The French, US and UK health systems are very different in terms of how they are funded and how contributions are made by individuals. In the US there isn’t a nationwide funding system and healthcare is paid for through a mixture of taxes, insurance and individual’s paying for their own treatment. In the UK, National Insurance payments and general taxation fund 99% of treatments, so that most services are ‘free at the point of use’.
Why health insurance matters in France
Ranking consistently highly in the World Health Organisation’s comparison of global healthcare systems, healthcare in France is also free for legal residents, but there are additional costs for some treatment options. Contributions are based on income – social charges are loosely the equivalent of the UK’s National Insurance – and usually you pay upfront for healthcare and receive a refund unless you are on a low income or have complex health conditions. If you don’t fall into these categories, the overall cost depends on the treatment, but only 70 per cent of basic costs will be refunded by the state. Most French people therefore use a kind of insurance called a mutuelle to top-up their refunds. For most foreigners moving to France, a mutuelle is obligatory once you have obtained residency rights. Before that you are usually required to have private health insurance from your country of origin.
What is a mutuelle?
A mutuelle covers most or all of the gap between the 70 per cent usually reimbursed by the state and the full cost of healthcare. The amount depends on the level of cover you choose. Having health insurance doesn’t give you faster access to treatment or access to different treatments however, it just affects how much it ends up costing you. A mutuelle is a policy that can be offered to individuals or to families and it will be tailored to your specific requirements. For instance if you have long-term health conditions that mean you are funded for 100 per cent of your medical costs, a mutuelle may still be useful primarily to cover hospital stays or dental treatment. If you have young children, prioritising orthodontist’s or optician’s fees for instance may be more useful. You can also upgrade your policy if something unexpected happens. Check with your insurer as sometimes you can do this straight away without incurring additional fees and sometimes there is a waiting period involved.
Understanding percentages
All French medical interventions have an index of official fees applied to them. This is the base de remboursement du régime obligatoire. CPAM will refund 70 per cent of the index fee if you have a carte vitale. A mutuelle will then take that reimbursement up to 100 per cent.
Some policies however offer to reimburse up to 200 or even 400 percent of the costs. To understand how this works, you need to understand that often quotes, for example for dental work or glasses will be considerably higher than the index fee refunded. There will always be an option that means you pay no extra, but it may not be the one you want to go with. A higher level of cover – often available for certain services – will cover more of the costs if you choose a more expensive option, such as an individual hospital room or designer glasses.
As an example of how the percentages work, your carte vitale will cover you for 80 per cent of the cost of a new pair of glasses. The price set by the state for the reimbursements is 2.84€ for the frames, so 80 per cent of that is 2.27€. If the frames you like cost 200€, you’ll bear a lot of the cost yourself without a mutuelle that tops up beyond 100 per cent.
RSR Assurance
Tom Furnival is an agent with RSR Assurance, based in Brittany. The company has been insuring people all across France for 70 years. Speaking perfect English, Tom explains why a mutuelle is so important: “It is indispensable to have top-up health insurance in France. This is especially true for the hospital cover as state reimbursement levels are particularly poor for hospital stays as well as glasses and dental work. Without it, you could be left with a bill for tens of thousands of euros even if you have been granted a carte vitale.
“This is why we highly recommend all our clients subscribe to a mutuelle health insurance policy so that we can top up what the carte vitale does not cover. Once the policy is in place it will kick in with immediate effect and we will then link up your carte vitale and mutuelle. This means that when paying for treatment, the system will automatically pick up your insurance details and deduct the amount that is covered there and then.
Shopping around
Tom adds, “the price of a mutuelle is based on two criteria – your age and the region of France you live in. It is also important to know that there are different levels of cover for this kind of insurance depending on your needs and your budget. Contrary to other insurance policies, the price will not increase based on the claims you make, whether you use the policy once a year or 50 times a year.
“Like all your other insurance policies, the law has changed when it comes to changing insurance companies. Once the policy has been in place for at least 12 months, it is possible to terminate it with only one month’s notice all year round and not just at the point of renewal.”
Find out more
To get in touch with Tom Furnival via email and get help in English, head straight to contact@rsr-assurances.bzh or to find out more about RSR Assurances, visit agence.gan.fr/10-gan-assurances-pontivy-caudan
