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MOVING TO FRANCE

Carte vitale: What your French health insurance card entitles you to

Everyone living legally in France is entitled to basic health insurance with their carte vitale. But it can be hard to get to grips with exactly which medical services you are reimbursed for and how much you get back. Here's a look at what you need to know.

Carte vitale: What your French health insurance card entitles you to
Photo: AFP

The French health service – despite having problems – is known around the world for providing high quality healthcare at low prices. 

However how low the cost really is varies greatly from person to person, with your age, financial situation, and whether or not you have top-up insurance known as a mutuelle – and how generous that is – all playing a part in how much you pay for your healthcare in France. 

We've taking a look at what you can claim back from the French state with your carte vitale if you have the basic cover afforded by the card, with no top-up insurance.

 

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There are basically two areas to charging in French healthcare – appointments with medical professionals and then the cost of any treatment (medication, tests, scans or surgery) that they prescribe.

When you visit any kind of medical professional in France you will pay on the spot for the cost of the appointment, which can come as a surprise to Brits reared on the NHS's free at the point of delivery model.

However the medic will then swipe your carte vitale and the French state will reimburse you with some of the cost of the appointment.

What percentage of the cost you are reimbursed, however, is complicated and varies by many factors including your situation (your age, whether you are in work or studying) and by the type of doctor that you see.

Appointments 

The standard charge for an appointment with a médecin généraliste (general practitioner or family doctors) is €25 and the standard reimbursement rate is 70 percent, so you pay €25 and the government pays you back €16.50.

However, as with French grammar, there are lots of exceptions.

Doctors work under two sectors – sector one doctors mostly charge the standard €25 apart from in exceptional circumstances, while sector two doctors are entitled to charge more, and you will not get refunds for any amount over the €25 minimum.

You can check which sector a doctor works under on the official site of France's state health insurance ameli.fr and it will also be listed if you are booking an appointment through the Doctolib app

But to get the full amount you are entitled to back, it is vitally important to choose a doctor as your main GP (médecin traitant) and use them as your first port of call for an appointment.
 
If you do not have a main GP registered on your card and visit them first so that they can refer you to any specialists, or you decide to visit a different GP, you will only receive 30 percent of the cost of your appointment back. 
 
However sometimes the surgery where you GP works will assign you a different doctor for your appointment and in that case you will get the 70 percent reimbursement. 
 
You will receive a form to declare your GP as part of your Carte Vitale pack when you apply for your card and you can also download the form here and send it off to your local CPAM (public health insurance body). 
 
Women who are more than six months pregnant, may be able to claim 100 percent of the cost back, and to check out some of the other exceptions click here.
 
 
Diagram: Ameli.fr
 
Appointments with specialists
 
Unlike in the UK, you can make appointments directly with a specialist without getting a referral from your GP first. But you will only get the standard 70 percent rate of reimbursement if you first visit the GP.
 
There are, of course, some exceptions to that rule.
 
You can have an appointment with gynecologists for periodic examinations, including screening, prescribing and monitoring contraception, monitoring pregnancy and abortions. 
 
You can also visit ophthalmologists for certain kinds of appointments, and psychiatrists if you are aged 16-25- years-old.
 
For the full list, check out the ameli website
 
Under 16s
 
If you have children aged under 16 then the cost of a visit to the doctor varies and, huge surprise, it can get a bit complicated. 
 
If you have a child aged under 6, a visit to the GP listed as sector one will cost more than it does for an adult. 
 
The standard health insurance approved price is €30 and this cost is refunded 70 percent as it is for adults, meaning you will be reimbursed €21. 
 
Once your child turns 7 a trip to the doctor will cost €25. 
 
However you may choose to take your child to a pediatrician, in which case an appointment will cost slightly more. 
 
A trip to a pediatrician under sector one will cost €32 and is also subject to the 70 percent reimbursement rate, which means you'll get €22.40 back. 
 
if your child is aged 7-16 and you choose to visit a pediatrician, the standard price for an appointment is €28. 
 
For more information on this, visit ameli.fr.
 
Treatments
 
Once the appointment is done the medic is likely to decide upon a course of treatment or prescribe some medication.
 
With prescriptions, you pay the pharmacist for the cost of the drugs, and then you are reimbursed some of the cost.
 
The general rule for medication is that 100 per cent of the cost is reimbursed if the drug is “irreplaceable”, such as drugs to treeat diabetes, AIDS, cancer and other chronic diseases.
 
If the medication is determined to be “a major or important medical service”, such as antibiotics, then you get 65 percent back. 
 
Drugs that have only “moderate” medical benefits and homeopathic remedies are reimbursed at 30 per cent.
 
While drugs that have only “low” medical value are reimbursed at 15 percent.
 
The thing to watch out for is generic drugs. Generally your GP will prescribe the generic drug, and if not the pharmacist will point out that there is a generic available if you want. You are free to refuse the generic and opt for a brand-name drug if you prefer, but the reimbursement will only cover the cost of the cheaper generic drug.
 
Ameli advises: “Do not hesitate to ask your doctor to prescribe a generic drug for you, and to accept a generic drug when your pharmacist offers it to you. You will be just as well cared for and spend less.”
 
 
 

Member comments

  1. Nice explanation for those who need the guidance although it omits the “conventionne” (accent acute on the second e) definition which identifies doctors charging the standard rate.

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PROPERTY

Garant: How the French guarantor system works for property rental

If you're looking to rent an apartment in a larger city in France, you're likely to see announcements that require a 'garant'. Here is what you need to know about finding a guarantor in France.

