SHARE
COPY LINK

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.

 

READ ALSO:

Healthcare in France: The essential French language you'll need if you're illPhoto: AFP

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.

Log in here to leave a comment.
Become a Member to leave a comment.
For members

PROPERTY

Bedbugs, mice, and mould: How to handle infestations in your French home

Pests (of the animal and fungal kind) are a common part of the experience of living in France, particularly in the cities - here's what you need to know if you have unwelcome visitors in your home.

Bedbugs, mice, and mould: How to handle infestations in your French home

From the horrors of bedbugs and mice to the health risks of mould, there are certain things that no-one wants to share their home with.

If you are renting, then first you need to know whether this is your responsibility or the landlord’s.

Rental law

The basic principle is that landlords are required to provide tenants with “decent housing” – this is defined by a law (found HERE) passed in 2002. Essentially, a dwelling can be considered indecent if it presents obvious risks for the physical safety and health of the occupants, and that could certain include an infestation of mice or severe mould, which can lead to respiratory problems.

If any repair work must be done, the landlord must inform the tenant, either by registered mail or in person. The landlord must specify the nature of the work, and how it will be done (ie start date, duration, level of access needed). While the tenant must allow access to the home for work being done, the tenant can refuse access for non-urgent work on weekends and holidays. 

If the repair work lasts more than 21 days, then the property owner must grant a reduction in rent that is “proportional to the duration of the work.”

The tenant has the right to bring a case to the administrative tribunal if the work makes the use of the dwelling impossible or dangerous to live in. In these cases, the judge may pause further work from being undertaken, put a stop to it altogether, or allow for a termination of the lease if the work makes the dwelling uninhabitable.

Mould

Mould (moisissure) affects between 14 and 20 percent of dwellings in France, according to data from the National Food Safety Agency (Anses). It can be found anywhere in a home, whether that be on ceilings, walls, carpets, in bathrooms and even in closets. Typically, mould is accompanied by a smell. It might also cause black or green spots to appear, or the walls or floors to swell or peel. 

First steps – If you are renting, then the first thing is to determine who is responsible for dealing with the mould.

The tenant must deal with it if they were responsible for causing the problem – for example, if the tenant obstructs air vents, fails to repair damage caused by his/her personal appliances, fails to heat or ventilate the home or allows mould to spread without responding. 

On the other hand, the landlord has a legal obligation to “provide decent housing” – this means that the home must have an efficient ventilation system, proper insulation and be completely protected against any water infiltration, whether through the windows, walls, roof, or floor. If these things are not in place, then the mould is the responsibility of the landlord.

Legal options – If you’re renting and you’re sure that the mould is the responsibility of the landlord then the first step is of course asking them to deal with it. Hopefully you have a nice landlord who puts the work in hand in a timely manner. If, however, you have the misfortune to have an unhelpful landlord then things can get complicated. 

If a polite request hasn’t worked, the next step is informing the landlord of the mould issue via lettre recommandée (registered mail). You may need to call an expert to determine the cause of the mould, which will help you enclose proof of who is responsible for the repairs. You can find an example of the letter to send HERE

If the housing is no longer “decent” – as in it poses a physical or health-related danger to the occupant – then the tenant can demand by registered mail that the landlord take action (citing the legal requirement to provide ‘decent housing’) and request that the work be carried out at the landlord’s expense within a given timeframe. 

If the landlord refuses or fails to respond to the registered mail, then the tenant officially has the legal recourse to take the issue to the administrative tribunal who can require the owner to begin work at their own expense. 

The second option for the tenant would be to contact the town hall (Mairie), to request an intervention with the municipal service for hygiene and health (SCHS) to certify the state of the housing. If the request is honoured, then intervention must take place within three months.

The report will then be sent to the landlord via registered mail, and in the 30 days following, both landlord and tenant will have time to write out their points of view regarding the state of the dwelling.

If you are seeking further assistance throughout the process, you can always contact ADIL (the departmental agency for information on housing) for free legal advice.

Practical options – If you either own your property or you don’t want to get involved in the lengthy and complicated legal process, there are some practical options you can take.

If the mould is minimal – meaning the area does not exceed 3 square metres, you will likely be able to get rid of it yourself using a sponge, dishwashing liquid, white vinegar, or bleach. 

For walls, you might consider using a chemical anti-mould product that you should be able to find in hardware stores, or repainting using anti-damp paint. You can also eliminate excess moisture with a dehumidifier. 

If you are a property owner, you might qualify for a renovation grant. Under certain conditions, energy renovation works, such as installing a mechanical ventilation system or improving insulation and waterproofing works might be eligible for public financial aid. 

READ MORE: EXPLAINED: How to access France’s €20k property renovation grants

If you’re a tenant, you might choose to simply move on. 

If you have a three month notice period this can be reduced to one month if you can obtain a medical certificate from your doctor stating the need for a change in residence because the mould in current residence is affecting your health. 

To find a professional to treat the problem, you might consider a plumber (un plombier) if the mold is resulting from a leak, or a roofer (un couvreur) if the problem is coming from the roof. The first step would be to request a “diagnostic humidité” (a moisture assessment).

READ MORE: What is a SIRET number and why is it crucial when hiring French tradesmen?

Bedbugs

Unfortunately, bedbugs (punaises de lit) are a common problem in France. According to a 2021 study by IPSEE, 4.7 million people or seven percent of the French population dealt with these pests in the last five years. 

While all regions are affected by bedbugs, they are particularly common to urban areas and the Paris region in particular – even some of the capital’s fanciest hotels have suffered infestations.

First steps – First learn how to recognise a bedbug – they are approximately four to seven milimeters long and brown to purple in colour.  

