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ESSENTIALS: MOVING TO FRANCE

MOVING TO FRANCE

Health insurance in France: What you need to know about a mutuelle

In the case of a no-deal Brexit, certain groups of British people will need to prove that they have full health insurance. With the government's new residency site now up and running, we take a look at what exactly a French mutuelle involves.

Health insurance in France: What you need to know about a mutuelle
Photos: AFP

What are mutuelles?

France’s mutuelles are non-profit organisations which have been in operation in the country for at least 150 years.

Their main purpose is to ensure social welfare but not just through additional health cover, also in terms of pensions, disability benefits and other forms of cover.

Mutuelles abide by the code de mutualité, which distinguishes them from health insurance companies in that members don’t have to pay premiums for pre-existing conditions and have a greater say in decision-making as part of this type of co-op or partnership.

READ ALSO France's new carte de séjour website: How does it work and what do I need?

While mutuelles are paid for by individuals they are not private health insurance and don't come up with preferential treatment or access to private clinics.

How does a mutuelle actually work?

If you go to the doctor or hospital in France or have an x-ray or some other kind of test, you'll normally pay up front.

You are then refunded a percentage of the cost via the carte vitale system, usually within a week, either by the French government if you are working or your home government if you are a pensioner (under the S1 scheme for British people).

In general terms the state covers around 70 per cent of the total, although for some serious conditions the percentage of state health cover is higher or even complete.

What a mutuelle does is cover, either partly or completely, the deficit or the part of the cost not covered by the state.

Essentially, a mutuelle is top-up health cover and one of the easiest ways of getting 100 percent health cover, although how much cover you get will depend on which mutuelle you have and how much you were charged (read on).

Recent figures for the French insurers' group Mutualité française showed that the average resident in France will have to pay out €235 a year in medical costs not covered by the state – unless they have a mutuelle. And of course for the elderly or people with long term health conditions the figure can be a lot higher.

Not every mutuelle is the same

Depending on the policy chosen, mutuelles can cover most or all of the remaining costs not reimbursed by the state, as well as some selected medical services and the cost of medicines at the pharmacy.

In general terms basic mutuelles will take you up to 100 per cent cover but often the next step up, a standard cover offering around 150-175, or 200 percent, won’t cost a lot more and could tie you over for a lot of expensive extras such as dental and optical treatments. 

Things are made more complicated by the fact that doctors in France can charge more than the base rates set by the state (tarif de convention).

This is known as dépassements d’honoraires and are added on by many specialist doctors. For example while most GPs will charge the base rate for appointment of €25 some will charge €40.

If you have a mutuelle that reimburses at 100 per cent that will only cover the €25 tariff de convention. To cover all of the €40 you'll need a mutuelle that reimburses at 200 per cent. And the same applies to all medical treatment. Note that more expensive mutuelles will reimburse to 400 percent. More info here.

The mutuelles and complémentaite santé market is fairly flexible in this regard so it’s worth having a search online for the policy that best suits your needs and budget.

And make sure you look carefully at the rate of reimbursement.

There are plenty if not too many to choose from, so also ask French friends or your local doctor for recommendations to get a better idea and more honest opinion. 

Your company might foot the bill

Since 2016 private companies in France have to provide employees with a private health insurance policy known as a mutuelle collective.

By law they have to cover a minimum 50 percent of the mutuelle’s cost and companies also tend to offer workers extended medical cover for their family members as a perk.

Employees are in fact expected to join the scheme unless they have a valid reason for not doing so.

However, if you work in the public sector, you’re job seeker, student, self-employed or a pensioner, this law doesn’t apply to you and you’ll have to opt for a mutuelle individuelle, which tend to offer less cover.

So what’s the cost?

Mutuelles are more affordable than private health cover in the UK, hence why most people in France have one.

However unlike in Britain, it doesn’t guarantee faster treatment at the hospital or get you access to private doctors and clinics either. It just assists financing the personal contribution element of France’s healthcare.

According to 2016 results by France’s Personal Insurance Price Index (IPAP), average yearly mutuelle costs range from €350 to more than €1,200.

Data from French insurance comparison site lecomparateurassurance.com found that for over 60s average annual expenditure is €2,500, roughly €212 a month.

For families where the parents are around 35 and their two children are between the ages of 7 and 3, a family bundle costs around € 90 a month, or €1083 per year.

For a 25-year-old worker on the other hand monthly mutuelle spending is around €26.

Another consideration worth noting is that different regions of France have higher and lower mutuelles prices, although this generally affects the rate by around 10 per cent. 

Read the small print

The mutuelles and complémantaire santé market is a competitive one so as mentioned earlier it’s best to ignore the sale pitches and cut to the real deal.

Make sure you read carefully through what your prospective mutuelle offers, in particular the small print of your contract, as this is often convoluted but still very telling.

Watch out for what calculation they use to actually reimburse you. 

Keep an eye out for the cancellation clauses too as they can be quite specific and require notice to be given several months in advance.

If you're not a mutuelle member already, you should probably become one

Unless you’ve got private health insurance or plenty of money stashed away which you’re willing to burn in case of a medical emergency, you’d be better off paying for a mutuelle or top-up health cover in France.

Keep in mind that healthcare isn’t completely free in France (as in the case of the NHS in the UK), so fees can run into the thousands of euros if you have to go to hospital.

It’s a case of being better safe than sorry…or in debt.


 

 
 

Member comments

  1. We are Brits, with a carte vitale and mutuelle – is this enough in the event of a no-deal or will the French withdraw the carte vitalle?

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FRENCH BUREAUCRACY

Everything you need to know about your vital French ‘dossier’

It's a crucial part of life and an incomplete one can bring about a whole world of pain - here's what you need to know about your French dossier.

