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Caisses, etc.


PossumGirl
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We've been covered by CPAM since we got here last year.  We have a mutuelle with Groupama.  But, we're now in the process of setting up officially as an individual enterprise, so we have to change our caisse.

That's fine.  I understand that each type of business belongs to a specific category of caisse.  But what I find weird is that your mutuelle isn't necessarily okay to use with the new Caisse.  So, we will have to drop our Groupama policy in favor of something else.  It seems rather bizarre to not be able to use one insurance company rather than another.

Mind, it's still all better coverage than what we were paying ten times as much for in the U.S., so I'm not complaining.  Just find it all a bit odd.

PG

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As far as I am aware there is no reason why you cannot use any top up policy with any caisse. The problem is many caisses have their own top ups, indeed, some caisses (like the one I use) are mutuelles themselves, so obviously want to discourage you from using any products other than their own. This doesn't cause any problem for me in the pharmacy, as they are able to link my top up with my carte vitale so it all gets done automatically, but for many things you have to claim the extra 30-35%, or whatever, yourself from your top up insurer.
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[quote user="Will the Conqueror"]As far as I am aware there is no reason why you cannot use any top up policy with any caisse. The problem is many caisses have their own top ups, indeed, some caisses (like the one I use) are mutuelles themselves, so obviously want to discourage you from using any products other than their own. This doesn't cause any problem for me in the pharmacy, as they are able to link my top up with my carte vitale so it all gets done automatically, but for many things you have to claim the extra 30-35%, or whatever, yourself from your top up insurer.[/quote]

This seems logical to me, Will.  And, indeed, Mme. Groupama has told us that we don't have to change mutuelles.  However, both the Chamber of Commerce and our new accountant have told us that we do.  We're going to call the new caisse today (which, indeed is a mutuelle as well) and find out what's what.  I'm scheduled for some minor neurosurgery in April and want it all straightened out before then.

PG

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When JM called to find out what to do about the mutuelle question, he was told that since we're now in the system for the new caisse, we shouldn't use our  current cartes vitale.  However, since we haven't received anything new in the mail, that would leave us with nothing.  We're supposed to get a call back from a counselor, who will hopefully be able to give us better information than that, as the person on the phone seemed stymied and unable to tell us what to do.

PG

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That was probably quite correct, as cartes vitales are issued by particular caisses. You shouldn't be stuck though while waiting for a new card - if you need any medication etc just pay for it, get a feuille de soins, and send it, with the prescription, to your new caisse. You will get a refund of the appropriate percentage, then claim for the rest from your top-up provider.

Don't forget to get a new European Health Insurance card from your new caisse if you plan to travel anywhere in Europe (including Britain). These are tied to organismes conventionés in France as well as cartes vitales.

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[quote user="Will the Conqueror"]

That was probably quite correct, as cartes vitales are issued by particular caisses. You shouldn't be stuck though while waiting for a new card - if you need any medication etc just pay for it, get a feuille de soins, and send it, with the prescription, to your new caisse. You will get a refund of the appropriate percentage, then claim for the rest from your top-up provider.

Don't forget to get a new European Health Insurance card from your new caisse if you plan to travel anywhere in Europe (including Britain). These are tied to organismes conventionés in France as well as cartes vitales.

[/quote]

I'm not surprised about the carte vitale being linked to the caisse, however, I would have thought they would have sent us actual notification that we were officially WITH them so that we would know!

It hadn't occurred to me to ask about a European Health insurance card.  We don't have plans to travel at the moment, but I'm sure that we will eventually.  Good suggestion.  Thanks, Will.

PG

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  • 4 weeks later...

I am just reading this thread re Carte Vitale. I am grateful that Will has reminded us to get a  new EHI. We were in the UK last week without our old E1-11 and my daughter required emergency hospital treatment. Although we gave our french address to the staff, they didn't seem to query anything and to date we haven't received a bill from the NHS - are we likely to? Anyway, i was just wondering how we can obtain a new European Health Card - are they called the same in France? - could we apply on line or do we need to visit the Caisee where our Carte Vitales are issued?

Thankyou

Kate

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[quote user="Katieb"]

 could we apply on line or do we need to visit the Caisee where our Carte Vitales are issued?

[/quote]

Hi Kate

I don't think you can apply for them by post or on-line. I went yesterday, requested  cards for all of us, handed over my Carte Vitale, and a couple of minutes later was told that we should receive them through the post in about 14days. Very straightforward.

Chris

 

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I'm glad the reminder about the EHIC was timely. I doubt if you will get charged for the UK treatment you received if that was all you were asked for - the charging option exists, though, for those who are not resident in Britain and cannot produce a European passport, identity card or EHIC (as the E111 replacement is known in Britain).

In France, the EHIC is called the carte européenne d'assurance maladie (CEAM).

I think the procedure for getting them depends on your caisse. Being self-employed, I deal with a dedicated insurance provider for my profession, which is in Strasbourg, so not really practical to visit them from most other parts of France. I had in previous years applied for E111 by post, but this year they introduced an e-mail application system which worked a treat. Mrs Conq, being salaried, deals with the local CPAM and if I recall correctly she ordered hers by phone (I would certainly have remembered the complaints if she had been forced to visit CPAM 30km away during office hours).

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