comprehensive medical insurance cover

[londoneye]

There is so much information now on here (a good thing!), that I am not sure if I have missed this.   Like many, we are in position of E106 expiring January and are trying to find suitable health cover.    On the French health issues site (and well done to everyone involved, it's truly impressive, easy to understand and factual) it mentions that 'comprehensive medical insurance cover' will need to be obtained by those who will no longer be covered by an E106 or able to affiliate to the French system by some means.

Because myself and OH are (relatively) young and (relatively) healthy and (relatively !) poor, we are looking at options which cover only emergency medical cover, eg primarily hospitalisation, at least in the first year, whilst we assess other options.    Does anyone (eg cooperlola !) know if there will be, or are likely to be, any definitions of what 'comprehensive insurance cover' actually means, or is the feeling that as long as you have some kind of health cover (eg as described above) you will be, effectively, compliant.

I hope this makes sense; if this has already been covered I apologise, but couldn't find it.

Which reminds me, bearing in mind above, now might be a good time to visit doctor/optician, if you are already paying for these options in your current top up insurance option, in case you cannot afford the same level of cover in future.

[Deimos]

Sorry, but to sidetrack things a little - based on the title of this thread; something struck me the other day.

I have no health problems, so when I fill in my health insurance application form I can say "none" to everything.  But then we come to the "Family history" questions and the fact that my father has had triple heart bypass surgery has to be declared.  In the past when I have had private health insurance (in the UK and provided by my employer and NOT my choice) this had raised questions and I understand has resulted in conditions of exclusions of the resulting policy.  Thus, when I apply for Private Health Insurance I would not be surprised if there were not caveats and limitations applied by the insurance company meaning that, whilst in practice it is fine, it would not be "comprehensive".

Actually this is more of academic interest and does not bother me as, provided the insurance policy is thick enough and has loads of small print, the French will never read it to verify it (add to that a policy document in some language other than French and one is "in the clear").

But it does raise the question about people who are here completely legally one minute and then effectively become illegal immigrants because of their family history.

Then when you have the issue of chromic and long term illness and throw in the pre-existing conditions and me thinks the French have opened quite a can of worms in trying to apply this to those already resident (even before their 5 years are up).

And, as Londoneye comments, take out a policy one day and then have the French decide its not "up to their standards" (though they have never published "their standards", etc.

These people are meant to be running a country !!!  (Piss-ups and breweries seem relevant).

Ian

[cooperlola]

It is a very good question which nobody in authority has yet answered - in spite of our having asked the question! We plan to go down the route you describe. We certainly cannot afford the £5-6k which total cover would cost us.

We'll keep plugging away and if we ever get a difinitive answer, we will let you know.

[londoneye]

Thanks.  

We will work on that proviso unless told otherwise, although it would seem a little late for any insistence on a more comprehensive policy at this point in time.   Perhaps they will get around to that in a few more years ??

We are fortunate in the sense of currently being healthy(ish) and able to take the risk .....   fingers crossed.

 

[Boiling a frog]

There is legislation which covers what form the medical assurance must take

CODE DE L'ENTREE ET DU SEJOUR DES ETRANGERS ET DU DROIT D'ASILE
(Partie Réglementaire)

Section 3 : Séjour d'une durée supérieure à trois mois

 

Article R121-4

(inséré par Décret nº 2007-371 du 21 mars 2007 art. 1 Journal Officiel du 22 mars 2007)

   Les ressortissants qui remplissent les conditions mentionnées à l'article L. 121-1 doivent être munis de l'un des deux documents prévus pour l'entrée sur le territoire français par l'article R. 121-1.
   L'assurance maladie mentionnée à l'article L. 121-1 doit couvrir les prestations prévues aux articles L. 321-1 et L. 331-2 du code de la sécurité sociale.

