Healthcare & Asthma

[junebaby]

Hi everyone

We are moving to France in mid-May and I am totally confused about what needs to be done before I go and when I get there as regards healthcare.

Please correct me if I'm wrong but this is the situation as I see it:

1.   When this tax year is up and my P60 has been done by my two employers (I have two part-time jobs) I need to ring DWP and tell them the date we are leaving the country and they will issue an E106 for me, my husband and daughter.  (Husband is retired early so he doesn't pay NI and I believe therefore will go down as a dependant of mine).

Question - What do I do with the E106 when I get there?

2.  When I get to France I need to go and register with a doctor (I think?).  I believe I pay for the doctor and then send off the bill to someone (don't know who or where!) and then receive the money back until my E106 runs out in 2009.

My main worries are that I take regular medication for my asthma and whilst I know they will be able to provide me with similar medication I don't know how I go about getting the money back.

Also, I know I need a Carte Vitale but do I get this after the E106 has run out or is the E106 the Carte Vitale?

As you can see I am quite confused and any help clarifying the chain of events would be much appreciated.

Thanks again

[cooperlola]

1.  Correct.  You don't need to wait for your P60s though.

Take your E106's to your local CPAM (health and social security office), together with your passports, proof of address and a RIB (the details of your French bank account of which the bank will supply you with as many copies of as you need), plus your birth and marriage certificates.  They will issue you with an "attestation" which will include your social security number.   After a week or two you will then receive your Cartes Vitales.

2. They will also give you a form for your chosen "medecin traitant" which you take along to the GP of your choice, who then fills it in for you to send to the CPAM.  Until your Cartes Vitalles are issued, and after then for anybody who does not have a card reader, you will indeed have to obtain a "fiche de soins" - a brown form which you send of to the CPAM in the event of a claim.  Don't forget your Carte Vitale when paying at phamacies, opticians, dentists etc either!

My o/h has asthma and got the same drugs as he has always used in the UK, and all the costs were re-imbursed (70% from the health authorities, the rest from our insurers) - now automatically since the Cartes Vitales arrived.

A couple of months before your E106 runs out, phone the Centre for Non Residents in Newcastle and ask them to send you the letter which confirms that you are no longer covered by this.  Take this letter - it comes in English and French - along to your CPAM, with your tax return (take a RIB and id etc again to be safe) and they will then enter you into the French system, where you will pay 8% of your "Revenue Fiscale de Reference" - your combined income less allowances - which will be shown on your French tax return.

When you reach UK state retirement age you will once again be paid for under the UK system and won't have to pay the 8% any more.

You should also check that your husband has paid enough NI contributions in the UK to qualify for a UK state pension.  If he has not, he should consider paying voluntary contributions.

Don't forget to get top-up insurance as the French system only pays around 70% of most costs - although this varies a bit.

[Will]

Just a couple of minor things to add to the above, to save confusion. Your E106 may not be issued until after you have actually left Britain. Your husband may need to get his own E106, that seems to happen in some cases. However, depending on how long since he last worked, and his NI contribution record, he may not be eligible, so in that case it should be possible for him to be included on your French social security number.

Reimbursement of most medicines is at 65% (35% for some less essential items). If you have a long-lasting condition you may, subject to recommendation by your doctor and the agreement of the French health authority, be granted 100% cover for treatment and medication related to that condition. That does not normally apply to conditions like asthma, unless regarded as severe. Although the carte vitale is useful, it can be a confusing piece of plastic. Sometimes, such as in pharmacies, you just hand it over and no money changes hands, other times, such as in most doctor's surgeries, you pay and hand over the CV (using the CV means you get refunded quickly, at least in theory), and occasionally (in my experience commonly with dentists and with things like blood tests) they do not take the CV at all, so you pay, and send off the form (feuille de soins, which is your official receipt) to your local CPAM for a refund. As I said, it can be confusing, and quite hard to get your head around in a strange country with a different language. Actually living in France is very different from being on holiday.

If you do have trouble getting into, or using, the system, there is an English language CPAM helpline which seems to work very well indeed - you may like to make a note of the number,  0820 904 212 (in France).

[cooperlola]

Thanks Will.

This should be the subject of an FAQ really, as it affects practically all of us on here at one time or another.  "How to apply" etc is all there, but not what happens subsequently. Mods?

[Benjamin]

Just to add a little point here to cooperlola's paragraph about paying voluntary contributions towards a UK State Pension.

I read recently in, I think, a Sunday Times article that  with the impending change to the number of qualifying years to receive a 100%  pension, that if you  have paid any voluntary contributions  since May 2006  and you already had 30 or more qualifying years, you can obtain a refund of your payment.

