woolybanana Posted January 14, 2012 Share Posted January 14, 2012 Well, there we are, Carte Vitale through in about six weeks which includes Xmas and NY. Not bad. Not had medical cover of any type for xxxxx years!Then to register with the doctor on Monday, but a couple of questions which wiser minds than mine may be able to deal with, svp: Firstly, I know that one needs a private top up to cover such eventualities as hospital room and bawd, but in the case of having treatment stemming from a long term illness, such as diabetes, is that also the case, even though medication in such cases is free?Secondly, the EHIC is issued through UK, but in the event of needing it, does it offer the level of cover of the issuing country, the country of residence or the country where the treatment happens to take place?Within Europe, does the EHIC card replace what we used to call holiday insurance within the EU?Thanks in advance, guys. Link to comment Share on other sites More sharing options...
cooperlola Posted January 14, 2012 Share Posted January 14, 2012 If your treatment is related to an ALD signed off by your doc' then the state covers your costs (including daily charges iirc but not a single room.)The EHIC covers you up to the level of a national of the country you visit (eg 100% in the UK, 70% here)so you need to be aware of the local system. It doesn't replace travel insurance 'cos you won't get paid for trips cancelled due to illness, repartration, lost luggage etc etc, only direct medical costs. Link to comment Share on other sites More sharing options...
woolybanana Posted January 14, 2012 Author Share Posted January 14, 2012 Thank you Mrs Pooksie. You must be sitting there getting right bored if you answered so quickly. Link to comment Share on other sites More sharing options...
cooperlola Posted January 14, 2012 Share Posted January 14, 2012 Nope, just kicked the old man out of the door, logged on and there was a subject I knew a little about. Keeps me off the streets.[:)] Link to comment Share on other sites More sharing options...
NormanH Posted January 14, 2012 Share Posted January 14, 2012 The GP with whom you are registered, (médicin traitant) not the specialist treating the disease has to write to the CRAM and apply for you to be covered for an ALD.You then get a form called a 'protocole de soins' which specifies which things you are covered for at 100%, and an Attestation, normally valid for 5 years but renewable.You may sometimes have to produce these. Only the illnesses specified on there are covered at 100%In understanding the importance of going though your GP this is useful:http://www.ameli.fr/assures/soins-et-remboursements/comment-etre-rembourse/le-parcours-de-soins-coordonnes/choisir-et-declarer-votre-medecin-traitant.php Link to comment Share on other sites More sharing options...
Wilko Posted January 14, 2012 Share Posted January 14, 2012 Hi Cooperlola.After 6 years, don't ask, have finally got Mrs W's CV however they missed me off the CV, let's hope they do't take another 6 years to sort it. We are both of retirement age.We have never had any sort of mutuelle and have been looking at them on the i/net........all a bit confusing.What are the sort of things to look for when buying a mutuelle. We are both in good health, touch wood, especially Mrs W. I have had a stent put in 10 years ago and have had check ups in France and all is good. The thing I don't really understand is this 200% 300% etc. Be obliged for any sort of run down as to what we should look out to be buying, and from whom ThanksWi;ko Link to comment Share on other sites More sharing options...
Wilko Posted January 14, 2012 Share Posted January 14, 2012 One thing i forgot to ask is that we have not specified a doctor, will do so in next couple of weeks"n'a pas declare un medecin traitant. Does this make a difference to our reimbousements ?W Link to comment Share on other sites More sharing options...
Loiseau Posted January 14, 2012 Share Posted January 14, 2012 [quote user="woolybanana"]...Within Europe, does the EHIC card replace what we used to call holiday insurance within the EU?[/quote]As Coops so swiftly said, the EHIC does not cover any part of your holiday insurance except for medical treatment.However, look closely at your bank account description, as often holiday insurance is included with that for repatriation, emergency trip home etc. It allegedly is with my UK one - though I do not entirely trust it. And some French friends found that they were covered by their French one when tragedy struck their family during a holiday in the UK.As regards theft or breakage of personal belongings while abroad, my UK household insurance covers that kind of thing - and I have had cause to claim once or twice.Angela Link to comment Share on other sites More sharing options...
