What are the rules on holiday health cover for pensioners in France?

If you're a pensioner living in France and planning a holiday, then the rules around healthcare can get pretty complicated. Here's what you need to know.

What are the rules on holiday health cover for pensioners in France?
Illustration photo: AFP

Having access to France's lauded healthcare system is seen as a positive, even an incentive, to move here once you're retired. 

But in order to make the most of it, you need to first understand the rules – and they aren't always that clear, as one reader who wrote to us pointed out. 

Gordon Spector, a British retiree living in the south west of France said: “From reading relevant online sites I understood that if I was a member of the French healthcare system with a social security number I (and all Britions in same situation as I in France) would be entitled to apply online to the French 'CEAM' European travel health card.”
Gordon said he believed that as a resident in France, he would not be entitled to the UK's EHIC card. 

Photo: AFP

But somewhat confusingly there are a few exceptions to the rule regarding EHIC vs. CEAM cards. 
The page on the NHS website covering this subjects states that if you live abroad and you:
  • receive a UK State Pension or exportable UK benefit
  • you are a posted or frontier worker
  • or you are living in the EEA and are family member of someone working in the UK
then you need to apply to renew your EHIC by contacting Overseas Healthcare Services. You can find the address under the Living abroad section here, as well as a contact number. 
British pensioners in France are registered with their local health authority in France with an S1 form. 
This form means that the UK is your ‘competent state' – responsible for funding your healthcare. You are affiliated to the French health system via CPAM and receive health care on the same basis as a French national, but the UK reimburses France for your health care costs.
Similarly holding an EHIC card, rather than a CEAM, means that the UK will cover any emergency treatment you need in other EU countries. 

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Carte vitale: How much will dental and eye care appointments cost me?

The basic health insurance you are entitled to with your carte vitale covers you for a certain amount of dental and eye care. Here's a look at what you need to know.

Carte vitale: How much will dental and eye care appointments cost me?
Photo: AFP
Working out what your carte vitale entitles you to within the French health service can be a complicated business. 
After 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, in terms of general healthcare, this time we're focusing on what happens when it comes to dental and eye care. 
This is what you need to know. 

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

Dentist appointments
Helpfully dentist appointments are reimbursed in exactly the same way as appointments with GPs, which means you will receive 70 percent back from the French State on the cost of your consultation. 
Like doctors, dentists in France work under two sectors – sector one dentists mostly charge the standard €23 apart from in exceptional circumstances, while sector two dentists are entitled to charge more, and you will not get refunds for any amount over the €23 minimum. 
That means that in most cases you will receive €16.10 back from the French State for your appointment. 
You can check which sector a dentist works under on the official site of France's state health insurance and it will also be listed if you are booking an appointment through the Doctolib app
Unlike when you visit other specialists you do not need to a referral from your registered GP first to get the 70 percent reimbursement (for more on that read here) and you are free to consult a dentist at any time. 
Dental care 
The list of reimbursed dental care includes removal of tartar, treatment for decay, as well as tooth removal, among other services, and you will get 70 percent back, with prices for each service varying. 
For example if you visit a dentist for tartar removal it will cost  €28.92 and, with the basic reimbursement of 70 percent, you will receive €20.24 of that cost back. 
Meanwhile for root-canal work on a molar tooth, which is far more expensive at €81.94, you will receive €57.35 back from the French State. 
For the full price list of services visit the dental care section of the site. 
Photo: AFP
False teeth
The price of certain treatments on false teeth was capped as of April 1st 2019 to make treatment more accessible. 
That means that dentists are not allowed to charge more than the maximum price agreed with the French State for 11 types of care, including crown implants (€107.50) and a complete set of dentures (€182.75). 
It's important to remember that the government is set to bring in a round of further changes set to make dental care even more accessible over the next couple of years, with certain dental surgery set to be 100 percent covered by basic health insurance. 
This will include the cost of metal crowns for back teeth and ceramic crowns for more visible teeth at the front of the mouth as well as certain kinds of bridges and dentures. 
While costs will be capped on other kinds of dental surgery, such as the fitting of a ceramic crown at the back of the mouth.
Appointments with eye doctors are not reimbursed by the French State, however basic health insurance will cover the some of the costs of your prescription glasses. 
The reimbursement system is particularly favourable to those aged under 18. 
If you are under 18, frames are reimbursed by 60 percent on the basis of a cost set at €30.49 and lenses are reimbursed at 60 percent of the cost, with prices varying according to the kind of prescription you need. 
For example the cost of single focus clear lenses you will be reimbursed 60 percent of €12.04 – even if they cost more, while for the most serious prescriptions you will be reimbursed 60 percent of €66.62, and again that's even if they end up costing you more. 
Photo: AFP
Meanwhile, if you are over 18, you'll also be refunded 60 percent of the price of your frames – but the catch is that this is based on a cost set at €2.84. 
Similarly the price you'll be refunded for on your lenses is also much lower. 
For the lowest prescriptions you will 60 percent of €2.29 back and for the most serious prescriptions, you will receive 60 percent of €24.54 back. 
For the full list of reimbursements on eye care, check the site here.
However there is some good news for anyone who can hold off on getting their specs for another year. 
From 2020, the price of glasses will be fully covered for “quality lenses” and for frames costing up to €30. 
Opticians will stock 17 adult frames and seven children's models, all available in multiple colors and wearers will be able to renew them every two years and once a year for under-15s. 
On the other hand, customers who want branded frames or a special treatment on the lenses may have to cover part of the cost themselves, depending on the benefits of their top-up health insurance known as a “mutuelle”.