The rub is that you will not receive a refund automatically; you will have to apply for it. This only applies to voluntary contributions made since last May. If you had  30 or more qualifying years and  had  made  voluntary contributions before May 2006 then ......... tough.

 

[cooperlola]

Yes, there is more comprehensive stuff about this here

http://www.completefrance.com/cs/forums/747499/ShowPost.aspx

but I have not heard about the progress of the proposed legislation.  Anybody got an update?

Anyway, in essence, if he has paid in for more than 30 years he should be OK.

[Will]

The voluntary contributions to maintain your pension entitlement are not great, about £10 a month I think. But even so if you have overpaid by two or three years it's probably worth claiming.

[Benjamin]

[quote user="Will"]

The voluntary contributions to maintain your pension entitlement are not great, about £10 a month I think. But even so if you have overpaid by two or three years it's probably worth claiming.

[/quote]

One of the points I was making Will, is that you will not get any refunds for payments made before 25 May 2006 so the most refund you could get back would be less than one year.

The article I was refering to can be found at Timesonline and then type in voluntary contributions+state pension into the search facility. The article was dated 21 January 2007.

[Will]

Thanks for the clarification Benjamin - I was thinking maybe it would apply to all contributions made since May 2006, even well into the future, for those like me who still pay them. But obviously not.

[Owen]

Hello,

Just a small point; but many CPAM offices do not issue a "carte vitale" to E106 holders as, by definition, it is of limited validity. They do of course issue a social security number, so refunds are still made - albeit more slowly.

Regards

Owen

[email protected]

[cooperlola]

Sorry.  Ours did, though.  So I guess it depends where the OP moves to then. I don't get the limited validity argument though, as they can be (as ours were) done with an expiry date embedded.  When we came off our E106's they just altered the validity for us - same cards though - they were updated as we watched.

I hope you're keeping up, June!

[Owen]

Hello Cooperola,

The reason why you do not get the argument is because you do not understand the rules about issue of E106. E106s' , which always have some sort of time limit (essentially temporary in nature), are issued to all sorts of people.. It is not only issued to those, who live but not work in France and are below retirement age, Somebody like Sunday Driver will be able to confirm this.

Regards

Owen

[email protected]

[cooperlola]

Yes, SD probably has a handle on it!  Maybe Cartes Vitales are issued to those who have a longer time limit. As I say, I do not know, only that we got ours as did another couple I recently sorted this for with our CPAM.  Or, it's a regional thing.  Somebody?..

[Sunday Driver]

I think the key issue is that holders of an E106 are entitled to CMU cover for the period of its validity and in practice, they are issued with a social security number. That means that expenses will be reimbursed (to the limits of the tariffs in place) just like any other CMU benficiary.  The carte vitale is merely an IT based token which enables those reimbursements to be made automatically and as a result, more quickly.

There is no reason why an E106 holder should be denied a carte vitale.  In fact, according to the French healthcare website, every person over the age of 16 years has the right to their own carte vitale.  Anyone who is refused a CV is therefore being disadvantaged by having to endure slow repayment, even though they have the same CMU rights as anyone else.  When you think about it, refusing a CV means that the CPAM will incur the additional costs of manually processing the reimbursements, so it's illogical that they should wish to do so. 

Like many similar reports of differing experiences, it's often due to a local administrative person misinterpreting the standard procedures, so anyone faced with a refusal to issue a CV should draw it to the attention of local CPAM management.

 

 

 

[cooperlola]

Thank you, as ever, SD for clearing this up.  Ever thought of writing a book?...

[Teamedup]

In the past few years I have found some posters Carte Vitale obsede. I keep saying and will say again that the most important thing to have is the attestation from the Caisse de Maladie and that should be looked after better than any card. Once you have an attestation you are in the system and can reclaim for medical things.

What each caisse de maladie does about issueing cards with an E106 which is usually temporary is up to them. The carte vitale is not that important really, convenient but not that important.

[cooperlola]

Yes, O/P, Teamedup is quite correct.  Before your head spins out of control - just get the atttestation.  The Carte Vitale is great but not a real problem if you don't have one.  If your CPAM does issue them automatically in your case, just think of it as a bonus.  Then you can chase them up at a later date if needs be.

[powerdesal]

Whats the procedure if neither of you is entitled to an E106 because of limited NI payment history.?

What is the situation if, for instance, a person (normally a woman) has never worked in UK since marriage and her husband either died young leaving her a widow but with independent means (no employment) or alternatively the husband has limited NI payment history?

[cooperlola]

I would imagine that they get the letter of non-entitlement straight away and pay directly into the French system.  Goodness (or SD)knows what the situation re UK state pensions are though.  One of the reasons I never stopped paying contributions all my life.

[Owen]

Hello SD,

You do not seem to be making any distinction between CMU and E Forms.