Garant: How the French guarantor system works for property rental

Renting in large cities in France – particularly in Paris – is a known challenge for foreigners, especially new arrivals. In the countryside, it’s a bit easier, with less competition properties, but in the big cities compiling your dossier and landing the right place can be a challenge.

One of the biggest surprises for many people is that most landlords ask for a guarantor (garant) in order to sign a lease for an apartment. It is not a legal requirement, but in competitive real estate markets, it certainly feels like one.

Though asking for a garant might feel a bit juvenile, it is quite common, and applies to a lot more people than you might realise. Here is what you need to know:

Who typically needs a guarantor?

The most common group to need guarantors are students. However, if you are a foreigner who is not employed with a CDI (indefinite contract) and if you do not make over three times your monthly rent, you will likely need a guarantor as well.

If you don’t collect your income in France (or if you don’t have an income) you will need a guarantor.

You will also likely need one if you are still in the probationary period of your CDI, or if you cannot show three months worth of pay stubs from your job yet (even if you pay meets the three times a month requirement). If you do have a CDI, you could ask your employer to sign you an attestation d’employeur which verifies your monthly income. 

If your income is not steady or consistent (perhaps you are a freelancer). Typically, if you use an agency during the leasing process, they will require a guarantor, especially if any of these conditions apply to you. 

It is worth noting that showing bank statements typically do not suffice – landlords are looking for proof of ongoing income, not savings.

Who can count as a guarantor?

The guarantor should be a third party, such as a parent or close relative who agrees to pay your rent if you fail to pay.

This person must fulfil all the requirements outlined above (ie earning more than three times your rent with an indefinite contract).

The other tricky part is that this person must work and live in France, and usually it’s best that they are French themselves.

However, this can pose a problem for foreigners who might not know anyone that fits that description, so thankfully there are some other options fill this requirement, like taking out a caution bancaire or using an online agency. We explained the ins-and-outs of these bellow.

What does my guarantor need to show?

The guarantor needs to put together a dossier of documents including;

  • Proof of identification (a passport or French ID card)
  • Proof of residence that is less than three months old (eg utility bills).
  • Most recent tax returns
  • Employment contract and typically three months worth of payslips
  • If they earn money via real estate, they must also provide documentation for this
  • If the person in question is retired, they must provide proof of pension (again, this must exceed your monthly rent threefold). 

So, what if I don’t have a French person who can be my guarantor? There are a few options for you:

Use an online service

There are two main online services that can act as guarantors for foreigners in France.

The first is Visale, which is accessible primarily to foreign students.

This is a programme offered via the French state through “Action Logement” and it covers up to three years of unpaid rent. You must be between 18 and 30 years old to apply, and you must hold a long-stay visa (VLS-TS) – either a student visa or a ‘talent’ one.

For students who are already citizens of a European Union country, then simply presenting a student card and a valid passport will be sufficient. It can be applied to private housing and student residences, but it is ultimately up to the landlord as to whether they will accept a tenant who uses Visale as their guarantor. The main benefit to Visale is that it is free for the user.

Visale does come with some restrictions, however. Your rent (including charges) cannot exceed €1,500 in Paris, and €1,300 in the rest of the country. In addition, the lease must be for a primary residence, and your rent should not exceed 50 percent of your total income.

Another option is GarantMe, a paid online website that can also serve as an official guarantor.

Landlords might actually prefer this service over a physical guarantor who might refuse to pay or for whatever reason not have the funds to do so. The benefit to GarantMe is that they accept a wider range of tenants for their service, but the downside is that there is a fee. The minimum payment (per year) is €150, but the fee is normally 3.5 percent of the annual rent (including charges) and it renews automatically.

The nice thing about GarantMe, is that in order to apply for the service, you basically need to create a full dossier that will be identical to what you’ll need for your apartment search anyways.

Take out a Caution Bancaire

Basically, a caution bancaire is a bank guarantee, and typically its a bit more of a last resort option because it is quite restrictive for the tenant. It involves blocking off a large sum of money to be used to pay rent if you fail to do so.

Depending on the landlord (and the bank), they might ask you to block between six months worth of rent to sometimes up to two years. This would be used as guarantee during the duration of your lease, but it takes a bit of administrative coordination and obviously requires a large sum of liquid funds.

Sometimes activating a bank guarantee can take a few weeks, and for foreigners, of course, this would require already having a French bank account. There can also be fees, depending on the bank, for using a caution bancaire, and simply closing of caution bancaire account in itself can involve fees.

The other downside to this is that not all landlords will accept it, which is why this option might be best served as a last resort.

Attempt to find an apartment that does not require a garant

This is quite difficult in Paris (and other large cities around France). It is possible sometimes if you stick to foreigner-oriented sites like NY Habitat or Paris Attitude. Another possible loophole could be to see if your insurance plan offers coverage of unpaid rent. This is quite uncommon, but could be a possible option. If you rent specifically particulier-à-particulier (meaning you do not use an agency at all) you might be able to negotiate with the landlord, or if you have a sub-lease you might not need to show proof of a guarantor.

Ultimately, however, in most cases when renting in France’s large cities, you’ll likely need a guarantor.

What should I be aware of when it comes to guarantor websites?

As mentioned previously, Visale is only for people in the 18-30 age group, so unfortunately it does not apply to everyone. It is also intended for lower income people or students, so if you are a high earner you might be rejected.

Regarding using a website like GarantMe, beware that they will charge you every year – it is not a one time fee. This will be deducted from the card you put on the site and the only way to cancel the charge will be to show proof that you have moved out (i.e. an état des lieux or letter releasing you from the obligation signed from your landlord)

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