Long Term Illness does 100% mean 100%

[Krin]

Hubby has a condition that we are alsmost certian will qualify for 100% cover when we move to France. Can anyone tell me if this is likely to be 100% of everything related to this condition, or does it mean 100% of convention (sp?). For example if he sees a consultsant who charges more, is he fully covered or do we need to make sure that we have a mutuelle that will cover the additional cost. We will have a mutuelle anyway, but don't want to pay out more on that each month than we need to.

Three year old daughter also has a condition from birth which is permanent that will also mean doctors and hospital visits from time to time. Is this also likely to be covered 100%?

Have checked the archives but can't find the precise answers to these questions, but apologies if they have been asked, and answered before

Thanks

Krin

[LesLauriers]

This question has come up before and the answer as I remember it was that 100% is 100% of convention.

[Zippy]

100% of convention I am afraid. However if you need medical treatment that a doctor will certify is life threatening they pay the full amount.

[Poozel]

The 100% is confusing because it is used in 2 ways.
1.You have 100% cover referring to the tarif of convention(which applies to everyday medical situations and lesser illnesses/conditions and covers only a percentage of the costs, leaving the rest to you and /or your top up insurer)
2. You have 100% exoneration of costs. This is for affections de longue duree. This means that charges are taken in hand 100% by CPAM and cover the following circumstances:

(1)30 listed illnesses of long duration
(2)other conditions considered grave and not listed above and incurring high costs for treatment for a period longer than 6 months
(3)situations where several lesser conditions group together to cause a long period of treatment, of more than 6 months. (ie an elderly person breaks a hip and then cannot walk and requires further medical intervention.

Your doctor must apply for an exoneration of expenses to the CPAM. You will get a letter stating that you are exonerated for a fixed period of time (7 years, 20 years, whatever).

Note that the forfait journalier and the added cost of a private room are up to you/your assurer as in all other cases.

The 100% exoneration applies only to the particular condition for which it was given, for example diabetes - if you fall and break your arm, the usual reimboursement will come into force.

You can visit the website www.amelie.fr (Assurance Maladie on line)for lots of other info. Good luck!

Poozel