French health insurance for expats

Are you looking for an expat health insurance in France? It is important to inform yourself on the local healthcare system first.

France’s universal healthcare system is regularly rated as one of the best globally. The country dedicates one of the highest percentages in the world to the health of their population (around 10% of their gross national income), meaning that people moving to France can benefit from an excellent quality of healthcare at highly subsidised rates.

Our guide gives you an overview of the French healthcare system and explains the different health insurance options for expats. Read on for information on finding doctors and specialists, the average cost of healthcare and how the 2016 healthcare reforms affect you as an expat.

Health statistics

* Data from the WHO

  • Total Population: 66.9 millions
  • Gross national income per capita (PPP international $, 2016): 37,970
  • Life expectancy at birth m/f (years, 2016): 80/86
  • Probability of dying between 15 and 60 years m/f (per 1 000 population, 2016): 94/48
  • Total expenditure on health per capita (Intl $, 2014): 4,508
  • Total expenditure on health as % of GDP (2014): 11.5
The French healthcare system

The state healthcare system is known as l’Assurance maladie (sickness insurance) or Sécurité sociale as a broader term for the whole social security system. As soon as you become a resident in France, it is obligatory to enrol, and anyone in employment will have social contributions (cotisations sociales) deducted from their salaries. The rates of contributions vary depending on income and household, but it averages around 8% of your net income above a minimum threshold.

Once you enrol onto the system through your local Caisse Primaire d’Assurance Maladie (CPAM) office, you will receive your carte Vitale: your key to accessing healthcare and claiming reimbursements. Everyone over the age of 16 receives a carte Vitale, and children under the age of 16 will be included on the card of a parent/guardian.

It is important to prepare for your expatriation well in advance, as administrative procedures, especially those to sign up to your local healthcare system, can be long and cumbersome.

Healthcare in France is not free but highly subsidised. Patients pay upfront medical fees (that are cheap compared to the medical fees charged in other countries because of the subsidies). On average, 70% of the cost of these services are reimbursed by the standard compulsory health insurance scheme (l’Assurance maladie). It is possible to purchase a supplementary top-up policy, often called a complémentaire santé or mutuelle, to cover the remaining 30% of the cost. On top of their Sécurité sociale and optional mutuelle, expats living in France can subscribe to an international health insurance policy which will cover their medical expenses abroad or some medical expenses that neither a mutuelle or the Assurance maladie would reimburse.

While an international health insurance can be taken out instead of mutuelle, note that, importantly, international health insurance cannot be taken out instead of enrolling with the obligatory state system.

See our ‘Top-up health insurance options for expats in France’ section below for more information.

French health costs regulation

French healthcare is split into two cost brackets – “conventionné” and “non conventionné” medical professionals:

  • Conventionné: the healthcare professional is in a contract with the Sécurité sociale to apply capped fees that are set by the government. All conventionné health professionals follow the Sécurité sociale chart of prices. Under the umbrella of conventionné is ‘Secteur 1’ and ‘Secteur 2’ professionals. Secteur 1 doctors charge fixed rates set by the social security. Secteur 2 doctors can charge higher fees but within reason as they are bound by law. Consultations with conventionné doctors will be reimbursed up to the capped fee by the Sécurité sociale.
  • Non conventionné: a “médecin non conventionné” has the freedom to apply the fees that they want and can exceed the statutory fees. Prices for non conventionné doctors are very variable. The Sécurité sociale may cover the fees of these doctors at a minimal rate.

You can find more information about reimbursements on the Ameli website.

Doctors and specialists in France

Patients are free to choose their primary care physician (médecin traitant), which is their first point of contact for referrals to specialists and tests. Patients can choose to have a general practitioner or a specialist as a médecin traitant.

While you can go and see a specialist or have tests done without a referral from your médecin traitant, you will be reimbursed less than if you were referred. This freedom and choice of health care facilities, whether in the public or private sector, are more key benefits of the French healthcare system.

Visit the indispensable Annuaire santé website (in French only) to perform a comprehensive multi-criteria search for healthcare professionals, types of procedure or healthcare facilities based on your location. It also shows the rates and reimbursement amounts for the services in your search results.

Examples of medical costs in France

Examples of costs of accessing conventionné secteur 1 healthcare professionals (correct at the time of writing):

  • Consultation with a GP – €25 with 70% reimbursed.
  • Consultation with a specialist – €30 to €60, with the reimbursement depending on the complexity of the issue and whether you have been referred by your médecin traitant.
  • Consultation with a gynaecologist – You do not need a referral from your doctor to go straight to a gynaecologist, but it is cheaper if you have been referred by your médecin traitant: just €30 with 70% reimbursed. If you have not declared your médecin traitant, it will cost €35 with 30% reimbursed.

