State of health

If you are planning in taking early retirement and moving to France, it pays to do your homework on the French health care system first, says Ron Wright

It’s not uncommon for British people to take early retirement; giving up work with the intention of spending their retirement in France. Before making this major decision to change their country of residence, however, they often want to know if they can receive state health cover in France as non-working, permanent residents.

The official definition of an early retiree is a person who is not yet in receipt of their UK state retirement pension. Under EU social security regulations, which have now been in force for more than 40 years, receipt of a UK state pension gives the retiree access to an S1 health form, which provides basic French state health care at UK expense for the holder’s lifetime whilst resident in France. The S1 holder is not involved in the accountancy procedures for his basic French state health cover at UK expense. This takes place at national level between the UK and France.

One option for people nearing state pension age, is to wait until they have their S1 before moving to France because this is the safest state health route for them. Registration of the S1 at the local French health office, the CPAM, means that France becomes entirely responsible for the S1 holder’s basic state health care.

Early non-working retirees who are some years away from receiving their UK state pension have to consider how they can be covered for health care. French state health cover will probably spring to mind in the first instance, but if this cannot be accessed, then private health insurance will have to be considered. Health cover is a legal requirement in order to live permanently in France.

A long Department of Health consultation document, published this summer, contains the following: “Early Retirees Proposal. We propose to stop issuing residual S1 forms from 1 April 2014.” If this proposal becomes law, it would mean that the short-life S1 (based on a person’s national insurance contribution record in the last two to three years) would no longer be issued by the Department for Work & Pensions.

Couverture Maladie Universelle (CMU)

Non-working, early retirees living permanently in France who have no state health cover whatsoever, can decide to apply for CMU at their local French health office, which is known as the Caisse Primaire Assurance Maladie (CPAM). Such applications are generally a two-stage process, although CPAMs can vary in their procedural requirements: a questionnaire, followed by a CMU application form. Both documents are available from the applicant’s local CPAM.

Initial questionnaire

The questionnaire is of course in French and consists of two pages. The first page includes information to guide you through completion of the second page, and it is this second page which is the actual questionnaire that needs to be completed and submitted to your local CPAM.

The guidance notes on page 1 have a preamble, followed by four main headings as follows:

*Your social protection with regard to your situation

*Your residence in France

*Your resources

*Justifying documents to attach to the questionnaire (on page 2)

Page 2 (the questionnaire) also has four main headings within which there are questions/ boxes to tick/information to provide:

*The person who is asking for the examination of their rights

*Your social protection with regard to your situation

*Yours residence in France

*Your resources

Finally, the questionnaire ends by asking you to certify on your honour that the information you have given is exact, and also that you undertake to inform your health office of all changes in your situation which could modify this information, such as starting or stopping work, changes in levels of income etc.

The CMU application form

Changes in CMU procedures introduced in 2013 are contained in the following statement by the European Commission: “Following continued pressure from the Commission to comply with the requirements of EU law, the French authorities established in mid-July 2013, a new centralised administrative system in Nîmes to deal with all new applications by non-active EU nationals to join the CMU. Applications should still be made to the local CPAM and, if the applicant is a non-active EU national, the application is sent to Nîmes for processing. The Commission is hopeful that this new centralised system will resolve the problems of non-compliance with EU law, but notes that the 2011 Circular on CMU admission remains in place. The Commission is currently monitoring how the new centralised system is working – no reports of refusals have been received so far.”

Prior to the new centralised system in Nîmes, the situation was very ambiguous because each CPAM, being autonomous, had applied the rules on a case-by-case basis in an inconsistent way across France. As a result, some applicants were granted CMU and others were not. Therefore, applicants could not rely on this route for CMU cover before they had completed five years of legal and continuous residence in France, at which time they could apply to their préfecture for permanent residence and, if this were granted, could then apply to their CPAM for CMU on that basis. At the time of writing, it remains to be seen whether this latest EC communication will change the CMU situation for non-active UK applicants. In fact, access to CMU is still governed by rules in the 10-page circular of 9 June 2011, issued by the Directeur de la Sécurité Sociale, and as you see, this circular is mentioned in the EC statement quoted above.

Basic French state health cover

The phrase ‘basic French state health cover’ needs further explanation because, unlike the NHS, the French state system is not an entirely free one. In fact, the two systems are not comparable. The French state health system is a reimbursement of medical expenses system, but the reimbursement is only partial; for example, 70% of GP fees, 80% for hospitalization, always strictly in accordance with state tariff rates. French nationals and other permanent residents can choose to cover some or much of the shortfall by purchasing complementary or top-up health insurance, known as a mutuelle.

Complementary health insurers generally offer a range of policies and no medical questions are asked in respect of this top-up insurance. If you do not have top-up insurance, then you have to pay the shortfall out of your own pocket, and a long hospital stay could turn out to be costly in terms of the remaining reimbursement shortfall that the patient has to pay.

Ron Wright works for French insurance specialists Exclusive Healthcare www.exclusivehealthcare.com