Owen

Hello oh, This subject has come up before and I received a real slagging from some posters.  Under certain circumstances it is possible to continue with private insurance legally. If you would like to send me a private mail outlining your circumstances I can advise you better.   Regards Peter Owen [email protected] 

This is clearly an emotive issue but I have to say that the French natives are blaming others, and particularly the Brits, for this abuse and abdicating their own responsibility at the same time Most foreigners do not have the right to vote in France apart from European eletions.  So it was overwhelmngly the natives that voted in Jospin, Aubry etc in the 90s.  So not surprisingly the most left wing government in Western Europe introduced things like universal healthcare for all, 35 hour week etc.  So Jacques/Jacqueline do not blame the Brits for your voting habits. There are approximately 4 million who benefit from CMU legislation.  I have no idea how many are foreigners, of those how many are Brits and how many of those do not pay anything.  But the total can only be a tiny percentage of all the beneficiaries. Of course there are abuses but most expats are quite simply obeying the law requiring them, with certain exceptions, to affiliate to CPAM.  If in fulfilling their legal obligations they are receiving excellent healthcare at little or no cost that is the fault of the politicians who drafted the law and those that voted them in office.   Regards Peter Owen [email protected]

Hello Indiana, I think there are two sides to this question. I am not familiar with BUPA/PPP premiums in the UK but I will try and offer a chink of light. I should say if you have a BUPA policy via a corporate scheme in the UK you will have a very good deal indeed; the premiums for an individual are considerably higher. First of all I suspect that you would have to take out a very high level of cover with a French complementary insurance to match the premium of a BUPA policy. I cannot believe that if you took out a French complementary insurance that just covered hospitalisation for example, that it would attract the same premium as a BUPA policy offering a similar plan. Secondly to a certain extent you are comparing apples with oranges in the levels of cover offered. BUPA will apply exclusions. Sure if you want a hip replacement this is OK but what about treatment for chronic conditions? There may well be a blanket exclusion on such treatment. And of course there will be no cover for pre-existing conditions. And even with the best of private policies will offer little in the way of dental and optical care. French complementary insurers do apply exclusions but they are nothing like as draconian as those applied by BUPA or any other full private insurer. In the main pre-existing conditions can be covered. Teeth. Anything over and above routine dental treatment is expensive and the level of cover offered by CPAM is not good eg; crowns. CPAM cover for routine optical is even more miserly. It should come as no surprise therefore that complementary insurance that does give very comprehensive cover in these 2 areas will attract the premiums to match. Having said all that, and at the risk of incurring the wrath of the insurance industry, my researches in the complementary health insurance market lead me to believe there is a lot of mediocrity about. This is not helped by a lack of transparency by the providers. They use various criteria in assessing premiums but not all providers use the same ones. I expect I have probably bewildered you as opposed to offering clarification but the nature of healthcare in France makes it a murky subject. Regards Peter Owen [email protected]

Hello Penny, I do understand your theory and I have explored this avenue myself (sort of!) but from a different perspective. About 3 years ago I had sight of letter from Alan Milburn, the then Secretary State for Health, to an MP representing a constituent. Milburn stated that the maximum period of entitlement (to E106) was "about two and a half years". The most plausible formula to achieve this maximum entitlement is the example you quote in that someone is full paid up to April 2005 works for another couple of months in the UK, arrives in France June 2005 and has an E106 up to Dec 2007/Jan 2008. But the reality is that the E106 will expire 12 months earlier. Another culd de sac! Going back to the STIB angle. I suppose it is possible that although a self-employed has made contributions in the last 3 years but the Class 2 variety were not equal to at least 25 times the lower earnings limit in at least one of those years, then E106 could be shortened. But the logical outcome of that scenario is that E106 would be refused in entirety not just shortened. And in any case there is no reason for the DWP to be evasive on the issue. They could quite legitimately state that E106 has not been issued or shortened because it is linked to entitlement to STIB for which you do not qualify because of insufficient Class 2 contributions. Regards Peter Owen [email protected]

