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What is France's PUMa healthcare system and am I eligible?

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What is France's PUMa healthcare system and am I eligible?
Accessing medical treatment in France could be about to get a lot more complicated. Photo: AFP
13:40 CEST+02:00
As the UK has proposed covering just six months of healthcare for British pensioners in France after Brexit, many may now need to register for the PUMa healthcare system - but what is it?

Before Brexit, many British people in France - particularly pensioners - have had the costs of their healthcare covered by the UK. But with that all set to change, it's worth knowing how the different parts of France's health insurance system work.

Unlike the NHS, which is free at the point of delivery, in France healthcare costs - whether it's a doctor's appointment or a prescription or medical procedure - are paid for up front by the patient. 

READ ALSO 'A massive betrayal' - UK's no-deal Brexit healthcare pledge for pensioners in the UK sparks fury

After a medical consultation in France you will need to pay the doctor, then swipe your card to get the costs refunded. Photo: AFP

The patient is then refunded some or all of the cost, but who refunds it and how it happens depends on your individual circumstances and the scheme you belong to.

If you are working in France you are entitled to have most of your healthcare costs refunded by the state - you can find out more about that here, but it operates on the simple principle that you pay taxes or social charges in France, therefore you are entitled to state healthcare.

But if you are not working the picture is a little more complicated. 

Since January 1st 2016, France has had Protection Universelle Maladie (universal sickness cover) commonly abbreviated to PUMa.

PUMa is based on residency - so as long as you have been legally resident in France for three months you are entitled to register for it.

Until now British pensioners in France have been eligible for the S1 scheme whereby the UK covers their health costs. The S1 also offers cover to people on certain types of disability benefits, some posted workers and students.

But with the UK government now warning that it will only cover healthcare for six months in the case of a no-deal Brexit (unless a further bilateral agreement is reached with France or a Brexit deal with the EU) those people will likely have to join the French system.

PUMa has until now been primarily used by early retirees, although not all have registered as they have preferred to rely on the EHIC card - which will also cease to work after Brexit.

To get yourself registered with PUMa you can download the form here and begin the process of applying. Documentation is likely to vary according to your situation, but you will definitely need to supply a passport, birth certificate and proof of a stable residence in France - for example a rental contract, house deeds and utility bills.

Be warned - the process is not a speedy one. It varies from place to place but many people wait six months or longer for their application to be processed - although if you need healthcare in the meantime you can ask your doctor to supply a feuille de soins (type of receipt) and get the costs reimbursed once you are in the system.

Another drawback is that although it entitles you to free or greatly reduced medical treatment other charges do apply.

Once you are in this system you will have to start paying the social charge that French pensioners do. This adds up to around 9-10 percent of pension income, and anyone with other capital income of more €20,262 a year - for example from investments or rental income from the UK - faces other charges.

One final note - this is only open to people who are permanent residents in France.

Second home owners who spend significant portions of time here - who until now have generally used the EHIC card if they need medical treatment in France - will in future have to rely on private medical insurance or travel insurance.

And all of the above only applies to getting healthcare while you are in France - if you're heading back to the UK to visit friends and family it's likely that the NHS will not cover any treatment you need while you're in the UK.





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