Private health care

[letrangere]

I think I understand what Logan is trying to say and sympathise to some extent.  Assume you are domiciled in France but your work commitments require you to travel extensively outside the country, including the UK, something that is not uncommon today. You will need to have full private health insurance.  So you will be paying for private coverage in addition to paying 8% of your income in to the French system.  Although it isn't possible to opt out of the government health system in the UK and nowadays France, in many parts of the world it is, so long as you can prove that you have adequate private coverage.  And I think it's this lack of choice that the poster is bemoaning.  Though Miki's explanation of why it's necessary for everyone to fund the system as a whole makes perfect sense too.  M

[Logan]

[quote]I think I understand what Logan is trying to say and sympathise to some extent. Assume you are domiciled in France but your work commitments require you to travel extensively outside the country, inc...[/quote]

Exactly MWJ.

Perhaps I didn't make my reference to Spain very clear.

If you go to live in Spain as a resident. It is not compulsory to pay into the Spanish NHS. You can opt to take out private health care with Sanitas for example. The costs are reasonable. In doing that you can then keep your NHS status in UK (not absolutely legal because entitlement is based on residence)or extend your Sanitas policy to cover you privately whilst in UK. However this is not possible in France because you are legally obliged to join the system and by default have a decent top up. You loose automatically therefore your rights in UK and have to pay for anything except emergency treatment. So you pay or take another private policy to cover you in UK. I appreciate that most folk do not live for a few months each year in either country but quite a number do. The whole point of this thread is by making it obligatory to be in the French system it removes personal choice and that to me is unaceptable in a democratic society. I believe this is the reason so may Brits rely on form E111 for medicare in France when they are actually residents. They don't want to give up their NHS status in UK and who can blame them.

I hope I have now made my point a little clearer folks!

[Lori]

Logan: Private message sent to you.

Lori

[Russethouse]

>>>The whole point of this thread is by making it obligatory to be in the French system it removes personal choice and that to me is unaceptable in a democratic society. I believe this is the reason so may Brits rely on form E111 for medicare in France when they are actually residents. They don't want to give up their NHS status in UK and who can blame them.<<<<<

If you feel this way why did you choose to live in France ?

I think the reasons so many people rely on form E111 in France is either because they believed probably from some chap they met in the French equivilent of their local pub that they could - or they they think they can get away with it !

Look at Quillans friend - what a tragedy for them.!

Surely in a civilised society healthcare is available to all -the 8% is your contribution to that - other countries may tackle that differently, but you have chosen two that have this system.

Shouldn't you only have a problem if you choose to have routine care in a country other than that where you are resident ? The E111 will cover emergencies which ever way you go.

[Quillan]

In the UK you have 2 years of NHS treatment entitlement after you stop paying NI. If you are of retirement age then you no longer contribute, if you are under retirement age you have to ‘sign on’ and in doing so you automatically get your NI stamp paid which entitles you to use the NHS and contributes towards your state pension. So technically you don’t get NHS treatment for free. Unfortunately the ability of the NHS to check that everyone has ‘contributed’ is very poor and even if you are asked for your NI number nobody bothers to pursue it if you tell you can’t remember it although I believe this is gradually being tightened up.

 

Even if you live abroad but hold a UK passport you can pay in to the UK system for your pension only (class 3 stamp), it is not possible to pay towards NHS or unemployment benefit.

 

Many, many people go down the E111 route which is fine if you have an accident like get run over etc but for other treatments like for example cancer you are not covered. You will find that you still have to pay (in France anyway) and claim the money back when you return to the UK. Annual travel insurance may help but there are clauses as somebody stated recently and you will have to prove you were on holiday not an extended stay. You could go down the BUPA route but as I said that is mainly for people who work away from the UK on contract work or are sent by their company. In this case you will be paid in the UK and therefore make NI contributions.

 

I am glad you have decided to ‘stick with it’ with regards to staying in the French system. The 8% is not really as bad as you think if you compare it to your UK contributions and the way they are calculated (they are taken before tax and personal allowances). I guess if I wanted to complain about anything with the French system it would be the 10% they take from everyone to pay for the previous years deficit and I was not even here when they ran the debt up put as I choose to live here I guess I have to pay.

 

The ‘top up’ insurance is also not as bad as it seems and as a family where both of us have to have drugs to keep us alive and/or increase our quality of life we are actually better off. Our dentistry and glass’s are paid for and we don’t pay for any prescriptions (which exceeded £60 per month in the UK) and it only costs us just over 900€ per year for both of us so we have had our money back probably twice. The only thing we have ever had to wait for has been an eye test.

 

I think that judging by what others are written most of us that live here year round are very happy with the French medical system even though we may feel it costs a lot. My own mother-in-law is presently in the last two or three days of her life due to cancer (there seems to be a lot around at the moment) and since being taken to St Bart’s Hospital in London for chemotherapy has contracted both Chicken Pox and Pneumonia from within the hospital. In comparison to the treatment and standard of care my friend’s wife is receiving in Carcassonne St Bart’s looks like a third world medieval hospital. So I for one don’t mind paying and it worries me that the quality of the French health service will drop to English standards if more people try to circumnavigate the system hence my previous comments. I also think and believe I am right, that those of us that do pay get really niffed about those that don’t but should.