Hello Penny, You are not the only one who is wrestling with this problem of E106 and the self-employed. Various sources have told me verbally that it makes no difference but clearly, at least in some cases, it apparently does. I say apparently because I do not have access to their NI contributions records. There seems to be a conspiracy of silence on this issue at least in written form and I am coming to the same conclusion as you seem to be doing, ie; the self-employed are being discriminated against. This would be in keeping with how the self-employed have been hammered with NI contributions generally compared to their employed contemporaries. I did wonder whether it had anything to do with entitlement to Short Term Incapacity Benefit. You will know that issue of E106 to those coming to live but not work in France is actually based on if they have an underlying entitlement to Short Term Incapacity Benefit irrespective of whether it is actually paid. Of course the self-employed can claim IB but I would be interested in any further comments you may have on this angle. But this official silence is deafening because admittance that the self-employed are being disadvantaged really would open up a can of worms not to say Pandora's Box too. In the end it will probably have to be tested in the European Court of Justice possibly as an infringement of Regulations 1408/71 and 574/72. Regards Peter Owen [email protected]

Hello, In your postion I would not do anything with the E121 except to tuck it away in reserve. The E121 has been given to you as a standard item in the DWP retirement pack but is irrelevant to your needs. Presenting this to your "caisse" sets you on a path of repairing something that is not broken. This could cause confusion and even worse initiate thinking among the staff of your "caisse" Thinking with these sort of people is a dangerous and unnatural activity and you could end up in a bureaucratic quagmire. You are paying cotisations to a "caisse" and when you/your husband retires from French employment/self-employment this "caisse" will continue to provide cover. In any event you would not receive a lesser or greater level of cover with E121. But as I say keep the E121 in reserve and the same with your husband if he receives one as he approaches UK retirement age. You never know what shenanigans these quasi government "caisses" will get up to in the future to try and curb benefits. If you are looking to cut your health costs have a look at your complementary health insurance. There are many providers who reduce premiums for the self-employed and/or base the premiums for a couple on the age of the younger partner Regards Peter Owen [email protected]

Hello, Top up insurance is not obligatory but is certainly recommended and you will have no problems finding cover for pre-existing conditions. As far a recommendations is concerned what is good for one may not be suitable for another. As far as Wills comment about there not being a lot to choose between any of them, I would go some way in agreeing with this because there is a lot of mediocrity about. Nevertheless having studying this subject I have come to the conclusion that there are many people who could probably obtain better value cover.(I am not an insurance broker). The reason for this is that insurers apply all sorts of criteria when assessing premiums but not all insurers apply the same criteria. Even the obvious criteria of age can be applied differently. Some providers, for example, insuring a couple will base the premium on the younger partner. Where you live can also be a factor. You will probably pay higher premiums if you live in a big city but the converse does not necessarily apply. If you live in a remote rural area some providers will load your premium because things like ambulance costs and doctors home visits will cost more. In short there are no hard and fast rules but the one conclusion I have come to is that if you are in general good health and a looking for cover the serious stuff such as hospitalisation only then you are likely to obtain a better deal from a commercial insurer as opposed to a "mutuelle". Regards Peter Owen [email protected]

Hello, The tarif for a scale and polish is 28.92 € Regards Peter Owen [email protected]

Hello Logan, You have made the decision that all you require from your "top up" is hospitalisation cover and any other medical costs that you may incur, and not covered by the CPAM, you will fund yourself. You are comfortable with that. Equally there are many who want more from their insurance and it is not obligatory for them to be pathological hypochondriacs to make such a choice. For example, in the event of an accident that results in a broken arm hospitalisation may not be necessary. But from seeing a doctor, pain killers, X- Rays, perhaps referral to an orthopaedic specialist and 10 - 20 sessions of physio the bill can soon mount up even with 60 - 70% cover by the CPAM. Of course this sort of scenario or other extended out-patient treatment may never occur and over 5,10 years or more, premiums paid may well exceed costs reimbursed. But the insured has had peace of mind and, as such a plan may well include routine visits to doctors, pharmacy, dental etc, he may well consider the money well spent. I would agree that for hospitalisation only cover, a commercial insurer is the best bet but after that, as I have maintained from the start, the distinction between them and the "mutuelles" is less clear. Many commercial insurers do not require medical questionnaires at all for their lower to medium level plans and there is a very good reason for this - they are competing with the "mutuelles". Regards Peter Owen [email protected]