Everything you need to know about your vital French 'dossier'

The French word un dossier simply means a file – either in the physical sense of a plastic or cardboard item that holds documents together or the sense of a collection of documents. You might also hear civil servants use dossier to refer to the responsibilities they hold, as in English we might say their ‘brief’. 

But by far the most important use of dossier, particularly to foreigners in France, is its use to indicate the collection of documents that you must put together in order to complete vital administrative tasks, from registering in the health system to finding somewhere to live.

When you begin a new administrative process, you will need to put together a collection of documents in order to make your application. Exactly what you need varies depending on the process, but almost all dossiers will include;

  • Proof of ID – passport, birth certificate or residency card. If a birth certificate is required check carefully exactly what type of certificate is being asked for (and don’t freak out if they’re asking for a birth certificate no more than three months old, it doesn’t mean you have to be born again).

Birth certificate: Why you need it in France and how to request one

  • Proof of address – utility bills are usually the best, if you’re on paperless billing you can log into your online account with your power supplier and download an Attetstation de contrat which has your name and address on it and also acts as proof of address
  • Proof of financial means – depending on the process you might have to show proof of your income/financial means. This can include things like your last three months payslips or your most recent tax return. If you’re house-hunting you might be asked for your last three quittances de loyer – these are rent receipts and prove that you have been paying your rent on time. Landlords are legally obliged to provide these if you ask, but if you can’t find them or it’s a problem you can also ask your landlord to provide an attestatation de bon paiment – a certificate stating that you pay what you owe on time.

Paper v online

The traditional dossier is a bulging file full of papers, but increasingly administrative processes are moving online, so you may be able to simply upload the required documents instead of printing them all out. 

If you have to send physical copies of documents by mail, make sure you send them by lettre recommandée (registered mail), not only does it keep your precious documents safe, but some offices will only accept documents that arrive this way. 

If you’re able to send your dossier online, pay careful attention to the format specified for documents – usually documents like rental contracts or work contracts will be in Pdf format while for documents like a passport or residency card a jpeg (such as a photo taken on your phone) will suffice. If you’re sending photos of ID cards, residency cards or similar make sure you upload photos of both sides of the card.

If you need scanned documents there is no need to buy an expensive scanner – there are now numerous free phone apps that will do the job and allow you to photograph the documents with your phone’s camera and convert them to Pdf files.

Some French government sites are a little clunky and won’t accept large files – if you get an error message telling you that the file you are uploading is too big, you can resize it using a free online photo resizing tool. 

Payment

If the process requires payment (eg changing address on certain types of residency card or applying for citizenship) you may be asked for a timbre fiscale – find out how they work here

House-hunting

If you are looking for a property to rent you will need to compile a dossier and if you’re in one of the big cities – especially Paris – landlords or agencies usually won’t even grant you a viewing without seeing your dossier first, so it’s always best to compile this before you start scanning property adverts.

The government has put together a tool called Dossier Facile which allows you to upload all your house-hunting documents to a single site, have them checked and verified and then gives you a link to give to landlords and agencies, which makes the process a little simpler.

Find a full explanation of how it works here.

Attestations

For foreigners, especially new arrivals, it’s often a problem getting together all the documents required. It’s worth knowing that if you don’t have everything you need, you can sometimes substitute documents for an attestation sur l’honneur, which is a sworn statement. 

How to write a French attestation sur l’honneur

This is a legally valid document, with penalties for submitting a false one, and needs to be in French and written in a certain format – the French government website provides a template for the attestation.

Vocab

Déposer un dossier – submit your file

Pièce d’identitie – proof of ID eg passport, residency card

Acte de naissance – birth certificate. 

Copie intégral – a copy of the document such as a photocopy or scan

Extrait – a new version of the document, reissued by the issuing authority

Sans/ avec filiation – for birth certificates it might be specified that you need one avec filiation, which means it includes your parents’ details. Some countries issue as standard short-form birth certificates that don’t include this, so you will need to request a longer version of the certificate

Justificatif de domicile – proof of address eg recent utility bills. If you don’t have any bills in your name you can ask the person who either owns the property or pays the rent to write an attestation de domicile stating that you live there

Justificatif de situation professionnelle – proof of your work status eg a work contract – either a CDI (permenant contract) or CDD (short-term contract)

Justificatif de ressources – proof of financial means, such as your last three months payslips (employers are legally obliged to provide these), other proof of income or proof of pension payments or evidence of savings.

Avis d’imposition – tax return. Some processes ask for this separately, for others it can be used as proof of resources – this is not a copy of the declaration that you make, but the receipt you get back from the tax office laying out your income and any payments that are required. If you declare your taxes online in France, you can download a copy of this document from the tax website. 

Quittance de loyer – rent receipts

Attestation de bon paiment – a document from your landlord stating that you pay your rent on time

Un garant – for some processes, particularly house-hunting, you might need a financial guarantor. This can be tricky for foreigners since it has to be someone you know reasonably well, but that person must also be living (and sometimes working) in France, and they will also need to provide all the above documents. If you’re struggling to find an acceptable guarantor, there are online services that will provide a guarantor (for a fee).

En cours de traitement – this means that your dossier has been received and is in the process of being evaluated. Depending on the process this stage can take anywhere between hours, months or even years (in the case of citizenship applications).

RDV – the shortened version of rendez-vous, this is an appointment. Certain processes require you to first submit your dossier and then attend an in-person appointment.

Votre dossier est incomplet – bad news, you are missing one or more crucial documents and your application will not proceed any further until you have remedied this.

Votre dossier est validé – your dossier has been approved. Time to pop the Champagne!

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