mutuelle!!

[Nico]

i have just moved to france and was seeing a specialist in uk for a long term illness. i have applied for a mutuelle to cover my healthcare but am not sure when i will recieve the papers as proof. i have got a european health card from uk but with that i need to pay everything before and get reimbursed. i am going to need a through healthcheck so this is not viable as the cost is going to be huge and i cannot afford to pay it before. my problem is that i need to get to the hospital as soon as possible to get sorted as i am suffering waiting. does anyone have any ideas of how i can hurry things up abit? i cant go to the hospital until i recieve my papers for the mutuelle which should be next week but i am well aware that many french people do not rush themselves so im not holding my breath for it to be here then! if i just go to the emergency department will they see me or i will have to pay in advance?

[Cjlaws]

I sorted my Mutuelle out on the spot at their office. If things are taking a while I'd get down to see them or at least telephone to make sure they have everything from you that they need. Normally a Mutuelle will not pay for treatment as an in-patient until you've had the policy for a certain time - that's something you may like to ask them about, as sometimes you can shorten that period by paying an extra month's premium.

Once you have your Mutuelle in place you'll only get the sort of treatment you seem to need by first visiting your doctor. Have you got one?

[Quillan]

[quote user="Nico"]

i have just moved to france and was seeing a specialist in uk for a long term illness. i have applied for a mutuelle to cover my healthcare but am not sure when i will recieve the papers as proof. i have got a european health card from uk but with that i need to pay everything before and get reimbursed. i am going to need a through healthcheck so this is not viable as the cost is going to be huge and i cannot afford to pay it before. my problem is that i need to get to the hospital as soon as possible to get sorted as i am suffering waiting. does anyone have any ideas of how i can hurry things up abit? i cant go to the hospital until i recieve my papers for the mutuelle which should be next week but i am well aware that many french people do not rush themselves so im not holding my breath for it to be here then! if i just go to the emergency department will they see me or i will have to pay in advance?

[/quote]

I hope I have not misunderstood what you have written. Are we talking about the European Health Card that replaces the E111 as described here http://www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en ?

If that is the case then you are covered for emergency treatment although you will probably be charged and have to reclaim the money on your return to the UK. You don’t need a mutuelle because you will get a full refund back in the UK.

However, seeing as you said you have applied for a mutuelle coupled with your comment "i have just moved to france" I assume you are going to be here full time. In that case you need to register in to the French system and you will require a E106 or a letter rejecting your application for a E106 (for more information look here http://www.dwp.gov.uk/international/sa29/medical_06.asp) from the Department of Works and Pensions in Newcastle UK. Once you have joined the French state will pay typically 70% (as an average figure it can be lower or higher depending on the type of illness) of your medical costs. The mutuelle will then pick up the rest, it does not pay the whole lot. Once you have registered you will receive a Carte Vital which at present is a green credit type card to which your mutuelle can also be linked and a lot of the time you don't pay anything. The times you do pay they enter your card in to the machine and the money is paid directly back in to your bank account. Visiting the doctors is a typical example of how that works, you hand over 21 Euros, the docyor puts your card in his machine and part is paid to your bank by the state and the rest by your Mutuelle automatically.

You may like to search this section of the Forum for both E106 and Mutuelle as there is loads of good information here. It is important if you have a long term illness to get the right sort of mutuelle i.e. 100, 200, 300 or 400% cover which will effect the amount of money they pay back depending on the more qualified person you see. It's all about how people in the medical profession here are graded and I still find it quite complicated to understand but as I have a 400% policy I pay absolutely nothing for anything including glass's, hearing aids, heart specialists etc and it costs me just over 100 Euros a month (for two of us)  but well worth the money in my personal situation.

Hope this helps.

[Ron Avery]

Ummm..  as far as I am aware you cannot get a mutuelle without having an attestation to Health care from CPAM in France,  either via an E 106 as Quillan mentioned or by paying into the French health care system.  If you have neither you will not get a mutuelle as they will not pay the top up if the base is not covered. If you are registered disabled in the UK you might get an E 121 but that should have been dealt with before you left the UK.

In any case even if you do get a mutuelle, despite what Quillan says, you still will have to pay up front for most things, pharmacy is perhaps an exception,  for example dental treatment is not cheap and an X-Ray alone can cost 50€ or so, you get the money back partly from CPAM and the rest from the Mutuelle, but is far from instantaneous.