Hello Logan, I agree with just about all you say but my original point was that the difference between a "mutuelle" and a commercial insurer in France is not as great as it may seem and I hope that I have gone some way to establishing this. Actually I am appalled at the waste, over prescribing of medication etc and am still mystified by the national pastime of hypochondria. But I am sufficiently realistic to accept things as they are and, not being a French national, as I would like them to be in my adopted country. Regards Peter Owen [email protected]

Hello Logan, Can I say that I am not pro mutuelle and/or anti commercial insurer. In fact I use almost identical criteria as you for my own healthcare provision. But 30% - 40% for out-patient, lab tests etc can still be a lot to find out of your own pocket and of course the 60 - 70% proportion you quote is of the tarif which is not necessarily the full bill. Secteur 2 Specialists often charge up to double or more of the tarif. so you may receive 70% of 27 Euros by the state while actually being charged up to 50 Euros or more for the consultation. You receive almost nothing for a Specialist in Secteur 3 and some dental treatment but the cost can be picked up by a "mutuelle". I do agree with you that the premiums of mutuelles are going to rise but so will those of the commercial insurers for the reasons you state and also because medical inflation rates are running at around 8% in France. We are all going to pay more for our healthcare; it is a question of how we, as individuals, choose to do it. Commercial insurers in France, by the way, are still subject to the "Code D'Assurance", which hardly lends itself to unfettered capitalism. Regards Peter Owen [email protected]

Hello Logan If I may so your posting is a little simplistic. I am not an insurance broker, I hasten to add. The difference between a commercial insurer and a "mutuelle" is there but is less distinct than it used to be. Certainly "mutuelles" put less emphasis on medical risk which obviously invites higher claims than what a commercial insurer may have to meet. But nothing is simple in France. "Mutuelles" receive favourable tax treatment. Since the rewriting of the "Code de Mutualité" they have been allowed to introduce some conditions of acceptance. Commercial insurers have to ignore medical conditions to obtain potentially lucrative group contracts. Commercial insurers generally apply more criteria than "mutuelles" in establishing premiums but not all insurers use the same criteria.. For example, some providers will take into account sex (women under 60 claim more than men!). A "mutuelle" would not make such a distinction. As for the provider of your choice they clearly meet your needs. But some people would rule them out immediately because their underwriters do not have (as far as I know) a rating by an independent agency such as Standard and Poors or A M Best. In short, both commercial insurers and "mutuelles" have a part to play in healthcare provision. In my opinion they will play an increasing part, in percentage terms, in healthcare funding in France so the choice of provider will take on greater importance. Regards Peter Owen [email protected]

Hello Hubber, You and your employer are likely to get yourselves in a real mess if you are not careful. Firstly your present international health insurance will probably be irrelevant as far as healthcare in France is concerned. It may well be possible for you to continue to pay your NI contributions in the UK and your tax in France provided you or, more accurately your, employer sets things up properly. The key to this is for your employer to contact the Inland Revenue (Centre for Non-Residents (CNR)) in Newcastle upon Tyne not the Department for Work and Pensions. As you are certainly going to be working abroad for over a year but under 5 years you could well be issued with a working E106. The CNR would have to agree this with the French authorities. The latter could argue that you should pay the full French contributions but my view is that you would obtain E106 since it looks as though your stay in France will be of limited duration. You would then affiliate to the system and your basic healthcare costs, and those of any dependants, would be covered. Although your diabetes will be almost certainly covered 100% you may well consider complementary insurance to cover the difference in respect of other healthcare needs. It is possible that the business in France already has a group contract with an insurer or "mutuelle", which you would be eligible to join. Indeed it may well be part of your contract to subscribe to this scheme. If not there is a wide choice of providers in the market so you should be able to find something suitable. Regards Peter Owen [email protected]

Hello Aussie, In your case if your household income after (French) allowances is is below 14518 € then you can apply for a free top up insurance. But if your income is above this amount, say, 20,000 € then your contribution will be 8% of 20000 - 6849 = 1052.08 € payable in 4 quarterly installments of 263.02 €. Regards Peter

