Owen

Hello overeduc8ed, You should definitely go down the route of 2 separate policies. Complementary health insurers will usually only offer cover, if any, for treatment abroad up to the limit of what it would cost in France and even then there will be a overall maximum amount they will pay. And this will almost certainly not be enough for North America. The other thing that many people do not put great emphasis on when they go to the USA is Personal Liability cover So definitely take out a annual multi trip travel insurance most of which will cover these two items as well as other stuff such as Baggage and Cancellation. Cooperola. Your preference for a mutuelle against a commercial insurer on the grounds of shareholder interests is not really a valid argument. In reality the difference between the two is not that great and as ever personal circumstances are the paramount factor. Someone who is a good risk may well obtain more appropriate and better value cover from an insurer whereas someone, for example, seeking more comprehensive optical and dental cover may well do better with a mutuelle. Regards Owen [email protected]

Hello All, It is indeed "early days" but my view on this is as follows: I think it is worth bearing in mind that replacing IB with ESA is directed at the vast majority of claimants who are living in the UK. Although those recipients living abroad can or will be affected they are not going to be a particular priority. I cannot see how E121 could be withdrawn simply because of residence in another EU state. ESA, like IB, will still be based on UK NI contributions and as Long Term Incapacity Benefit is classed as an invalidity benefit under EU regulations, those same regulations deem it exportable. (I have had this specific point confirmed by the DWP). It could be withdrawn on review of the level of incapacity but that does not constitute any difference to the present state of affairs. Where there is likely to be a change is in HOW INCAPACITY IS MEASURED. There is a suspicion that the new tests are specifically designed to reject claimants and it is new claimants of ESA, introduced 27 October 2008, who are likely to be initially affected. There are no immediate plans to move those presently receiving IB to ESA. Just because there may be no immediacy it does not mean they will not in due course do so! However, even if they do apply these new incapacity measurements to existing claimants it is likely to be a long drawn out business. Still a matter of concern but not a reason to panic at this stage. We had enough of that in the autumn of 2007! Regards Owen [email protected]

Hello Bubbles, Even though you are considering putting away a sum of money each month for unforeseen medical expenses I think you would be better of taking out an insurance. if you are in good health and are prepared to pay out of your own pocket for infrequent treatment of minor ailments I still think it would be a good idea to take out an insurance (rather than building a cash reserve) for the potentially expensive stuff such as hospitalisation. The policy is unlikely to actually guarantee covering all "dépassements". However, depending where you live a hospitalisation only plan covering between 200% - 500% of the Tarif de Convention should take care of most of your costs. Even if a surgeon was, for example, planning to charge a 400% "dépassement" the insurer may well negotiate this figure down towards the limit of your plan. For such hospitalisation only policies you will probably obtain better value from an insurer rather than a "mutuelle". Regards Owen [email protected]

Hello Norman, I was not suggesting that you were comparing UK with France. I really had in mind those who have not yet moved to France and may associate a private hospital such as a BUPA establishment in the UK being the same as a private clinic in France most of which are still conventionné. The frais de séjour are the overall costs of a hospital stay eg; operating theatre costs and will be picked up by the CPAM in conventionné establishments. You are quoting the private room benefit which is never picked up by the Sécu and the hotel charges (forfait journalier) very rarely so. A provider will usually separate these 3 items in the table of benefits related to the policy. But if you live in an area where these "dépassements" are more commonly and more heavily applied eg; the Cote d'Azur then this can affect your choice of insurer or a particular plan within that provider's stable. Regards Owen [email protected]