Hospitals in France

There are two types of French hospitals: state-run “hôpitaux” and privately run “cliniques”. Whether in the private or public sector, the waiting lists for hospitalisations in France are short.

Both cliniques and hôpitaux have the same reimbursement rates fixed by the Sécurité sociale: 80% of the cost of hospital/clinic stay is reimbursed to you by the Sécurité sociale (the 20% left is paid by you or by your top-up insurance, if you have one). These costs include the treatment and the room. You need to pay extra for personal comfort add-ons such as a private room and use of the telephone and television.

After 30 days of hospitalisation, hospital or clinic stays are 100% reimbursed. When the stay is longer than 24 hours, each patient must also pay a fixed fee of €20 per day in a hospital or clinic (this fee is also called a “forfait hospitalier”), which is usually for a shared room unless you require a private room for medical reasons.

Some people in certain situations don’t need to pay the €20 fee or may have their hospital or clinic costs reimbursed at 100%. Click here to read the exceptions.

The fact that hospital stays in private facilities are not more expensive than in public facilities is another key benefit of the French healthcare system.

Dental care in France

You have the choice of which dentist you go to, and costs are reimbursed the same way as other healthcare. Dental charges are normally reimbursed at 70%, including dental prevention-related examinations, however some dental procedures are not covered. Example of costs:

  • Dental consultation with a secteur 1 dentist – €23 with 70% reimbursed
  • Tooth extraction with a secteur 1 dentist – €33 with 70% reimbursed.

Optical care in France

Optical costs (including glasses and contact lenses) are reimbursed at 60% by the Sécurité sociale, and can be fully reimbursed if you have a top-up insurance. This is another strength of the French healthcare system compared to many other countries where optical costs are either minimally subsidised or not at all.

Medications in France

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:

  • 100% for medications considered to be not substitutable and particularly expensive. Extensive medical treatment costing €120 or more may also be reimbursed 100%.
  • 65% for medications with major or significant therapeutic value
  • 30% for medications with moderate therapeutic value, homeopathic medications, and certain pharmacy compounds
  • 15% for medications with insufficient therapeutic value

 

Maternity and paternity benefits in France

France’s maternity and paternity insurance is included in Sécurité sociale, and it covers medical and pharmaceutical expenses, laboratory tests, examinations, preparatory classes and prenatal classes, amongst other care, at 100% reimbursement rate. Maternity and paternity cash benefits may also be claimed for the time taken on leave from work, although there are exceptions and you must fit the qualifying criteria. Click here to read more.

Accessing French health insurance as an expat

It is mandatory for all residents to enrol with the French social security system, whether or not they are employed.

Major new laws were put in place in 2016, making it easier for foreigners to apply for state healthcare in France. The Protection Maladie Universelle (PUMA) now grants all residents in France, including expats, easier access to healthcare in France as long as they have lived in the country for more than three consecutive months on a ‘stable and regular basis’. This includes the overseas territories of France: Martinique, Guadeloupe, Réunion, Mayotte and French Guiana. ‘Stable and regular’ residency means your principal home or family is in France, where you must have initially lived for three continuous months and will do so for at least six months (183 days) annually thereafter.

For more information, read our article on how to sign up for French health insurance as an expat.

I am an EU, EEA or Swiss citizen:

Citizens from the European Union (EU), European Economic Area (EEA – EU plus Iceland, Liechtenstein and Norway) and Switzerland and their families will be obliged to apply for the Assurance Maladie, providing they will be staying for more than three months. If you are staying temporarily (less than three months) in France, you can typically use your European Union Health Insurance Card (EHIC) for coverage. However, there are instances in which an EHIC may not be sufficient or even invalid. Find out more in our EHIC article.

I am an employed worker:

Employees who work in France are entitled to French healthcare insurance through the social contributions (cotisations sociales) they pay to the French social security system. Speak to your employer about declaring your status as an employee before taking the necessary paperwork to your nearest CPAM office to apply for your social security number. This is likely to include a proof of residency (utility bill or rental contract), passport or ID, a copy of your employment contract, birth certificate and your bank account information (or RIB – relevé d’identité bancaire).

My European company has seconded me to France:

Take the same paperwork as above, along with form E101, to your local CPAM office to submit your application for the healthcare system.

