ALD Reimbursements

[Âme]

[quote user="Benjamin"]The piggy backer (in our case me) is only covered for the standard level of reimbursement not 100%.

EDIT I need to clarify that my answer is in response to Boiling a frog and only relates to E121's issued for invalidity before a person reaches normal retirement age.

[/quote]

Same for me. My partner has an E121, issued to a working age person for invalidity. He receives reimbursements for 100% of all health care.

I am registered (piggy-backing) on the same E121. I receive the 'normal' 70% or whatever applies, therefore I have a mutuelle to cover the difference.

[Tony F Dordogne]

[quote user="cooperlola"]

As far as the percentage of reimbursements for E121s of various sorts is concerned, my belief is that Ame is right.  However, after one reaches retirement age one loses the 100% entitlement, except for the ALD.  I don't know how old you are Tony but if over 65 then you would not get 100% for the lot.  I'm also not convinced that this is uniformly adhered to throughout France and at all CPAMs.

[/quote]

Coops, I'm 62 and have been on 100%, E121, for the ALDs for three years.  And I certainly don't get 100% for all, when I checked this with my local CPAM, they confirmed that what they are doing is correct.  This is interesting because it flys in the face of many threads on LF which have stated something similar for many recent years, 100% for ALDs only, even for those on disability E121, mutuelle for the rest, if this isn't the case and I'm supposed to get 100% across the board, CPAM owe me a few bob.

And, if my 100% covers all of J's medical bills - can't see the Uk government agreeing to that somehow - we're €uros in pocket.

[cooperlola]

As Benjamin and Ame state, above, the 100% is for the ICB recipient only, not his/her dependents.  I think your CPAM owes you a few bob.  When I get the chance, I'll try to find the chapter and verse on this Tony, but it's not so easy at the mo'.

[Tony F Dordogne]

Coops, that would be superb, thank you.  Less of course, the 1€/2€ stautory deductions that is.

[Âme]

[quote user="Tony F Dordogne"]Sorry Ame, If I've read what you have written correctly. that isn't my understanding of things, from our own experience.  When we first arrived, I piggybacked on my OH's E121, she having reached retirement age.  When we got ourselves organised, I recieved my E121 for disability, which covers me for 70% of treatment for my ALD.  When I got that organised, I got - and get - 100% for my cancer and all the associated things that go with it.

Neither I, nor she, get 100% for anything else, tho in my case it's so difficult to determine what is or isn't directly related to the cancer, my GP and specialist tend to write everything off as 100%, like my recent RMI for something that may be related to it.  J has to pay as she goes (abopve the 70%) and reclaim the rest from the mutuelle, as I have to for things which clearly aren't related - for example, if I broke my leg - and then I'd claim from the mutuelle.

So all treatments aren't covered.

 [/quote]

I thank you for correcting me gently, it is appreciated! 

I have yet to find definitive information on how the different E121s are reimbursed, so we can only piece it together based on individual experiences. 

I am left wondering... When CPAM receive an invalidity E121 how do they decide whether to allocate 70% or 100% cover. At that point they have no further medical information, do they?

There are five boxes on an E121: Old age; Invalidity; Survival; Accident at work; Occupational disease.  Might yours have had a different box ticked?

As Coops says, if you were over 65 by the time your E121 was issued, then that could be the answer to why only the ALD is covered cent pour cent.  

Intriguing but perhaps not really helping Grecian. Sorry for the thread hi-jack.

Edit: Sorry, I'm way behind here, crossed posts & that, but I think the "which box was ticked" question is still relevant.

[5-element]

Ame, Benjamin and Coops are right. E121 IB holders are seen as being the equivalent of the French AAH, and so they get 100% over everything. Of course, when they become 60 (women) and 65 (men), they revert to getting 70% cover, as the status of their E121 changes.

I am puzzled as to why TonyF doesn't have 100% cover if he is 62 only. Surely, some mistake?? Good luck with rectifying. 

[Âme]

[quote user="cooperlola"]As Benjamin and Ame state, above, the 100% is for the ICB recipient only, not his/her dependents.  [/quote]

Coops, Just to be clear does ICB stand for incapacity benefit?

[Benjamin]

[quote user="Tony F Dordogne"]

  When we first arrived, I piggybacked on my OH's E121, she having reached retirement age.  When we got ourselves organised, I recieved my E121 for disability, which covers me for 70% of treatment for my ALD.  When I got that organised, I got - and get - 100% for my cancer and all the associated things that go with it.

 

[/quote]

I'm a bit confused here Tony F. Are you saying that your right to an E121 because of disability wasn't recognised by the UK authorities until after you became resident in France?

[Tony F Dordogne]

No, Benjamin, I didn't realise that I would be covered by my own E121 until I got here, OH's stuff was easier to sort than mine at the time but they sent me an E121 as soon as I asked for it, was only a matter of weeks.

Edit: Sorry, should read that I didn't realise how important it would be for me to have my own with the 100%, especially when they started sending me to Bordeaux to see a specialist and the treatment that entailed.

[Benjamin]

Tony F

As Âme states above you need to check which box was ticked on your E121 as that is probably the likeliest explanation.

[Tony F Dordogne]

No, it was invalidity, just looked at the copy.  Visit to CPAM coming up, when Coops can send the stuff to me :)

[cooperlola]

[quote user="Âme"][quote user="cooperlola"]As Benjamin and Ame state, above, the 100% is for the ICB recipient only, not his/her dependents.  [/quote]

Coops, Just to be clear does ICB stand for incapacity benefit?

