Words: Caroline Harrap
Internationally renowned for its excellent healthcare, France is widely considered to be among the best in the world when it comes to medical provision. However, whether visiting for a holiday, temporarily relocating or moving here permanently, getting access to the French healthcare system can be a little daunting (this is France, after all!). So, here we bring you a simple introduction…
To start with, it’s useful to understand a bit about how the healthcare system works in France – especially as it’s quite different from either the UK or the States. Funded mainly by obligatory contributions, with employer, employee and the self-employed all contributing a share, every legal resident of France is entitled to some level of healthcare. However, as the State only pays for around 70% of most healthcare costs, many people choose to take out complementary health insurance to cover the shortfall (not to be confused with private healthcare in the UK, which is an entirely different thing). If a person has neither State nor private health cover, they will be billed for medical treatment and have to pay for it out of their own pocket.
There are also some other important differences from the UK health system. Firstly, unlike the NHS, you have to pay upfront and are then reimbursed. Also, the quality of care between public hospitals and private clinics is generally much the same – with not much difference in price either. Furthermore, going into a private clinic doesn’t necessarily mean that you will have to stump up for the entire bill either – or have to wait less time. As a general rule, waiting lists such as those in the UK are rare in France.
So how does one go about getting access to French healthcare? Well, if you reside in Europe and are visiting temporarily, you’ll need a European Health Insurance Card (EHIC), which will enable you to access State-provided healthcare at a reduced cost, or sometimes free, for the duration of your stay. If, however, you are an EU resident relocating here for a longer period of time, the first thing on your list needs to be an S1 form (formerly E106/E121).
In short, the S1 is a certificate of entitlement to healthcare if you don’t live in the country where you are insured – useful for posted workers, cross-border workers, pensioners and civil servants and their dependants. Available in your country of origin, it entitles the holder to register for basic French state healthcare for the duration of the S1’s validity and at the expense of the issuing Member State. Of course, all this could change for the Brits, with the advent of Brexit, but for the purposes of this article, that’s the situation for now.
So, in summary, the form means that all EU residents can get access to healthcare in France on the same terms as French nationals, except that you won’t need to pay French social security health contributions for the duration of the S1. However, if you enter employment/business in France, the S1 ceases to be valid, and you will be required to pay social security health contributions. For those who reach the age of retirement, and are in receipt of a State Pension from their home country, the S1 cover applies on a permanent basis.
The green card
If neither the EHIC or S1 apply, you will need to apply for your green card, the ‘carte vitale’. This facilitates your reimbursements and avoids you having to pay upfront for your healthcare. Before you can have a carte vitale, you need to be ‘in’ the French healthcare system and your healthcare rights need to be activated – two separate processes. And you may of course wish to think about taking out the ‘top-up’ cover we mentioned earlier, known as the ‘mutuelle’.
For now, though, this at least gives you a basic introduction to the French healthcare system – and, whilst we hope that you don’t have to call on its services any time soon, at least you will know where to start if you do.