CMU Law 641-99 provided for basic universal healthcare for those French residents who did not otherwise have any entitlement to state healthcare. Further, for the poorest of households healthcare would be free and for the rest a financial contribution would be payable.

F Forms are totally different and therefore affiliation via these means is not subject to CMU legislation. You do have an entitlement to healthcare under EU reciprocal arrangements and you pay no financial contribution for basic healthcare. So to say that an E106 holder has an absolute right to a CV is a moot point and particularly as E106 has a limited life. And clearly some CPAM offices take the view that a CV will not be issued to those with a temporary affiliation. And often the social security number issued is a temporary one too. Whether those CPAM offices are acting improperly with this policy I would not like to say, but I do not think it would be worth getting into a dispute with CPAM about it. We must dance with the girls we have.

Regards

Owen

[email protected]

[Ron Avery]

A big omission from the documents Cooper  L listed that will be needed at the time of giving the E 106 letter to your local CPAM office is  Birth and marriage certificates.

You must take these and without a marriage certificate your OH will not be able to piggyback on your E 106.  Also the ability to piggyback is not a foregone conclusion, you have to be a dependant of the holder to do this and if he has a pension in his own right then he is not a dependant and may not be allowed to piggyback on your form and he will have to join and pay into the French healthcare system from day 1.

[cooperlola]

[quote user="Ron Avery"]

A big omission from the documents Cooper  L listed that will be needed at the time of giving the E 106 letter to your local CPAM office is  Birth and marriage certificates.

You must take these and without a marriage certificate your OH will not be able to piggyback on your E 106.  Also the ability to piggyback is not a foregone conclusion, you have to be a dependant of the holder to do this and if he has a pension in his own right then he is not a dependant and may not be allowed to piggyback on your form and he will have to join and pay into the French healthcare system from day 1.

[/quote]Again, this is interesting Ron - certainly not needed by either me or my friends (the latter for whom Idid this just a couple of weeks' ago.) - the birth certificates etc.  I piggy-backed onto my O/H, but it was clearly marked on his E106 that "other members of immediate family" living at the same address were included. As said above, I think this would be a good subject for an FAQ sticky.  Our experiences are all clearly different and one can only speak from one's own!  I'll add the birth certificate stuff to my original post as it obviously does no harm to be prepared for all eventualities!

[Sunday Driver]

Just to nit-pick a bit, CMU Law 641-99 provides for an obligatory state healthcare insurance for those French residents who are not already covered by another obligatory health insurance regime. Insurance cover is not conditional upon resouces, but a contribution (think of it as a kind of insurance excess) is required from those whose income exceeeds a certain level.

So, if you take up permanent residence in France, then unless your personal situation qualifies you for an alternative heathcare insurance scheme, you are obliged to register for CMU and once you have done so, you are entitled to all of your rights as the "insured" - which includes the provision of a carte vitale.

The purpose of the E form is to provide proof that your costs will be temporarily met by the UK so you can be exempted from paying your CMU contributions for the duration of its validity.  The fact that you are a holder of an E form does not detract from your obligation to register for CMU and does not diminish your rights once you have done so.

Personally speaking, if I was refused a CV and was made to spend the next two years shelling out cash in advance, filling in paper forms, then waiting for my reimbursements whilst the rest of the CMU insured population of France doesn't have to, then I would certainly query this situation with my CPAM. 

They even have a concilliation service to start you off.......[:)]

 

[cooperlola]

O/P are you still with us?  Has this helped or confused you?  It would be good to hear.

[Ron Avery]

CL wrote "Again, this is interesting Ron - certainly not needed by either me or my friends (the latter for whom Idid this just a couple of weeks' ago.) - the birth certificates etc.  I piggy-backed onto my O/H, but it was clearly marked on his E106 that "other members of immediate family" living at the same address were included. As said above, I think this would be a good subject for an FAQ sticky.  Our experiences are all clearly different and one can only speak from one's own!  I'll add the birth certificate stuff to my original post as it obviously does no harm to be prepared for all eventualities!"

Well it seems that as usual in France, the requirements of CPAM offices vary, but I feel that your recent experience was the exception as apart from my own experieces of having to produce certificates when depositing the E 106 and when joining the CMU, I recall a post on here about somebody applying for cover under an E 106 who was refused because they only had the short form of UK birth certificate, another person had a problem because the spelliing of a "pre nom" on the birth certificate was written differently on the Marriage certificate by the Registrar and despite a letter from the Registrar admitting the error this was not accepted by CPAM, nor was a friend's South Africam birth certificate accepted without a lot of scrutiny.

You are right, a FAQ on what to do with an E 106 in France is needed. There is a sort of FAQ on applying for an E 106 in the UK but not what to do with it in France, the original FAQ is now obscure because someone has chosen to post to it[:-))], shouldn't FAQs be locked?