Hello SB and Opas, You are both muddying the water here although I am sure it is not your intention to do so, therefore I will try and clarify. The tarif for a visit to a GP (généraliste) is 20 Euros. Under certain circumstances he/she may charge extra (a "dépassement"); for example if they have extra qualifications. But the "Sécu" will only reimburse the % of the tarif. However the tarif for a GP performing an examination on an infant, between birth and 2, is 25 Euros. The tarif for a paedatrician ie; a specialist, performing the same examination on the same infant was 28 Euros but has now increased to 30 Euros. The tarif for a consultation by a paedatrician concerning a child between 2 and 16 has increased from 25 to 27 Euros. Regards Peter Owen [email protected]

Hello, You can continue to pay Class 3 contributions towards pension. but it is only towards pension. There is no health cover and neither can you pay another class of contribution in the UK to obtain health cover whilst in France. As you are presumably below state retirement age but are not intending. at least initially, to take up formal residence in France, an E106 will not be appropriate either. Issue of E106 is a tacit admission that you are shedding UK residence. Essentially therefore you are coming to France on a long holiday so you should take considerable care about healthcare provision. You can obtain E111 from the Post Office and the new version will be valid up until 31 December 2005. This now covers "necessary" as opposed to previously "immediately necessary" or emergency treatment. But E111 will probably only be valid for up to 6 months. After this you will be considered as being no longer a resident of UK for health cover purposes. E111 will still only give a level of cover that would be available to any French resident, so depending on the treatment received, you could still face a considerable bill. E111 + travel insurance. I have posted on this subject before. This is a possible solution but again you need to take care. When you take out the insurance it must be for a specific period or in the case of an Annual Multi Trip policy there will be a maximum length for each trip. But in either case, in the event of a claim you will probably have to produce proof of your intention to return to UK eg; return air/ferry ticket. In the absence of such proof a Loss Adjuster will probably refuse any travel insurance claim whatsoever. Full private insurance. This is another option and the insurer will want to know what your intended country of residence will be. You can safely state France even though you will not be taking up formal residence immediately. A health insurer is not particularly interested in whether you have completed bureaucratic formalities of residence - just the geographical location of the risk. The disadvantage with private insurance is that you will probably not have cover for any pre-existing conditions, although that would apply to a travel insurance too. Regards Peter Owen [email protected]

Hello, DLA does not continue on leaving the UK except if you started to be in receipt of it before 1 June 1992. Regards Peter Owen [email protected]

Hello Cyclebum, In my opinion the arrangements you have in place are the best you are going to obtain. Although I am not a lawyer I think you and your employer are safe on legal grounds too. If one works in two or more EU/EEA countries then you remain insured by the UK if the company for whom you work is based in the UK. This appears to be the case with you. I would certainly not approach either the Hotel des Impots or URSSAF. I also think that trying to be paid gross is a no brainer too. You and your employer are going to have to pay contributions somewhere and they are almost certainly going to be less heavy in the UK. If you really want to try and confirm your status I would contact the Inland Revenue (Centre for Non-Residents) in Newcastle upon Tyne. But do not preface any request with a wish to pay nothing! Regards Peter Owen [email protected]

Hello, My knowledge is of healthcare in France and I comment because of mention of E106. There are key points in the replies so far. If you are actually living in France and you are exercising your business activity here (albeit remotely) then you should be registered as either self-employed in France or as an employee of a UK branch office. But the UK branch office must be effectively registered as a business in France with the associated costs involved. The fact that you are working for a UK registered company and even if you are paying UK NI and Tax is irrelevant. The basic concept is that of your "principal establishment". If you work for a UK company and you actually conduct your activity in the UK then this is a different matter. You can quite properly pay contributions in the UK. Because of budget airlines, weekly commuting to the UK and spending weekends in the family home in France is increasingly common. And, depending on your precise circumstances healthcare provision for you and your family in UK and France can be achieved by judicious use of E Forms. If you work for a UK employer actually in the UK for part of the time then these particular earnings can be subject to UK NI and tax. You will still have to declare these earnings on a French tax return but any UK tax paid will be offset against your French liability. Effectively for the vast majority of people there will be no further tax to pay in France. But work conducted in France would be subject to French rules. Unless you are extaordinarily lucky, talking to accountants and lawyers is wasted money particularly when they are UK based. Regards Peter Owen [email protected]