NormanH Posted January 14, 2012 Share Posted January 14, 2012 [quote user="Wilko"]One thing i forgot to ask is that we have not specified a doctor, will do so in next couple of weeks"n'a pas declare un medecin traitant. Does this make a difference to our reimbousements ?W[/quote]Yes. On the link I gave:, si vous n'avez pas déclaré de médecin traitant ou si vous ne respectez pas le parcours de soins coordonnés, vous serez moins bien remboursé par l'Assurance Maladie lors d'une consultation. Par exemple, une consultation chez un médecin généraliste conventionné exerçant en secteur 1 coûte 23 € (tarif applicable au 1er janvier 2011) : S'il s'agit de votre médecin traitant déclaré, vous êtes dans le parcours de soins coordonnés. L'Assurance Maladie vous rembourse alors 70 % du tarif de la consultation, moins 1 € au titre de la participation forfaitaire, soit un remboursement de 15,10 €.Si vous n'avez pas de médecin traitant déclaré, vous êtes hors du parcours de soins coordonnés. L'Assurance Maladie ne vous rembourse alors que 30 % du tarif de la consultation, moins 1 € au titre de la participation forfaitaire, soit un remboursement de 5,90 €.In brief you would only get 5,90 € back for a consultation costing 23€ if you haven't got a médicin traitant, or don't go through him instead of 15,10 normally. And that is only an example of a low cost consultation. Link to comment Share on other sites More sharing options...
suej Posted January 14, 2012 Share Posted January 14, 2012 Just picking up on the ALD 100% point.....please would someone just clarify one or two things for me. My husband recently, early Dec , got his ALD documents through because of Horton's Disease and Diabetes( latter has become more complicated by the treatment for the former) . Does the 23euro consultation fee which he pays to our Medicin traitant fall into the 100% category, likewise the cost of pretty frequent blood tests, all related to either or both of the relevant illnesses?I ask because firstly he continues to pay the doctor the 23euros which is then reimbursed 16.10 euros by CPAM and 6.90 euros by our Mutuelle.I notice on the monthly reimbursement statement that we had today from the Mutuelle that this is still the case even since the ALD notice and the same CPAM and Mutuelle reimbursement is going on for the blood tests. I had assumed that at least the blood tests , necessary to monitor and to prescribe treatment for the two conditions, would fall into the ALD category, be covered 100ù and be referred to our Mutuelle. Perhaps I'm wrong . Any thoughts anybody? My husband has an appointment with the Medicin Traitant on Monday and it would be as well to know before then- we can ofcourse ask him himself but as he seemed to drag his heels a lot over the initial application and was a little discouraging about it , it'd be interesting to know where we stand.I'd appreciate some advice please.Sue Link to comment Share on other sites More sharing options...
NormanH Posted January 14, 2012 Share Posted January 14, 2012 If the doctor has given you a prescription written on the part of the Form intended for 100% then they should be re-imbursed.As for consultations with him it depends on him to some extent.For example I need my ears syringed, and at the same time I will have my monthly check up for blood pressure and he will give me a prescription for my fortnightly blood tests.The latter two are certainly covered in my case by 100% as I have had a stroke and am on anti-coagulants, but obviously the ear wax shouldn't be covered by my ALDs.In practice he usually makes no distinction, and I think your husband should be getting 22€ back from the CPAM and nothing from the Mutuelle for these diseases (you have to pay1€yourself)There will also be strange amounts kept back for medicines and blood tests that aren't taken off when you go in the the lab or Pharmacie. Each 'acte' has a small amount you have to pay that isn't covered either by the Sécu or by your MutuelleHave you updated your Carte Vitale since you had the ALD documents through? You can do this in Pharmacies stc. It may be that it still automatically sends the old details. Link to comment Share on other sites More sharing options...
suej Posted January 14, 2012 Share Posted January 14, 2012 Thank you Norman. My husband's appointments and blood tests have been for only the two ALD conditions, so that is fairly clearcut. The card has been 'mise à jour' now but you may have hit on a possible reason particularly regarding the lab blood tests there. We thought it had been done at the Pharmacie early on and it was only when he had another hospital appointment that they found it wasn't going through and they put it through the machine thing again to validate it.The doc and his 23 euro fee in cash is perhaps another issue..I'll keep an eye on all of it , perhaps it'll right itself by next month.Thanks for your quick response.Sue Link to comment Share on other sites More sharing options...
mint Posted January 14, 2012 Share Posted January 14, 2012 Hi, Sue, hope your husband continues to make progress. I shall be PMing you in the next day or two so can you please check your PM box after tomorrow? Link to comment Share on other sites More sharing options...