I don’t permanently reside in France:

If you are working in France on a temporary contract (for example, a secondment of less than three months), or you are living in France temporarily (for less than three months), you may not need to register for social security. You may instead be covered by international health insurance, or if you are from an EEA country or Switzerland, you can use your EHIC (European Health Insurance Card) during a short-term stay in France. The card, which is free of charge, covers you for medically necessary care for the first three months in France, but there are some exceptions you can read about in our EHIC article. After three months, or if you become a resident, you must apply for French social security.

I am looking for work:

If you are currently living in a country within the EEA, fill in a S1 form from the social security authority in your home country. It is a certificate of entitlement to access healthcare in other EEA countries (including France) on the same terms as French nationals. When you arrive in France you need to give the form to your local CPAM office.

I am retiring or retired:

If you are planning to retire in France, follow the instructions above regarding the S1 form (formerly E121 and E106 forms).

Children aged 16 years and under:

Anyone who is 16 years old and under is automatically eligible for healthcare insurance in France regardless of their nationality.

Unemployed or low-income resident:

You are entitled to French health insurance and can get subsidies through the CMU-C (couverture maladie universelle complémentaire).

Top-up health insurance options for expats in France

French residents can sign up for an optional insurance plan on top of PUMA, the state health insurance. If you would like to have top-up coverage, you can take out supplementary insurance from a mutual fund, a providence fund or an insurance company.

French mutuelle health insurance

These top-up plans, known as mutuelles, are government-regulated and provide additional coverage by paying the remaining share of expenses that the state scheme regulates but doesn’t cover.

Mutuelles are not equivalent to private health cover as we know it in many countries outside of France.

Mutuelles are not for-profit organisations, so there are no age limits or exclusions, and pre-existing medical conditions don’t affect your coverage or the premium you pay on a policy. Mutuelles must complement the public health system, meaning they have to adhere to the procedures and rules of social security. Therefore, you must be referred by your médecin traitant for better reimbursement rates. Mutuelles only reimburse the conventionné doctors’ fees. The excess fees from non-conventionné doctors (dépassements d’honoraires) are not reimbursed.

Moreover, mutuelles are not affiliated with private clinics or practitioners, and do not guarantee quicker treatment times or shorter waiting periods. The policies are purely to finance the personal contributions of healthcare in France.

Some mutuelles are catered to specific professions from accountants and real estate agents to engineers. Some French insurance companies sell mutuelle plans in English.

Private sector employers are now obliged to offer mutuelles to their employees, so speak to your employer if you are an employee in France.

 

French private health insurance

Local private health insurance plans work like typical private health insurance as we know them in English speaking countries. They don’t follow the social security rules and procedures (you don’t need to be referred by your médecin traitant for better reimbursement rates) and they do reimburse the excess fees from non-conventionné doctors. However, these insurance policies apply age limit or exclusions and don’t cover pre-existing medical conditions.

Private health insurance is quite marginal in France, representing only less than 5% of top-up health insurance plans. The rest are mutuelles.

International health insurance

International health insurance is a typical private health insurance with the additional benefit that that they are also valid abroad within the area of cover chosen.

International health insurance is the insurance option most adapted to the expatriate lifestyle. If you prefer to be treated in your home country or in another country within your zone of cover your medical costs will be reimbursed by your insurance company (within the limits of your policy). Moreover, if you leave France and move elsewhere, your international insurance may be able to follow you unlike a local private health insurance or a mutuelle.

If you don’t permanently reside in France (meaning you will stay for less than three months) you do not have to subscribe to the social security and can be covered by an international health insurance policy alone.

If you are a resident in France, international health insurance must only be taken out alongside the obligatory Sécurité sociale health insurance, and cannot be taken out instead of it.

 

How do I find the best international health insurance in France?

At Expat Assure, we help you identify the international health insurance policy best adapted to your needs.

The best health insurance is not the same for everyone, as each person has different needs and expectations. Finding the best health insurance is more a matter of finding which plan best matches your specific requirements. Don’t hesitate to contact us to request your insurance comparison.

If you would like to insure yourself and your family more fully, Expat Assure can also advise you on life insurance and income protection. To find out more, read our Protection page.

Practical information

Vaccinations

No vaccinations are required for entry into France, however it is recommended to confirm that your primary courses and boosters are up to date.

Emergency numbers

European emergency number: 112 or 114 (for hearing assistance)
Ambulance and emergency services (SAMU): 15
Fire brigade: 18
Police: 17
Find your closest out-of-hours emergency doctor: 116 117

For advice and information, Ameli’s English-speaking French Health Insurance Advice Line is available Monday to Friday from 8:30am to 5:30pm. Call: 0 811 36 36 46 (from France*) ; 0033 811 36 36 46 (from other countries)
*this call is billed at an average cost of 6 euro cents per minute. For more information, call 3008.

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