Code de la securite sociale says

Article L321-1

L'assurance maladie comporte :
   1º) La couverture des frais de médecine générale et spéciale, des frais de soins et de prothèses dentaires, des frais pharmaceutiques et d'appareils, des frais d'analyses et d'examens de laboratoire, y compris la couverture des frais relatifs aux actes d'investigation individuels, des frais d'hospitalisation et de traitement dans des établissements de soins, de réadaptation fonctionnelle et de rééducation ou d'éducation professionnelle, ainsi que des frais d'interventions chirurgicales nécessaires pour l'assuré et les membres de sa famille, au sens fixé par l'article L. 313-3, y compris la couverture des médicaments, produits et objets contraceptifs et des frais d'analyses et d'examens de laboratoire ordonnés en vue de prescriptions contraceptives ;
   2º) La couverture des frais de transport de l'assuré ou des ayants droit se trouvant dans l'obligation de se déplacer pour recevoir les soins ou subir les examens appropriés à leur état ainsi que pour se soumettre à un contrôle prescrit en application de la législation de sécurité sociale, selon les règles définies par les articles L. 162-4-1 et L. 322-5 et dans les conditions et limites tenant compte de l'état du malade et du coût du transport fixées par décret en Conseil d'Etat ;
   3º La couverture, sur décision de la commission mentionnée à l'article L. 146-9 du code de l'action sociale et des familles, des frais d'hébergement et de traitement des enfants ou adolescents handicapés dans les établissements mentionnés au 2º et au 12º du I de l'article L. 312-1 du même code ainsi que celle des frais de traitement concourant à leur éducation dispensée en dehors de ces établissements, à l'exception de la partie de ces frais incombant à l'Etat en application des articles L. 112-1 à L. 112-4, L. 123-4-1, L. 351-1 à L. 351-3 et L. 352-1 du code de l'éducation ;
   4º) La couverture des frais de soins et d'hospitalisation afférents à l'interruption volontaire de grossesse effectuée dans les conditions prévues à la section I du chapitre III bis du titre Ier du livre II du code de la santé publique ;
   5º) L'octroi d'indemnités journalières à l'assuré qui se trouve dans l'incapacité physique constatée par le médecin traitant, selon les règles définies par l'article L. 162-4-1, de continuer ou de reprendre le travail ; l'incapacité peut être également constatée, dans les mêmes conditions, par la sage-femme dans la limite de sa compétence professionnelle et pour une durée fixée par décret ; toutefois, les arrêts de travail prescrits à l'occasion d'une cure thermale ne donnent pas lieu à indemnité journalière, sauf lorsque la situation de l'intéressé le justifie suivant des conditions fixées par décret.

   6º) La couverture des frais relatifs aux actes et traitements à visée préventive réalisés dans le cadre des programmes mentionnés à l'article L. 1411-6 du code de la santé publique, et notamment des frais relatifs aux examens de dépistage et aux consultations de prévention effectués au titre des programmes prévus par l'article L. 1411-2 du même code ainsi que des frais afférents aux examens prescrits en application de l'article L. 2121-1 du même code et aux vaccinations dont la liste est fixée par arrêté des ministres chargés de la santé et de la sécurité sociale ;
   7º) (Abrogé) ;
   8º) (Abrogé) ;
   9º) La couverture des frais relatifs à l'examen de prévention bucco-dentaire mentionné à l'article L. 2132-2-1 du code de la santé publique.

 

Article 331-2

L'assurance maternité couvre l'ensemble des frais médicaux, pharmaceutiques, d'analyse et d'examens de laboratoires, d'appareils et d'hospitalisation relatifs ou non à la grossesse, à l'accouchement et à ses suites, intervenant au cours d'une période définie par décret. Lorsque l'accouchement a lieu avant le début de cette période, l'assurance maternité prend en charge l'ensemble des frais mentionnés ci-dessus à compter de la date d'accouchement et jusqu'à l'expiration de ladite période.
   L'assurance maternité couvre également :
   1º Les frais d'examens prescrits en application du deuxième alinéa de l'article L. 2122-1 et des articles L. 2122-3 et L. 2132-2 du code de la santé publique ;
   2º Les autres frais médicaux, pharmaceutiques, d'analyses et d'examens de laboratoires, d'appareils et d'hospitalisation relatifs à la grossesse, à l'accouchement et à ses suites, dont la liste est fixée par arrêté du ministre chargé de la sécurité sociale.