If you have bites on your arms and legs, and/or traces of blood on your sheets, then you might want to check for bedbugs. Concentrations of small black dots tend to be a sign of bedbugs.

They tend to inhabit dark, narrow and inaccessible spaces, and they often spread by being carried from one place to another in furniture, clothes, and luggage.  You might be at risk of bedbugs if you have travelled recently, or stayed in a hotel or other accommodation where bedbugs are present. You are also at risk if you recently bought second-hand objects, like used furniture, or if you live in a shared building an another apartment has bedbugs.

The French government has also opened a dedicated phone number –  0806 706 806 – for answering any and all questions about dealing with bedbugs. 

Legal and administrative options – The first thing is to determine where the bugs came from, as that affects whose responsibility the infestation is.

Sometimes bedbug infestations occur in common areas of apartment buildings, in this case, it would be up to the building ‘syndicate of co-owners’ (syndicat) to pay for treatment. 

The cost of the treatment would then be divided according to the number of apartments treated. In extreme cases, where the entire building is impacted by the pests, including in common areas, then the disinfection expenses would be charged in addition to usual building fees.

It is not unheard of to come across a situation where one apartment sought to exterminate the bedbug issue in their private space, but the neighbour has not dealt with it and therefore the infestation continues. In this scenario, if that home is deemed the source of the bedbug proliferation then legal action can be taken against the owner by the other owners in the building.

If you’re a tenant then your landlord should pay the costs as a home infested with bedbugs is not considered ‘decent housing’ – although if the landlord can prove the presence of bedbugs is due to the tenant, then this can allow them to waive their responsibility to cover the costs of the pests’ eradication.

A similar process to the one described above for mould would transpire if the tenant wishes to force the landlord to take action – the tenant should send registered, dated mail to the landlord to ask that the infestation be dealt with professionally and for the dwelling to be brought into compliance.

If the landlord does not respond within two months, the tenant may refer the matter to the administrative tribunal for an opinion.

Practical options – While you can take some steps on your own, like washing all bedding and linens at 60C or freezing at 20C for at least 72 hours, you will likely need to call in a professional to get rid of the bugs completely. 

To find a professional exterminator, you can consult the government approved list HERE. On the website, you can select your département and you will be given several options of qualified pest control professionals who specialise in bedbugs. If you want to find your own exterminator, you can try searching key terms like “débarrasser des punaises de lit” (get rid of bedbugs) or  “l’extermination des punaises de lit” (extermination of bedbugs) or “traitement punaises de lit professionnel.

If you’re renting, then your landlord may be responsible for costs, but if they’re dragging their heels and you can’t bear the bugs any longer you may decide to go ahead and pay for the pest-controller yourself.

If you do this, keep all receipts and quotes, and take photos when possible. You may still be eligible to gain compensation from your landlord for the work.

Mice and rats

Sadly the rodents in France are not as friendly and benign as Ratatouille might have you believe. 

French cities are in a constant battle to control the pest populations. In Marseille – as well as Toulouse, Vincennes and Limoges – the city invested in a plan to train ferrets to flush out rats. The city of Paris has a variety of rodent-killing operations but it’s still believed that rats outnumber people by roughly two to one.

READ MORE: Marseille recruits ferrets to deal with its rat problem

So it’s not particularly unusual to have to deal with mice or rats in your home. 

First steps – Look out for droppings (usually about the size of a grain of rice), as well marks or footprints, any signs that food in cupboards has been nibbled and a foul, urine smell. 

Legal options – Similar to bedbugs, landlords are required to “provide the tenant with decent housing that does not reveal any obvious risks that could affect physical safety or health, free of any infestation of harmful species and parasites […]”

This means that by default it is up to the landlord to implement all necessary measures to eradicate pests such as rats and mice, by calling in a pest control company, according to the rental organisation Check and Visit.

However, the landlord may not be responsible if they  can prove that the tenant does not maintain the dwelling sufficiently so as not to encourage the appearance of pests.

As outlined above, the tenant can send a registered letter and take action with the administrative tribunal if the landlord fails to respond.

If you buy a property and then discover it has a rodent infestation then there’s unfortunately not much in the way of legal recourse. 

For those living in the city of Paris, you can also report a rat or rodent (including pigeons) infestation to the préfecture. This will alert pest control to the presence of an “animal nuisance.” You can learn more HERE

Practical options – If the infestation is bad you may need to hire a professional exterminator, but there are some steps you can take first. 

The obvious one is to make sure there is no food to attract them – so clean up crumbs, don’t leave food out and keep items like cereal and biscuits in secure plastic, metal or glass containers as mice will have no problem nibbling through a cardboard cereal packet.

The next is to try and find where they are coming in and if possible block up any holes and use steel wool to block gaps behind radiators or next to pipes where the rodents might be coming in. 

The French newspaper Ouest France made a list of natural ways to keep rodents at bay, which include using peppermint, laurel, lavender, eucalyptus and sage essential oils, as apparently mice don’t like these smells.

The classic advice is get a cat, but you don’t have to go to those lengths to dissuade mice from entering your home. In fact, simply using cat litter can repel the pests, as they do not like the smell.

If none of these work, you probably will need to call in the professionals and it’s worth shopping around as costs can differ greatly from one company to another. Pricing will depend on the surface area, extent of the infestation, techniques the company plans to use, and the technical constraints present. Good exterminators will not only kill the rodents already there, but will also figure out how they’re getting in and show you how to block up entry points.

To find one, try searching terms like “dératisation” or “traitement souris” (for mice), “traitement rats” (for rats), or “traitement mulots” (for voles). 

SHOW COMMENTS