suej Posted January 14, 2012 Share Posted January 14, 2012 Yes indeed Sweet , with great pleasure! Link to comment Share on other sites More sharing options...
cooperlola Posted January 15, 2012 Share Posted January 15, 2012 My blood tests relating to the ALD are all marked on the prescription so I pay nothing to the nurse or the lab - the latter's invoice always comes back as 0 and the odd 50cs and euros which the government takes get sorted out from time to time. Thus I think you need to clarify this with your gp so that it goes through 100%. If it continues then you can always talk to your top-up insurer because it is in their interests not to pay for something which should be free! Hit somebody in the wallet and it's amazing how helpful they can be.[:)]Wilco, I find the 100%, 200% etc thing very hard to explain easily but it's about what the government deams each treatment should cost and what doctors and other medical professionals actually charge you. I've rarely been charged more than the standard (100% in insurance terms) by anybody except my dentist and opticians (so for the latter I go privately in the UK now as it's a lot cheaper) but in some regions (I suspect especialy around Paris etc) the charges can be a lot higher than the government agreed charges and that's when you need more cover. Important things to consider are single rooms (does this matter to you? Are you happy to share?), convalescent care, follow up treatments like physio etc - it's all in the small print! I'm sure lots of people have different priorities and a lot depends upon what you can afford, of course. Link to comment Share on other sites More sharing options...
NormanH Posted January 15, 2012 Share Posted January 15, 2012 I missed the question aboutMutuelles.Basically any consultation or medical 'acte' is given atariff de base ( a basic price) by the Sécu, who pay 70% of that in the case of aconsultation, with the rest to be found by the patientA 100%reimbursement is 100% of that price, in other words the mutuelle willpay the extra30%However that may not be the actualprice charged by the Doctor or the service you see.A Doctor'conventionné secteur 1' charges the Sécupricehttp://sante-medecine.commentcamarche.net/faq/493-comprendre-le-fonctionnement-du-secteur-1-et-secteur-2buteven in this secteur they can charge more for such things as a callout at night.In Secteur2 the Doctor is free to charge whatthey like (the word 'libre' means free in this sense, not thatthey are free) All the same the Sécu only reimbursestheir standard price, and the rest has to be paid either by thepatient or the MutuelleIf the Mutuelle pays 100% it is asexplained above, 100% of the Sécu tariff, not 100% of the Doctor'sprice. To work a couple of examples:Assuming you go to see your médecintraitant, the consultation secteur 1 costs 23€You pay the first1€The Sécu reimburse 70% (around 16€)The rest ( around 6€) is forthe patient to pay, or the Mutuelle will pay this if you have one which reimburses you at 100%Result you pay only the 1E which noother organisation is allowed to pay for you.If you see a Doctor in Secteur 2however you may be charged say 50€But the Sécu will still only give youthe 16€, so now you haveto find 34€If your mutuellecovers you at 200% they will pay up to twice the tariff de base, i.e.46€ of the 50, and so you would only pay 5€ if youhave a 300% cover they will pay up to 69€ so you would only pay the1ESo why see aDoctor secteur 2 I hear you ask.The answer is thatin many clinics there are no secteur 1 Doctors, and many specialistsare secteur 2 There can even bethe situation where both the Surgeon and the anesthetist arecharging their own prices so you get a double whammy On top of thisthere is what is called 'dépassement des horaires' supposedlyovertime but often added automaticallyThefinal bill for the services can easily come to 2 or 3 times thetariff de base Hence the needfor cover at more than 100%I have previously posted on what to look out for when choosing a Mutuelle.I have just changed to Swisslife because I liked the fact that they have 5 modules and you can choose you own menu of cover from each section, so for example you may want level 5 for Hospitals but only level 3 for the dentist or vice versa.I confirmed this with a couple of word of mouth recommendations, so I will see.They have a good guide (in French) heree/Dossiers/Guide-pratique-pour-Bien-comprendre-et-bien-choisir-votre-complementaire-sante Link to comment Share on other sites More sharing options...
idun Posted January 15, 2012 Share Posted January 15, 2012 Not just the Drs and hosptials. Dental cost, eyes, hearing, etc etc all need to be taken into account. Dentistry and it's associated things has specific tarifs associated with them and the base tarifs for somethings can be very low. And so I would recommend good cover for these things too, so seeing what you would actually get back is important. ie ask, if I need a hearing aid, how much do I pay and get back. if I need false teeth, how much and how much would I get back, same with crowns. Link to comment Share on other sites More sharing options...