Hello, A bit of clarification is appropriate here. One has to be careful using the term "private" in respect of healthcare matters in France particularly with so many viewers, who are UK Nationals and are familiar with the difference between private and NHS treatment. To compare private healthcare in France to that in the UK is almost like comparing apples with oranges. The vast majority of doctors, specialists, hospitals and clinics are conventionné; some of which charge dépassements". However, a GP or Specialist with his own "cabinet" will be very probably "conventionné", but by some UK measures he/she would be regarded as being in private practise. Private healthcare in the UK is quicker than the NHS for certain procedures, possibly of higher quality and definitely very much more expensive than a private clinic (conventionné) in France. There are private non-profit making clinics in France just as there are in other countries such as the Netherlands. Even the profit making clinics can have some advantage in costs over such establishments as the CHUs, which also have a teaching function. Sure, a surgeon performing an operation in a private clinic (conventionné) will charge a "dépassement'" but the general costs of a stay there - the "frais de séjour" will be picked up by the CPAM. I certainly agree that more of the healthcare costs are likely to be transferred to the insurers and the choice of provider will become even more important. Regards Owen [email protected]

Hello Jamesdee, Ask potential providers what criteria they apply in assessing premiums. There are several; age. sex etc but providers do not necessarily apply the same ones Regards Owen [email protected]

I am not a financial advisor. Wherever you place any money I would have thought safety is the paramount consideration at this time. Do not sacrifice quality for a scrap of extra yield. Remember the Icelandic banks. Ignore the professional advisors who state or imply that cash is trash. Keep hold of the stuff because you will be able to purchase more as the recession deepens. The yield on a 3 months US Treasury Bill is hovering at around 0.01% (and that is the annualised yield). Earlier this week I month Treasury bills were gobbled up even though there was no yield at all. If we are in for a repeat of the 1930s then expect the 3 month T Bill to slump to 0.001% (which it did in 1938). If your money is on deposit with a bank make sure it is with the biggest and best and in jurisdictions that offer the best protection. This effectively rules out all the UK offshore islands. Regards Owen

Hello Bear in mind that as you are self-employed you will be able to offset the AXA premiums against any income tax liability. Regards Owen [email protected]

Hello Coops, An American, for example, must provide proof of health cover to obtain a long term visa before coming to France. This will be in the form of private insurance which will inevitably have exclusions that would be covered by the state system. Your logic suggests that after having been issued with a visa, going through the whole process again to obtain a carte de séjour and in due course completing French tax returns he could still be regarded as an illegal resident. That is pushing credulity too far. Regards Owen [email protected]

Hello Coops, The law 2006-911 is quite clear to me. A EU/Swiss national coming to live in France should have sufficient financial resources and not be a burden on the social security including the “assurance maladie”. If you have a private insurance which gives a level of cover and the rest, such as for minor ailments, paid out of your own pocket then by definition you are not a burden on the “assurance maladie”. The idea also that, even in theory, after 5 years of residence you will be refused into the system because of existing conditions is incredible in my view. After 5 years you will be regarded as a permanent resident (in accordance with CRESEDA) and therefore be able to apply for affilliation under residence criteria (CMU). I simply cannot see at this juncture how the CPAM could or would discriminate against a EU/Swiss national on health grounds. My sources inform me that 5 years of French tax returns will be the proof required to prove length of residence. This sounds right to me and is in keeping with the much closer liaison there now is between the “Sécu” and the tax authorities. By the way, even if you are a non-working EU national and are not required to have a “carte de séjour, there is a requirement to register at your Mairie. Regards Owen [email protected]

Hello Judith, As indicated the time taken to receive your attestation can vary enormously but that does not mean therefore you should wait for weeks and weeks. It has already been mentioned that the CPAM does lose paperwork from time to time but hopefully you have a stamped copy of your application to affiliate. This would be useful if you needed potentially expensive treatment such as hospitalisation as the hospital/clinic would then be able to obtain confirmation from the CPAM that although no social security number had yet been issued, the application was being processed, and therefore the cover was there. However you should not wait forever for this attestation particularly as you will require medication in the near future and at least initially you will have to pay the full amount up front. Proof that you have paid the full amount ie; copies of your "feuilles de soins" would be good supporting evidence of an official complaint to the CPAM of them taking an inordinately long time to process your application. For once French bureaucracy is on your side. Once a complaint is lodged it has to be answered within 3 weeks. Finally, as you are affiliating via E106 you may not receive a "carte vitale". By definition it has temporary validity so some CPAM offices only issue an attestation. If your CPAM does follow this procedure then not been issued with a CV is the one disadvantage of you not piggybacking on your husbands E121. However, from what you have said the advantages of you going your own way in this matter far outweigh this possible inconvenience. Regards Owen [email protected]

