M


oving from the UK National Health Service (NHS) to the French healthcare system may bring about changes and cause some apprehension,


but it’s important to note that both systems aim to provide universal healthcare coverage. The French system, like the NHS, off ers comprehensive care and accessibility, although are diff erences in the way care is delivered, the administrative processes, and the fi nancing mechanisms.


HOW DO YOU QUALIFY FOR HEALTHCARE IN FRANCE? In France, the PUMa (Protection Universelle Maladie) system entitles all legal residents to healthcare coverage, regardless of their employment status. The diff erent statuses that make someone eligible for PUMa registration include: • Active status: Individuals who are legally residing in France and are considered active, whether through employment, self-employment or other forms of professional activity.


• Inactive status: This category includes individuals who are legally residing in France but do not have an active professional activity, such as retirees, students or individuals not currently engaged in employment.


HOW DOES THE FRENCH HEALTHCARE SYSTEM WORK? The French healthcare system operates as a mixed public-private system. It is based on the principles of universal coverage and solidarity, with healthcare being funded through a combination of social security contributions, taxes and out-of-pocket payments. The system provides access to a wide range of healthcare services, and patients have the freedom to choose their healthcare providers. Key components of the French healthcare


system include: • Sécurité sociale, CPAM & AMELI • Tiers payant • Ticket modérateur • Carte vitale and la feuille de soins papier • Mutuelle top-up health insurance • Participation forfaitaire


Let’s look at each of these individually: • La sécurité sociale is the broad term for the French social security system, which includes various branches and organisations responsible for diff erent aspects of social security, including healthcare, pensions and family benefi ts.


• CPAM (Caisse Primaire d'Assurance Maladie) is a local branch of the French social security system that specifi cally handles primary health insurance and benefi ts. It is responsible for the administration of health insurance, healthcare reimbursements and managing the healthcare coverage of residents at the local level.


healthcare expert


Paulette Booth is the Agency Director at Agence AXA International, providing all your insurance and banking needs in France


Telephone: 0033 (0)5 61 07 16 84


Email: agence.international@axa.fr


Website: axa-in-france.fr


The


• AMELI (Assurance Maladie en Ligne) is the online portal and digital platform of the French social security system, primarily managed by CPAM. AMELI allows users to access their health insurance account, manage their healthcare coverage, submit reimbursement claims and access various online services related to health insurance and benefi ts.


• The tiers payant system means patients do not have to pay upfront for healthcare services covered by the social security system. Instead, the healthcare provider directly bills social security and, if applicable, the patient’s complementary health insurance (mutuelle top-up insurance), without requiring the patient to make immediate payments. This system aims to make healthcare more accessible by reducing the fi nancial burden on patients at the time of receiving care. It is commonly used for medical consultations, prescription medications, and certain medical procedures covered by the health insurance system.


• If you do pay upfront for treatment, you will receive a refund from CPAM based on the base de remboursement for that treatment (I’ll explain this later). The amount leſt at your charge is called ticket modérateur. The refund from CPAM will usually be paid within a few days, then your mutuelle top-up insurance a few days aſt er that to cover the amount leſt at your charge, depending on the level of guarantees in your contract.


How does a ‘mutuelle’ top-up health insurance policy work?


Mutuelle top-up health insurance policies can be set up with many diff erent levels. The most basic is to cover hospitalisation only as a base, then the cover increases from there to 100%, 125%, 150%, 200%, with each level covering more types of treatment, including dental, optical and audiology. The percentage level of your chosen mutuelle top-up health insurance policy relates to percentage of the refund from CPAM that the policy will pay.


Expert Guide l 37


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