...

I'm applying for a long-term visa right now and there is no more "Carte de Sejour." Its now called "Titre de Sejour" and acts as Resident ID. As I retired U.S. diplomat, I have federal health coverage that's accepted in France (and elsewhere in Europe, etc.). I might pay for a supplemental health coverage only if I need it.

Brunofrance said...

But if you get ill - and you have lived here permanently for at least 3 months - you are automatically covered by the CMU according to the new law (which will probably change again after Sarkozy leaves in 2012) of 2007.
Confusing --- no shit....

Brunofrance said...

Sharette -
yes - it says titre de sejour on the card but it is still known as the carte de sejour. It's renewaBLE EVERY YEAR UNTIL YOU CAN APPLY FOR THE 10 YEAR CARTE (TITRE) AND BE ALLOWED TO WORK. BE SURE TO APPLY FOR THE CARTE (TITRE) AS SOON AS YOU GET TO FRANCE (WITHIN 2-3 WEEKS). And don't forget the change from euro to dollars for your healthcare make sure it covers everything.

Monica said...

What an excellent read - I'm so happy to have stumbled upon your blog through crazysexylife. It's so cool you are in the Languedoc region! I've often thought about moving to France but never really knew how to go about it. Perhaps your blog will give me the springboard I need. =) Also, I totally agree with Betty - this series should be an eBook!

Sue said...

Many thanks for this very udeful info - Nick and I hope to retire to Bordeaux one day (if I can ever get him to stop working!).

koralee said...

What a wonderful post!!! So filled with valuable info...oh how I would love to me moving to France. Thank you so much for your lovely comment the other day. xoxoxoxo

Emm said...

Helpful info, thanks. Two quick questions:
Are EU passport holders treated differently than US ones?
And, I may have missed it, how's your husband doing with his new hip?

Jennifer said...

The Carte de Séjour and Titre de Séjour are the same thing.
You're lucky to have coverage in France! Hope you enjoy living here.

It is confusing! And it changes all the time. That's why one needs to know the current rules and not expect the people at the CPAM to know.

Thanks for commenting! Betty has a very good idea there, I agree.

I thought you two already lived here, at least part time! :)
Hope you get him to retire soon, so you can get moving.

You're welcome! I'm very happy to have stumbled across your gorgeous blog. You photograph cherries beautifully! :)

My husband is doing just fine, thanks for asking.
I haven't done a lot of research for EU passport holders, I'm afraid. If you're from the UK there is a lot of information on the Internet for you. Not as much for Americans, that's why I decided to write this series. Sorry I can't be of more help.

Adriana said...

This post was INCREDIBLY THOROUGH. I thank you so much for this!

Jennifer said...

You're welcome!

Lillibetliz said...

Hi Loulou (sorry, not sure if that's your name!). I have just stumbled across your very informative blog while searching for information with regard to Non-EU citizens qualifying for the seemingly elusive Carte Vitale. My mother came to live with us here in France 2 years ago from South Africa and also had to get in via the Carte de Sejour (Titre de Sejour) as she did not automatically qualify to live here being from a non-eu country. We have renewed her Titre de Sejour once and the 2nd renewal is coming up next month (each time for 1 year) and it seems as though the process has been the same as yours. I was under the impression that she could not apply for a Carte Vitale as her Titre de Sejour states "carte de séjour temporaire", and we have to renew it every year. After reading your blog I am starting to think that perhaps she would be able to obtain a Carte Vitale... what are your thoughts on this? Any information from either you or anyone else reading this would be very welcome before I head down to CPAM ... Many thanks, Liz

Jennifer said...

I'm sorry for not responding to this comment sooner!
She should ask for a Carte Vitale if she is a permanent resident in France. Each département has their own "rules" it seems, so you're probably going to have to find the right person to help you.
Good luck!

bonnie groves poppe said...

Thanks very much for this. I too will be applying in Beziers for my Carte Vitale. I am on my second CDS and have just not gotten around to getting the CV. I seldom visit a doctor so have not needed it yet. If I get any more info while applying I will post.
bonnie in Roquebrun

Jennifer said...

Good luck and I would love to hear about your experience. Thanks for commenting!

Lana said...

Can someone tell me what the carte vitale costs?

Jennifer said...

The Carte Vitale itself does not cost anything, but you have to apply and be eligible to receive it, as I explained in the post.

Alexandra Roberts said...

Hello, some useful information here. I am a British citizen, currently living in Canada and plan to move to France with my Canadian husband. I am a little confused if i am covered by any health cover before i begin to work in France-do you have any information about this?
thank you

Jennifer said...

If you're a British citizen, then you're covered (as far as I understand). Not sure about your husband though. You should check with your employer and the French Consulate to make sure. Good luck with your move!

Liline said...

Great blog! I had to get a private international medical coverage so I could get my long stay student visa. I have my visa and I leave for France next week but I'm wondering if I should switch to French insurance instead. The current private coverage I bought is fully refundable if I request the refund before I leave...is it better to have the french coverage over an international insurance package?

Jennifer said...

Hi Liline
I suggest that you contact your school and see if you are eligible for French insurance with your student visa. They should know.
Since I don't know what your international insurance offers, I can't really answer the question you ask about which would be better.
Enjoy your time in France!