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Consequences of losing Incapacity benefit


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Hi,

I've been in france for six years. I came over on the E121 as I have a long term illness. I have a carte vitale and top up insurance.

I've now been informed by the UK that my incapacity ( recently changed to Employment support allowance) benefit will be stopped at the end of this year, and I really need to know where I stand as far as health charges and how things will change for me. I've looked on the Affection Longue Duree list and my illness is on there, but don't know which steps to take now.

Will I lose my carte vitale. I'm sure that I've read that if you've been in the health care system for 5 years, you can stay in it. Does that mean that I'll keep my carte vitale?

I'm hoping someone can give me an idea of any steps I need to take. Thanks

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There are two separate issues here.

One is how you can remain in the system, and the other is the ALD.

To deal with the ALD first you should have a médicin traitant that you have declared as such.

You consult that Doctor  who makes a protocol de soins with the specialists that treat you and gets this cleared by another Doctor at the CPAM.

You then have a piece of paper stating exactly which disease or diseases you have covered as an ALD, and these are reimbursed at 100%

This of course is dependent on being in ths system

On the issue of remaining in the system as you have been here for more than 5 years you are entitled to be treated as a Franch person would be, that is to say either you work or run a business and pay côtisations, or you have the CMU. If you have the CMU it might be free if you have a very low income, or you may have to pay a % of your income over a certain limit

http://www.cmu.fr/

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[quote user="NormanH"]There are two separate issues here.

One is how you can remain in the system, and the other is the ALD.

To deal with the ALD first you should have a médicin traitant that you have declared as such.

You consult that Doctor  who makes a protocol de soins with the specialists that treat you and gets this cleared by another Doctor at the CPAM.

You then have a piece of paper stating exactly which disease or diseases you have covered as an ALD, and these are reimbursed at 100%

This of course is dependent on being in ths system

[/quote]

There is one other possibility. If your doctor considers that your incapacity constitutes a disability as defined by CPAM then they can make an application on your behalf to CPAM to be classified as disabled in France. If this status is granted then most costs, not just those treatments covered by the ALD, are reimbursable at 100%. What isn't covered are costs such as accomodation/food costs when hospitalised, prescriptions which are reimbursed at less than the standard rate. I don't know all of the exceptions so, if you get that far, you should check with CPAM.

The classification of an immigrant as "disabled" puts you on the same footing as a French resident and you cannot be discriminated against because you are not French.

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  • 5 months later...
I would also like to ask a question on this subject too.

We came to France 9 years ago and we got our Carte Vitales fairly quickly.  When my 2 years was up on the English system, my CV became invalid so we filled out the forms and I became a dependent on my husband's CV as he  came on an E121.  However, like the OP, his Incapacity Benefit has now been stopped and although his prescriptions in France declare that his condition is Longue Duree, I don't know where this leaves my health cover as I don't have any longue duree conditions.

Although we have the CVs will mine no longer be valid?

Neither of us have a Mutuel as the cost prohibits us, but I do know that if you are on a low or no income then you can obtain a free mutuel and up until we moved house I did have the forms to fill in.  I can't find the forms and now I can't remember where I downloaded them from, so if anyone knows where I can find them, can you send me the link please.

I don't know if this is the way forward, but it is good to know that my husband will still be covered for his ongoing heart condition.  I do however, have to have an annual IRM (MRI scan) on my head because I suffered a brain haemorrhage before we came here and I need to have it checked regularly.  This is not on the list, but needs to be done and as we are a low income household, not sure how we are going to pay for these things if I lose my CV.

Would love to hear your views on this and help us find a way forward.

Many thanks.

Jan

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You should be able to find the form on this page:

http://www.cmu.fr/cmu-c-demarche.php

Surely you can both be covered by your husband’s Carte Vitale?

That is not dependent on having an ALD.

Each prescription or 'acte' can be either covered or not depending on the list  he has on his 'protocole de soins'

I suspect than none of yours will be at 100% but you should apply for the CMC C as in the link above.

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Is living in France worth the risk if you cannot afford a Mutuelle? The reason I ask, is that it seems to me having a potential liability for 20% of your medical costs could turn into a potential nightmare if you are taken seriously ill, or involved in a bad accident, which could run into thousands of euros. A French neighbour of mine is currently on the latest kinese enzyme inhibitor super drug for cancer and the three tablet a day regime she was told costs the French health service over twelve thousand euros a month, which would be unaffordable for most if you had to pay 20% of the cost.