As  an aside, I only pay my Doctor 20€ and I get 13€ back from CPAM and 6 € from Mutuelle I see that it should be 21€ but the Doctor has never asked for 21€ or CPAM questioned it.

[chirpy]

I believe the cost is age related as when i came to France when i was 64 i paid about 180euro for two of us and it does not pay everything.

THIS IS WITH AZZUR.

Whom do you insure with Quillan and are you much youger as i guess ?

[Quillan]

Ron - My experience listening to others is that the insurance compaines (well more the agents) will sell you anything although technically speaking you normally have to give them your French social number on the form but it's five years since I got mine and my memory may be wrong or things may have changed. I was told by Peter (forgot his last name) who used to post here that you can't get private insurance unless you are turned down by CPAM but it was a long time ago.

We used to pay for xrays because our small local hospital didn't deal (or have a computer link) with AGF but now they do and we don't pay for anything. Neither do we pay at Carcassonne. People using our local hospital who have a Swiss Life mutelle have to pay the top-up and claim it back, I know this because they are always waving their documents at the receptionist and shouting. I used the doctor just as an example, I know that you have to pay consultants and dentists, I was just trying to keep it simple, sorry.

Ab - I am with AGF and I am 51.

[Nico]

thanks everyone i think i kind of understand it abit more now!

[Ron Avery]

Quillan

It just shows how thing vary from town to town, I got sent for an X-ray last week and had to show ny attestation, Mutuelle etc at reception and still got a bill for 45€, which has now been refunded by CPAM and the Mutuelle, however, with the resultant course of physio, I pay nothing, he has a sign that says that mine is among Mutuelles where members do not have to pay. 

Private insurance like BUPA and PPP, are not a mutuelle, we have had the debate about the legality of such cover for French residents for a long time now, some say it is illegal here to have it and not join the Health system, others will tell you they have it, but not how long they have been here or where they come from. Peter will tell you there ae exceptions, but they generally they do not apply to EU citizens moving to France unless they are in the diplomatic corp.

[Gardian]

Nico ...............

Without wishing to delve in to the nature of your medical situation, it could presumably be classified as 'non trivial'?

On that basis, your condition could well need to be applied for by your GP and approved by CPAM as an 'ALD' (Affection de Longue Duree). Your GP may be happy to apply for that if the condition qualifies and on the basis of an examination, together with any other supporting documentation you may have (UK prescriptions, etc). However, he or she may not be prepared to apply for that (the form is Protocole d'Examen Special) until other tests or specialist examinations have been done - makes sense, because the end result is normally 100% rebate of medical and medication costs and you can't just turn up here and expect to get full cover willy-nilly. You would almost certainly have to fund these initial costs yourself.

The processing of the above form can take time - our experience was 2 months turnround, and in the meantime, you would need to fund the 30% not covered by your E106 (assuming of course that you've got one).  You can then claim reimbursement retrospectively, though this can be a bit of a game!  

[Quillan]

Ron – I think you are right because we have two physio’s in Quillan, one is excellent and one is good. The good one you don’t pay the excellent one you have to pay and claim back, it’s always the way I guess.

 

Re the BUPA/PPP thing, we bought BUPA International with us from the UK for the first two/three months, did what Peter told us to get in the system then dumped it (it cost a bomb). I think I shall change my comment to Peter told me that’s it’s illegal for a French insurance company to sell full health insurance in France to people living here for use in France unless they have been refused cover from CPAM which is I am sure what he meant just so as not to confuse things.

 

Ian - I believe you will only get 100% CPAM cover for the specific illness but some mutuelles give you a discount because they don't have to pay for things associated with that illness, diabetics and heart disease are the more obvious things that come to my mind although I am sure there are hundreds more and that there is probably a list on some French government website somewhere.

[Sunday Driver]

You will find the official list of long term illnesses (affections de longue duree) on the French health service website [url=http://www.ameli.fr/229/DOC/2259/fiche.html?page=4] HERE[/url].

 

 

[Gardian]

[quote user="Quillan"]

Ian - I believe you will only get 100% CPAM cover for the specific illness

[/quote]

Yes, that's right - should have mentioned that important bit !