The French social welfare system is based on the principle of ‘solidarity contributions’, which covers both French nationals and resident foreign nationals. This means that everyone living in France has access to France’s high-quality healthcare system, both in private practices and in hospitals, while benefiting from partial coverage of healthcare costs by France’s Social Security system (topped up with complementary cover).
Whether they work in France or reside in France on a regular basis, expats are covered via the Universal Health Protection scheme (PUMa - ‘Protection universelle maladie’), as long as they are not covered by the social protection system of another country.
The PUMa system allows foreign nationals living in France to obtain a Social Security number and a "Carte Vitale" [health insurance card]. Simply present your Carte Vitale to your doctor or pharmacist, and the French Social Security fund will be notified of the cost of your treatment or services. The fund (‘caisse’) then processes your reimbursement automatically, without any other procedure being required.
NB: these reimbursements are generally partial (except in some cases), and are usually capped. Obtaining complementary cover is therefore essential in order to guarantee full reimbursement of your medical costs, which can sometimes be considerable.
> Everything you need to know concerning French universal sickness protection (PUMa) for foreign nationals living in France
In France, everyone covered under state Social Security is free to choose their own GP, provided they declare them to the Social Security as their "treating doctor" (‘médecin traitant’). By declaring your GP, you have the right to the maximum repayment rate: 70% of the basic fee, currently set at €25. If you do not do this your GP consultations will be repaid at 30% of the basic fee.
However, you’re by no means obligated to remain with the same GP year in, year out. You can change your treating doctor at any time – just don’t forget to inform your Health Insurance Fund.
Your treating doctor is responsible for coordinating your treatment, meaning they’re responsible for recommending any extra consultations or referrals to a specialist (rheumatologist, cardiologist, dermatologist, etc.). Again, you’re entitled to select the doctor or specialist of your choice. By going through your treating doctor, you’re guaranteed to receive a 70% repayment of the basic fee.
However, you can consult gynaecologists, ophthalmologists, stomatologists, psychiatrists and dentists, without any prior referral from your treating doctor.
Did you know: in France, a flat-rate contribution of €1, payable by the patient, is automatically included when paying for a medical consultation.
Once again, every person covered by state Social Security has the right to choose which they’re treated in, whether public or private. The cost of care is divided into several categories:
Accommodation costs: 80% repaid by Social Security;
Supplements for personal comfort (individual room, television, etc.): payable by the insured;
Additional fees which may be charged by some hospital doctors, also payable by the insured;
The "daily flat-rate charge": a financial contribution by the insured of €20 per day.
The remainder of the fees, called the "ticket modérateur" [deterrent fee], is not repaid by Social Security, but can be covered by a top-up health insurance policy.
Whether they work in a private practice or a public hospital, French doctors (GPs and specialists) can choose from several pricing structures:
They can opt for rates based on French Social Security's repayment scheme (BRSS), for example €25 for a GP consultation. These doctors are part of what’s known as the "Sector 1" category;
They can charge (limited) additional fees, as a member of a DPTAM (Controlled Pricing Practice System – ‘Dispositif de Pratique Tarifaire Maîtrisée’);
They can charge unrestricted additional fees, and as such are not associated with a DPTAM.
Social Security reimbursements are restricted to the BRSS rates and prices, and don’t take into account any extra charges as a result of visiting DPTAM or non-DPTAM doctors. These supplementary charges will affect the remainder you’ll have to pay after any course of treatment, as well as the amount of the repayment guaranteed by your top-up health cover. As a result of regulations affecting "responsible contracts" (which must comply with the repayment caps imposed by French law), services offered by non-DPTAM doctors are reimbursed at a much lower level than BRSS- or DPTAM-affiliated doctors.
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