NormanH Posted January 15, 2012 Share Posted January 15, 2012 Oh yes and all the different medicines with the different colour 'vignettes', but those are other cans of worms, and I just wanted to explain 100% etc, and I had gone on enough :) Link to comment Share on other sites More sharing options...
Wilko Posted January 15, 2012 Share Posted January 15, 2012 Thanks everyone for the replies. Really helpful.Norman could you post a link to:"I have previously posted on what to look out for when choosing a Mutuelle".I don't seem to be able to find it.Cheers Wilko Link to comment Share on other sites More sharing options...
NormanH Posted January 16, 2012 Share Posted January 16, 2012 Can't find it atm as the search isn't working properly. I will re-post something a bit later. Link to comment Share on other sites More sharing options...
cooperlola Posted January 16, 2012 Share Posted January 16, 2012 The Google search works, Norman. Just add france forum to whatever subject your trawling for, iirc. Cathy posted this method a while ago. I'll give it a go in a minute or two.EDIT : Nope. That's not it. I'll have to find Cathy's post. Link to comment Share on other sites More sharing options...
cooperlola Posted January 16, 2012 Share Posted January 16, 2012 Here:"This link... search will workIt's a google advanced search,and is much more sophisticated than the forum's own search facility (which is pants at the moment anyway).Cathy"I'll try again.[:-))] Link to comment Share on other sites More sharing options...
NormanH Posted January 16, 2012 Share Posted January 16, 2012 Thanks, but I still can't find it. I was replying to a question from Wooly about what to look out for in a Mutuelle.Here goes briefly: 1) Read the small print and be sure to look out for exclusions. My last mutuelle for example paid for a single room in a Hospital, but not in the Nursing home that followed, and despite advertising that it paid the 18€ a day charge, had a nasty little clause saying that this was only in surgical wards...and they interpreted the nursing home (which was looking after me after a surgical procedure) as not being 'surgical'.I ended up paying over 3000€ even with their cover!2) Get one you can tailor to your expected needs. My new one has a 'modular' structure with 7 levels of cover, but you don't need to take the same level for each section.The sort of areas of cover to consider are: Hospitalisation are all the fees (surgeon/anaesthetist) covered? Do you want a single room? Will the 18€ frais de séjour be covered and for how longWill you be in a private clinique or a CHU, and will the extra in the former be covered? Bonuses might be help towards paying for a bed for your other half or for the TVTeeth and Eyes are poorly reimbursed so if you have problems here you might want to opt for a high coverGeneral Medicine (GP, X rays, blood tests etc) I have largely explained this above.I went for a 200% cover, and also get back 40€ for consultations with a chiropractor who are not covered by the Sécu Pharmacy Most Mutuelles will top up to 100% o the tariff, but may demand that you accept generics. A higher level of cover might see some non-reimbursable items covered, such as homéopathicsMedical Aids hearing aids, breathing apparatus, wheelchairs etc Link to comment Share on other sites More sharing options...
woolybanana Posted January 16, 2012 Author Share Posted January 16, 2012 Right, carte vitale in the bag, doctor chosen and long-term illness forms completed. So, could I just check that I have got it right about the EHIC, svp, ie that the French will process both copies of the S1 and send one back to the UK who will then issue me with a form to fill in to get the EHIC which they issue, which process may take a little while? Link to comment Share on other sites More sharing options...
tinabee Posted January 16, 2012 Share Posted January 16, 2012 [quote user="woolybanana"]Right, carte vitale in the bag, doctor chosen and long-term illness forms completed. So, could I just check that I have got it right about the EHIC, svp, ie that the French will process both copies of the S1 and send one back to the UK who will then issue me with a form to fill in to get the EHIC which they issue, which process may take a little while?[/quote]Absolutely correct! The "getting the form for the EHIC from the UK" bit, is still ongoing in our case from last September. Interim advice from the DWP is as follows:"If you have to travel to another EU Member State before you get yourEHIC you will still be covered for necessary state healthcare.If you require treatment you can apply for the Provisional ReplacementCertificate (PRC). The PRC can be faxed to the facility providing youwith treatment and is accepted in place of the EHIC.Of course this may not be practical under all circumstances. If youare charged for state healthcare you can apply for a refund.To apply for the PRC or a refund you must ring 0044 191 21 81999" Link to comment Share on other sites More sharing options...
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now