Hello, Although CPAM offices issue a social security number to E106 holders some of them do not issue a carte vitale as, by definition, the form has only temporary validity. Regards Owen [email protected]

Hello Blossom, The answer to your question; Is top up insurance really necessary: the simple answer is "No". Is the purchase of some level of top up insurance (perhaps hospitalisation only) advisable/recommended? For most people I would say "Yes". It is particularly the potential costs of a hospital stay (assuming one enjoys general good health) which makes the choice to insure or not a vexing topic. The post by Keith Channing alludes to this. It is not the treatment of life threatening conditions, expensive as they may be, because such treatment may well be covered 100%. Major surgery may also be covered 100% depending where it is performed. But a hospital stay does not, by a long way, necessarily mean treatment of life threatening conditions or major surgery. It can be a matter of minor surgery, observation, tests, scans etc which will be unlikely to be covered 100% - 70% - 80% is more likely. Add the hotel costs and a private room (if desired) the costs mount up. Apart from privacy I see other advantages of a private room. But even if you are admitted to hospital for something life threatening such as a heart attack and covered 100% this will not be the case when it comes to convalescence if so recommended. Only 80% of the costs will be covered plus hotel costs and again a private room. 30 days in a convalescence/rehabilitation establishment can begin to be quite expensive. You can of course put money by in a deposit account but how much? Impossible to calculate or forecast. For people like Logan I can only agree that a mutuelle offers less than decent value because it will undoubtedly offer benefits which are surplus to requirements for someone in general good health. But shop around amongst the commercial insurers for hospital only cover and there are some pretty good deals about. Depending on age you may obtain such cover for around 30 - 50 Euros per month. Of course many providers will look askance at you when you require hospital cover only. We are, after all, living in a country where hypochondria is one of the top national pastimes. Why people have hang ups about providers making profits/surpluses defeats me. I am sure this factor does not stop them from shopping in Carrefour. Worthwhile for most people therefore to have at least a degree of cover afforded by a top up. A pot of gold in a Livret A account can be available for other emergencies. Regards Owen [email protected]

Hello Rich, If you are unable to affiliate via an E Form and therefore require private insurance you should apply common sense and act in good faith and you will be OK.  So if you are in general good health you may only require cover for the potentially expensive stuff such as hospitalisation.  This of course is far from the definition of "comprehensive".  But taking out such cover and paying for any minor treatment out of you own pocket ie; not a burden on state, you would be deemed as acting in good faith. Regards Owen [email protected]

Hello David, Some of my clients have decided not to take out any top up insurance and in all probability they have made the correct decision or at least a more informed decision than most. Most French people would be horrified to hear that you had no top up but there again they are a nation of hypochondriacs. The point about peace of mind is a good one. Particularly in the case of hospitalisation. It is impossible to forecast what you may have to pay yourself. Almost everyone one has to pay the "hotel" charges and you will always have to pay for a private room. But over and above these certain charges it is impossible to forecast what extra you would have to pay. And what of when you come out of hospital? Convalescence/rehabilitation establishments are only covered 80% by the "Sécu". Say you need physiotherapy and or nursing at home which is only covered 60%. It mounts up. Taking out a policy covering simply hospitalisation and out-patient treatment relating to a hospital stay may be reasonably affordable and give peace of mind. I am not an insurance broker. But you do need to shop around. For a start in your circumstances some insurers will base the premium on the age of the younger partner. Also you could be quoted very different premiums from 2 insurers offering more or less equal cover. This is because providers use different criteria in assessing premiums; for example where you live. Regards Owen [email protected]