So it apears that an assurance that only covers hospital charges is not acceptable

 

[cooperlola]

duplicate post deleted

[cooperlola]

However, BoF, the interesting thing is that we who are already here are not required to prove we have comprehensive cover in order to be allowed to stay - that's where the sticking point comes.  I'm afraid in our case it's just "tough".  If I'm illegal then they're going to have to deport me.  I can't invent money and I can't afford to go home (even if there was any chance of selling up before 31.3.08)[Www]

Anyway, as my o/h has asthma it's impossible for him!

[Boiling a frog]

I have not read anything which says that people who are already here and have less than 5 years residency do not have to comply with the conditions laid down

ie

Droit au séjour

Conditions exigées 

Pour disposer d'un droit au séjour en qualité de "non-actifs", les intéressés doivent remplir certaines conditions. 

Les retraités et autres inactifs doivent disposer, pour eux et les membres de leur famille, de ressources suffisantes pour ne pas devenir une charge pour le système d'assistance sociale français et d'une assurance maladie-maternité. 

After all ,this is the part that the French Government are relying on to kick us out of the CMU retrospectively, so why would they not apply the part of registration at the Mairie and proving you have sufficient funds and assurance retrospectively also

[Deimos]

So I'm now on the search for PHI policy that covers contraceptives.  Does anybody know of a private health policy that includes all the contraceptives you might require ?  (pour l'assuré et les membres de sa famille, au sens fixé par l'article L. 313-3, y compris la couverture des médicaments, produits et objets contraceptifs ...  - or have I mis-translated; which is very possible).

And of course it must cover the ambulance taxi service thing (La couverture des frais de transport de l'assuré ou des ayants droit se trouvant dans l'obligation de se déplacer pour recevoir les soins ou ...)

And when it comes to 4º) La couverture des frais de soins et d'hospitalisation afférents à l'interruption volontaire de grossesse effectuée dans les conditions prévues  - I personally resent having to insure myself for that (as I do not intend becoming pregnant and if I did I think insurance would be the least of anybodies concern).

And do may policies include preventative treatments and checks (6º) La couverture des frais relatifs aux actes et traitements à visée préventive réalisés dans le cadre des programmes mentionnés à l'article L. 1411-6 du code de la santé publique, et notamment des frais relatifs aux examens de dépistage et aux consultations de prévention effectués).

On the (maybe incorrect) assumption that my translations are OK'ish I would doubt there is such a private policy offered/available anywhere.  That the case then this rule change is effectively expulsion from France - which definitely breaks EU law.

Mr Ian (whose poor French causes all sorts of embarrassing mis-understandings)

[cooperlola]

No, Ian, I totally agree with your interpretation.

Anyway, as said before - they can deport me if they like.  It's interesting, because the minimum income one is allowed to have would barely cover the premiums involved in having the kind of cover described.  Let alone pay taxes too.  I am convinced that the authorities have no idea what is involved in this kind of "comprehensive" cover.  And who's going to check all these policies - which will be written in English for the most part?

But as nobody who is here already is obliged to register at the mairie, or to prove any of this, who's to know?  At any rate, it's a subject worth bringing up as this is clearly impossible, as you say Ian.  Basically, because my husband has asthma, it's illegal for him to remain in France, as there is not one policy out there which will pay for his drugs.

Any insurance agents out there - what kind of policies are you advising your clients to buy? Are they legal?[Www]

[londoneye]

It's a ludicrous situation frankly.

Still, its here so we have to learn to live with it.

Cooperlola, if it comes to it (which it won't) then I will buy you a drink at the deportation centre, because myself and OH will be there also !!

[cooperlola]

[B]

[Deimos]

The question is what will it come to ?

Those of us here at the moment (i.e.

already resident) will probably not be looked at too closely but

those people requiring the new residence certificates will probably

be the first to experience difficulties. From what I have picked-up

it will be the Mairie who check the paperwork and some will be easy

going others (particularly as its new) will double check things

(maybe some even look for reasons to reject more British moving into

their commune). That may be where the problems with non-compliant

private insurance will start having effects and cause problems.

When I look back through my career, if

I had done anything even close to such a glorious mess as the French

gov. have done I would have been sacked long before this stage and

others would have stepped-in and immediately sorted everything out.

These people are running a country yet they seem total amateurs.

Ian

[cooperlola]

Goodness knows, Ian, how much this whole mess has cost already.  Could pay for several people's cancer treatments one would imagine.[:@]