 

Quick note: I type in Word and reduce to 10 pitch then cut and paste for posting. In my last post it didn’t work 100% and made it look like I was shouting which was not my intention. Hope it doesn’t do it again, sorry for that.

 

 

[Logan]

I now understand that the EU have plans in the pipeline to change the rules relating to E111 use within Europe. The E111 is to moving to credit card type format with a chip including your personal information and entitlement. In France this is to be included within the Carte Vitale. In future we will all be able to receive emergency and routine medical care within any member state for up to 6 months per year via this new E111. Costs will be based on the regime of the particular country. eg. UK, Spain - free, France 30% top up required.

If you go to the link below it explains rather well the thinking behind the plans. Common sense seems to be prevailing at last in the EU.

http://europa.eu.int/rapid/pressReleasesAction.do?reference=IP/04/508&format=HTML&aged=0&language=EN&guiLanguage

[BJSLIV]

The credit card E111 will simply update the technology, paper to chip, it won't in itself change the entitlement, ie emergency cover only all  EU states other than the one in which you reside.

It will also not override the contribution rules for each member state.

It may make it harder for Brits living in France to keep their E111s up to date becuase being electronic there will probably be more cross-referencing, and I think unlike the paper system it will need to be renewed annuallly.

The NHS are looking at allowing patients to be treated abroad but that will require authorisation in the UK before seeking treatment abroad, so again it will not really suit someone who is already living abroad, unless you want to pop back to the Uk to see your GP before any intervention in France.

 

 

 

[Owen]

Hello Logan,

In view of some of the replies you have received you would be forgiven for thinking that you have just gone 15 rounds with Muhammed Ali. Some of the responses have been pretty vitriolic. 

It strikes me that you are simply looking at the options for funding your healthcare in France. You are certainly not looking for ways to obtain it free of charge, which contributors to this forum in the past have been clearly seeking.

Should you affiliate under pure residence criteria then a financial contribution is required. This contribution, whichever way you slice it, is a tax. It may be one that many do not mind paying but it is, nevertheless, a tax. You should take comfort from the words of US Judge Learned Hand who stated: " There is nothing sinister in so arranging one's affairs as to keep taxes as low as possible...........nobody owes any public duty to pay more than the law demands; taxes are enforced exactions not voluntary contributions".

I am not a lawyer or an accountant (thank God!).

Depending on your individual circumstances, and if you plan ahead, you can certainly delay payment of these contributions. It may be that you cannot avoid them forever but you may well be able to mitigate this liability. But in any case there may come a time when it makes sense anyway to affiliate and pay up. Medical inflation rates are running at around 8% a year which is reflected in premiums. There are also exclusions applied by private insurers, particularly in respect of chronic conditions, and where this cover is available it is expensive. And of course premiums increase with age.

European Healthcard. We are a long way off this card allowing access to universal treatment of both a routine and emergency nature as a matter of course. What it will do eventually is enable treatment to those on temporary stays in other EU states. On immediately thinks of E111 in this context but there are other E Forms issued if the stays are of a particular nature eg; students studying abroad and those in receipt of UK Jobseekers allowance seeking work in other EU states.

Regards

Peter Owen

[email protected]

[Logan]

Thank you Owen for that reply and I appreciate that what you say is probably correct.

However I have recently had a private communication as a result of my posting which illuminates the dark corridors of French double standards. If you are a Non-European with a desire to reside in France but not to work in France then you can opt not to enter the French health service system. You simply have to declare a none dependency on the state for Medicare. i.e.. produce proof that you are covered by a private healthcare policy and sign a declaration that you are not dependent on the state for healthcare.This done you do not have the obligation to pay 8% of your gross income to the state or pay the excessive mutuelle charges for 400% cover. I have contacted a number of Medicare companies. I can obtain a policy to cover all my needs at around 40% less than the costs of being in the French system/mutuelle. The crux of this is. If non-Europeans are allowed such an exception why not others? I am seeking further clarification. Watch this space.

[Owen]

Hello Logan,

Most of the contributors to the forum are EU Nationals particularly UK nationals so therefore their room for manoevre is more limited.

I am guessing that you are American and if not a national of a country that does not have some sort of system of obligatory contributions towards healthcare. UK Nationals have no choice but pay taxes and NI contributions, a proportion of which funds healthcare. Most EU countries also have a system of obligatory contributions towards healthcare. Obligatory contributions to the state is a key factor in all this. You do not have this in the United States so you can legitimately avoid this 8% contribution when coming to live in France as long, as you say, you have private insurance in place ie; you will not be a burden on the French state. Even some EU nationals can avoid it. For example in the Netherlands if your income is above a certain level then you have to contribute to a private insurance. So the Dutch in this category, on coming to live in France, can continue having private insurance quite legitimately should they so wish.

Finally you do not pay 8% of your gross income. You pay the percentage between a threshold (currently 6721 Euros) and your income less allowances. Excessive "mutuelle charges of 400%" has appeared elsewhere in this forum and I have commented separately on this subject.

Regards

Peter Owen

[email protected]

[Lori]

Peter is correct. We are American and the situation you describe fits our situation. Our cost for private medical coverage is quite reasonable and good anywhere in Europe.

Thanks for posting some good tips Peter.