Hello, I am not an insurance broker! The term "top up" is not an official term at all but is commonly used to describe any type of complementary health insurance policy in France. There are essentially 2 main providers, to which expats can turn, for such policies; the "mutuelles" and the commercial insurers. They are regulated by different legislation and their underlying philosophy differs. I do not think there is any point in asking a Forum such as this for advice on a good provider. It is whether the benefits offered are applicable to your individual health and financial circumstances that is the key factor. The insurance broker with whom you are dealing strikes me (like most of them) of not having a real understanding of the French health system much less advising you on the best plan to suit you. Just to make things more complicated, providers use various criteria in assessing premiums. The trouble is that not all providers use the same criteria. If you are female and are paying higher premiums than a "copine" with another insurer offering the same benefits, it may be that your insurer is loading the premium simply because of your sex (females under 60 claim more than males!). Add to this the terminology providers use in describing their benefits and it can be become a real minefield. Dental is a good example. Routine dental treatment is covered 70% by CPAM. A plan offering 100% (of the tarif) for routine treatment will actually probably cover the full costs. Crowns, bridgework and orthodontics are another matter. For example, the tarif for a crown is 107.50 € and CPAM will cover 70% of this (75.25 €). So a plan offering 100% for crowns will only pay 22,25€. But the actual cost of a crown is likely to be around 400€. It certainly pays to shop around! Regards Peter Owen [email protected]

Hello, If you are residents of France and are affiliated to the French health system then I would be very wary about approaching UK insurers. TU has given a very good example as to why this may not be advisable. Another is that as your journey actually will start from France then your flight from the UK would be considered as a connecting flight and this may well invalidate claims on some or all benefits. I am pretty sure a Cancellation claim would not be met in these circumstances because you have already started your journey ie; departed your country of residence. I used to be in the UK travel insurance business and have some idea how clients can be caught out by sharp eyed loss adjusters. I would admit that the latter can be a pretty unscrupulous lot and will sometimes use spurious ruses to drag things out hoping that the client will give up the fight for a claim. From time to time I have been able to help people in this situation but more often than not the claim has been refused for a fundamental reason such as country of residence or non-declaration of a pre-existing medical condition. As a general guide I think you will be on safer ground to shop around among French providers both for the reasons above and also they may well be less discriminatory because of your ages than UK providers. Regards Peter Owen [email protected]

Hello, “La loi Madelin” (Decree 99-775 of 5 September 1994) allows the self-employed (“travailleurs indépendants”) to deduct complementary health insurance premiums from their taxable income up to a certain limit. The policy must satisfy the criteria laid down by “loi Madelin” and the majority of providers will qualify. Regards Peter Owen [email protected]

Hello, I have no first hand knowledge of health costs in the Limousin so hopefully a resident there will be able to help. But you should certainly take time in your choice of provider. In a survey by the IRDES the conclusion was that roughly a third of plans on the market were below an average. Admittedly the term "average" is subjective but the IRDES is independent and one has to start somewhere! Hospitalisation. 100% for hospitalisation is low for many areas eg; Paris and Provence- Alpes-Cote d'Azur. But I am sure that the Limousin is not a particularly high cost area. This does not mean that healthcare in the Limousin is inferior. Indeed the CHU Limoges was rated by an independent 2003 survey as being the 13th best hospital in the whole of France. As a general rule a charge of more than 100% is more likely to be applied in a private clinic than a public hospital. (In France the difference between public and private hospitals does not have anything like the same connotation as in the UK). 100% for Sector 1 specialists is OK but Sector 2 can charge much higher than this even though they are "conventioné" Depending on your health circumstances it may well be better to approach a commercial insurer as opposed to a "mutuelle". You should also be aware that providers use different criteria for assessing premiums and not all of them use the same criteria. At the risk of being sexist some providers will charge females under 60 more than males in the same age group. The former claim more! Regards Peter Owen [email protected]

Hello, MS is one of the conditions that can qualify for 100% cover by CPAM. A final decision cannot be made until you have been examined by a doctor here in France and a case put up to CPAM. Regards Peter Owen [email protected]

Hello, If you live in a rural area then you will find that a nearby village has a CPAM rep visit for half a day a week. The Mairie will give you details as he/she often locates there. The advantage is that it is usually the same person ech week which can be helpful if you have a protracted problem. Regards Peter Owen [email protected]