[/quote]Yes.

At home amongst my papers I have copies of both types of E121 (ie ICB and Retirement) which were kindly sent to me by forum members.  As I remember it, they are worded differently so it's obvious that the reimbursements should be 100% for the ICB type.  Until I have these in front of me, I can't help further, or confirm my memory of how they both work!  I may be able to get this done this weekend but don't hold your breath as I have visitors but I'll try.  I also have a contact in the insurance industry.  He was talking to me about the possibility of his company producing a policy specially for those on ICB E121s, to cover the things that aren't included like full dental, meals in hospital etc etc. at a much lower cost than a normal policy. I can't imagine this would even be mooted if my info weren't correct.  This is why I reckon Tony's CPAM is not correct.

[Grecian]

Thanks to everybody for the fantastic responses.

Just to bring the situation up-to-date, we visited our local CPAM office again this afternoon, it was the same grumpy bloke behind the desk who was there when we last visited, but he must have had an extra glass of red wine with his lunch, as today he was very cheerful. We explained the attestation had the wrong address number on it, so he just photocopied our original, and wrote the correct address number on the copy, and informed us a new attestation will be issued. He explained that the CV's would be sent out later, and showed us how to fill out our medecin traitant forms, all in all a good afternoon's work.

Just to try and shed some light on the 100% issue, my wife's E121 is IB based, and on the attestation it definitely states she is covered 100% for sauf médicaments and 35% for vignettes bleues, myself who is 'piggy-backing' is just the usual 70%. Hope this info will help you Tony.

BAF, regarding my response to your reply, I thought your response came over rather rude and patronizing, implying I should be up to speed with all things French after only 4 months of residency. I will apologise regarding my weird reference in my response, as I think this probably also came over as rude, and as I don't regard myself as a rude person I fully retract that remark.

Now for the tax form... [:-))]

[Âme]

Good result, Grecian.  That is exactly what it says on my partner's attestation:

100% saufs medicaments vignettes bleues (-35%)

which, I believe, translates as

100% cover for all consultations, procedures and medicines, except for medicines with blue labels (for those you pay 35% of the cost)

However: There is a 1€ "franchise" for every consultation/procedure and for each item on a prescription.  This franchise is not reimbursed. 

It can lead to confusion when the first statement from l'Assurance Maladie arrives.  For example you may pay the doctor 22€, have a prescription for five items, but not pay the chemist anything.  When you receive reimbursement for the doctor's fee, it will be have the five pharmacy franchises deducted +one for the doctor = 6€.

Hope that helps. GL with the impots, they are equally helpful if you speak to the right person after a good lunch!

[Âme]

[quote user="cooperlola"]At home amongst my papers I have copies of both types of E121 (ie ICB and Retirement) which were kindly sent to me by forum members.  As I remember it, they are worded differently so it's obvious that the reimbursements should be 100% for the ICB type.  [/quote]

If you would like to see another invalidity E121, I can blank out

personal details & send you a copy of my partner's. Let me know if you

would also like the covering letter that came with it... because there doesn't

appear to be much information on the form itself.

[quote user="cooperlola"]I also have a contact in the insurance industry.  He was talking to me about the possibility of his company producing a policy specially for those on ICB E121s, to cover the things that aren't included like full dental, meals in hospital etc etc. at a much lower cost than a normal policy. [/quote]

My partner is covered 100% dental.  I am certain because I'm looking at the Assurance Maladie statement for a prosthetic & other dental procedures, all reimbursed to 100%. (of course, that doesn't cover the total prosthetic cost...)

I can't comment on hospital meals, no experience of those.

Coops, I follow your progress in another thread.  I hope you have a great w/e and don't think about healthcare at all.  [:)]

[cooperlola]

Yes, sorry Ame, I was not clear.  I meant the excess dental charges - I realise that some money is reimbursed by the state but not all by any means.  As for hospital meals, these are not covered by the state and the tab for these would normally be picked up by a top up.  However, as you realise, to pay for a full complementaire would be a bit mad if you've got 100% cover, thus my contact's idea for a special bargain price policy for people like this to pay the little things that aren't included.  For instance, I've been banged up now for 5 months.  The meals here cost in total 15 euros a day.  That would be a lot of dosh if my insurance company (ultimately the insurance company of the person whose fault the accident was, but that isn't sorted yet) wasnt' coughing up.

[Benjamin]

As an aside to this CPAMs do make mistakes. We went to our local one this morning with a query where we thought an unrelated reimbursement was wrong. It was a fairly simple calculation of add two figures together, multiply by another and add the result to another figure. They got it wrong by nearly 65 euros so it's always worth checking the statements online or when you eventually receive them in the post.

It was very politely checked and we were told we will receive the repayment next week.

Just another bit of information. On the reception desk was a notice which stated that this week requests for reimbursement made using the carte vitale were taking 8 (presumably) working days to pay but those without a card were taking 22 days!!!!! It's a long time to be outstanding if you've had to give out a lot of dosh.

[Tony F Dordogne]

[quote user="Benjamin"]
Just another bit of information. On the reception desk was a notice which stated that this week requests for reimbursement made using the carte vitale were taking 8 (presumably) working days to pay but those without a card were taking 22 days!!!!! It's a long time to be outstanding if you've had to give out a lot of dosh.

[/quote]

Seems like the right time for those without a CV to getone then Benjamin.