HEALTHCARE
Which doctor? There are three types of doctor for social security purposes. Sector 1 (médecin conventionné) doctors are contracted doctors whose consultation fees are reimbursed by social security (excluding co-payment). Sector 2 doctors are known as ‘conventionnés à honoraires
libres’. This means that they apply the standard tariff but are authorised to charge higher fees. Additional fees may be covered by your mutuelle top-up health insurance. Practitioners in sector 3 are doctors who are not covered
by the agreement and charge unrestricted fees. Your mutuelle top-up policy may not fully cover the higher cost in this case. The doctor’s status indicating if they are conventionné 1 or
2 or non-conventionné will be displayed in their practice. You can also inquire about their status when contacting them.
Your mutuelle top-up policy will be linked to your social security number so that when a refund is made by CPAM a notifi cation is sent to your mutuelle insurance company. If the treatment is covered by you mutuelle policy, the refund will then be made. Occasionally, the link between your social security number and your mutuelle insurance company is lost but can be easily put back in place. For example, a visit to your GP will cost €26.50. The percentage of the base de remboursement for this type of treatment is 70%, so you will receive €16.55 from CPAM which is 70% of €26.50 minus the €2 participation forfaitaire.
• When you have been allocated your social security number, you will receive a carte vitale in due course. The carte vitale is a smart card that contains the essential information about your social security account. It is used to electronically process reimbursement for medical expenses and to streamline administrative procedures when accessing healthcare services.
• While you are waiting to receive your carte vitale you will be given a brown form called la feuille de soins papier. This paper is used to claim reimbursement for medical expenses and is sent to CPAM by you to receive your refund.
• The base de remboursement is the offi cial reimbursement rate set by the sécurité sociale for a specifi c medical procedure, treatment, or healthcare service. This rate serves as the basis for calculating
38 l Expert Guide
"The French healthcare system off ers relatively low out-of-pocket costs for patients"
the amount that will be reimbursed by CPAM for eligible expenses incurred. A medical professional can charge more than the base de remboursement. The average percentage of reimbursement of the base de remboursement is 70% but this varies greatly!
More on the web
More healthcare advice…
FrenchEntrée's relocation pages are packed with information on every aspect of moving to France.
Find answers to questions such as: ‘What is the process for obtaining a carte vitale?', ‘How can I find a GP in France’ and ‘What do I need to know about top-up health insurance’ on:
frenchentree.com/healthcare
• Something that can cause confusion is the participation forfaitaire. This is a fi xed contribution of €2 which applies to all consultations or procedures carried out by a doctor and also radiology tests and laboratory tests for over 18s. There is a limit to €8 a day and €50 per year for this contribution. When this is deducted from your refund from CPAM and is only €2, it’s barely noticeable. However, if you have had previous treatment that benefi ted from tiers payant and did not require any upfront payment, the €2 contribution will be deducted from a future reimbursement, irrespective of the reimbursed procedure for either you or your dependents. CPAM has a fi ve-year window to reclaim these sums.
HIGH-QUALITY CARE In summary, the French health system off ers a comprehensive range of services, high number of healthcare professionals, emphasis on preventative care, and relatively low out-of-pocket costs for patients. Like any national healthcare system, it also faces challenges and areas for improvement but overall, it is well- regarded for providing accessible and high-quality care to residents.
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