Presumably if you cannot pay you are putting your house at risk if recovery proceedings are taken against you? I suppose the fall back is you can return to live in the UK, but it does make me wonder if those without a Mutuelle fully understand the risk they are taking. 

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It is not a case of not wanting a Mutuelle, but one of not being able to afford it.   I fully understand the implications of not having one, which is why I am enquiring about the free one.   I do know that you are  trying to help, and your comments on the consequences are quite scary, but if you just don't have the money to pay out monthly then you are kinda stuck with it.  

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Surely cancer is an ALD?

I think the reality is that many people simply go without expensive treatment if they can't afford it, In the case you quoted, there is no obligation to agree to a treatment that would bankrupt you: most doctors would understand that and offer an alternative expensive treatment that the patient can afford. If it came to it, I suppose you could stall, return to the UK, and then start treatment on the NHS once you were back. And in most cases emergency treatment is 'free'. But I agree, the risk is there.
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We've been here 11 years now and have only had a mutuelle for the last 2.

As a result of a bill for 1200€ for an emergency ambulance and some tests for my husband.

They let you pay in installments, as many as you can afford.

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Depending on what else you paid for in those 11 years Patf you are still winning - 11 years of mutuelle you hadn't used would have cost far more than 1200€;

I've also heard that it's perfectly possible to take out a mutuelle after you have been diagnosed with something expensive, and be covered straight away.
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Perhaps it is worth pointing out that a very sizeable number of French people (I wish I could remember the official figure....) are also without a mutuelle, as they cannot afford one either. Like some posters here, I naively imagined that those people who really can't afford a Mutuelle don't need one, as surely they would be eligible for CMU-C complémentaire, or even CMU-B de base - but there is an astounding amount of people who actually fall through the net.

This might account (at least partly) how  the state of someone's teeth as you see them, denotes their degree of wealth or poverty...

Dental and optical care, this is where it shows the most...

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[quote user="EuroTrash"]Depending on what else you paid for in those 11 years Patf you are still winning - 11 years of mutuelle you hadn't used would have cost far more than 1200€;

I've also heard that it's perfectly possible to take out a mutuelle after you have been diagnosed with something expensive, and be covered straight away.[/quote]

This may be true (I have heard it confidently asserted where British immigrants sip their rosé) but the ones I have investigated have a delai d'attente.

Délai d'attente

Avant de souscrire un contrat, informez-vous sur l'existence d'un délai d'attente (appelé délai de carence).

Il s'agit d'une période, à partir de la souscription et variable

selon les contrats, durant laquelle vous n'êtes pas remboursé pour

certaines prestations.

Par exemple, le contrat peut indiquer un délai de carence de 6 mois en cas de soin dentaire.

http://vosdroits.service-public.fr/F20314.xhtml

I wouldn't like to put it to the test but that is a personal decision

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[quote user="Sprogster"]

Is living in France worth the risk if you cannot afford a Mutuelle? The reason I ask, is that it seems to me having a potential liability for 20% of your medical costs could turn into a potential nightmare if you are taken seriously ill, or involved in a bad accident, which could run into thousands of euros. A French neighbour of mine is currently on the latest kinese enzyme inhibitor super drug for cancer and the three tablet a day regime she was told costs the French health service over twelve thousand euros a month, which would be unaffordable for most if you had to pay 20% of the cost.

Presumably if you cannot pay you are putting your house at risk if recovery proceedings are taken against you? I suppose the fall back is you can return to live in the UK, but it does make me wonder if those without a Mutuelle fully understand the risk they are taking. 

[/quote]

As far as I know, particularly expensive but essential treatments are covered 100%, and this seems to be supported by the rates of reimbursement listed on the Ameli website

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/releve-et-taux-de-remboursement/les-taux-de-remboursement_orne.php

Also, hospital costs (apart from the usual room fees, etc.) for people with long term or major illnesses are also fully covered.

 

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Suninfrance, you can check your elegibility for CMUC or ACS on the Assurance Maladie website http://www.ameli.fr/

Click on "Vous êtes assuré" (in a red box), then "Avez-vous droit à une aide pour une complémentaire santé", which will take you to a "simulateur".

This will provide you with an anonymous estimate of your elegibility.

Although our income is fairly low, and seems to qualify us on the basis of published figures, we don't qualify for either, as we own our house, and a notional rental amount for this is added to our income, moving us beyond the limit.

Secondly, dee4020 and Suninfrance, can you not appeal the UK decision to terminate your allowance?

 

 

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