BREAKING NEWS ON EXPAT HEALTH COVER

[Clair]

[quote user="Deimos"]What is AME (forget its full name from the DWP removed thing)

Ian

[/quote]

page 56 of this thread

Aide Médicale de l'Etat (AME):

http://vosdroits.service-public.fr/particuliers/F3079.xhtml

http://www.cmu.fr/site/

http://www.ameli.fr/assures/droits-et-demarches/par

situation personnelle/vous avez des difficultes financieres/aide

medicale de l'état

http://www.adai13.asso.fr/fiches/san/san_ame.htm

http://www.abc-lettres.com/fiches-pratiques/aide-medicale-etat-ame/sante/fiches-pratiques/pratique.html

[Lenht1951]

Hi Claire,

Thanks for your efforts but had a look at the above using a translation service, maybe my brain is not working today but it seems as clear as mud. Very [8-)][8-)]

[Ron Avery]

[quote user="ErnieY"]

We're on the cusp so to speak in that, on the strength of my E106, we had out attestation before Nov 23rd, it was dated the 15th actually, so does that mean we're in post E106 ?

[/quote] 

No I don't think you are Ernie, unless your Attestation is specificaly for the CMU.  When did your E 106 expire?  As you are working isn't your E106 different to those of inactifs, ie renewed annually?

[Cat]

[quote user="Lenht1951"]

Hi Claire,

Thanks for your efforts but had a look at the above using a translation service, maybe my brain is not working today but it seems as clear as mud. Very [8-)][8-)]

[/quote]

I've typed this out quickly, after reading the AME information on one of the sites listed by Clair. My understanding of it is this (but feel free to correct me if you read it differently).

Briefly, it's for people "en situation irregulaire" (usually meaning living in France but not complying with residence regulations) to allow them access to health care.  It is often issued to illegal aliens. 

People claiming this must have lived in France for at least 3 months, and be on a low income (the actual figure varies according to your personal situation, but are the same as the thresh holds for access to free CMU complimentaire).

1 person
 7 272 euros
 
 
2 people
 10 908 euros

 
3 people
 13 090 euros
 
 
4 people
 15 271 euros

 
more than 4 people, for each extra person
  + 2 908,844 euros
 

It can also sometimes be issued on humanitarian grounds (as a possibility, not an automatic right).  These grounds are..

If you are living in France and are not eligible for health cover paid for by your country of origin, nor private insurance, nor CMU, and your state of health is such that you need health care for illness or after an accident.

 

[Jazzer]

If this is the system that is adopted would I be right in assuming the following

  For someone who has an E106 expiring in January, one party in good health the other with pre-existing condition.Social contribution of 8%, PHI premiums for the healthy person and €7272 for the other plus top up insurance?

[Lenht1951]

Thanks Cat...[B]

[makfai]

[quote user="Jazzer"]

If this is the system that is adopted would I be right in assuming the following

  For someone who has an E106 expiring in January, one party in good health the other with pre-existing condition.Social contribution of 8%, PHI premiums for the healthy person and €7272 for the other plus top up insurance?

[/quote]

This is a good point. I have already discussed this with someone who is preparing info for FHI and said that the issue for E106 holders could become complicated not least because of the question of whether affiliation to the CMU for one person would extend cover to that person's dependents. I explained that, as I saw it at this time, 

There are two major categories:

1. there are those who were in residence before the 'effective date'  (was 1 October 2007 may now be 23 November 2007)

2. there are those who have (or will) become resident after the 'effective date'  (was 1 October 2007 may now be 23 November 2007)

but there are also several sub-categories to the two main categories

• those who  do not have pre-existing conditions and have no dependents

•  those  who do have pre-existing conditions and have no dependents

• those who do not have pre-existing conditions and their dependent also does not

•  those who do have pre-existing conditions but their dependent does not

• those who do have pre-existing conditions and their dependent ALSO has a  pre-existing condition

Whatever the outcome of the French Government's current deliberations I suspect that there will be things to iron out for E106 holders and that is why I was hoping to raise NOW with the French Govt how they might treat E106 holders.  Based on previous performance I do not feel it safe to assume that they have thought this through.  BUT others have argued I should not rock the boat. If I was an E106 holder whose cover expired in a few weeks I would want to be seeking answers now bearing in mind we are entering a holiday period.

 In the time that is left and with these holidays approaching, what will happen if these people want to appeal? Has that been given enough thought by the French Government? Will they be given affiliation to the CMU until the appeal is completed?  There is an argument for such treatment under Article 41 of the CHARTER OF FUNDAMENTAL RIGHTS OF THE EUROPEAN UNION (2000/C 364/01) [see below]  but it is going to take time to get THAT argument accepted and time is not on the side of the E106 holders whose entitlement expires next month.  This is one of the reasons why I believed that delaying lobbying for their cause was not an option.

Article 41

Right to good administration

1. Every person has the right to have his or her affairs handled impartially, fairly and within a reasonable time by the institutions and bodies of the Union.

2. This right includes:

. the right of every person to be heard, before any individual measure which would affect him or her adversely is taken;

. the right of every person to have access to his or her file, while respecting the legitimate interests of confidentiality and of professional and business secrecy;

. the obligation of the administration to give reasons for its decisions.

[cooperlola]

[quote user="Jazzer"]

If this is the system that is adopted would I be right in assuming the following

  For someone who has an E106 expiring in January, one party in good health the other with pre-existing condition.Social contribution of 8%, PHI premiums for the healthy person and €7272 for the other plus top up insurance?

[/quote]Therein, I suspect, lies the complication. Under AME as I understand it, health cover is 100%.  Therefore, as you say, this makes the rules incredibly complicated for couples and families.  Who pays what?  Is one person exempt from social charges (because they are healthy and have PHI?) whilst the other pays - or are they exempt because they're a special case too since the income qualifications (as Cat shows) are based on the entire household? It's a minefield and my personal suspicion is that this is what the CPAMs are really concerned about - because they're the ones who are going to have to put all this into practice and deal with all the individual AME applications, which have two lines of appeal if somebody is rejected.  This could drag on for months - or even years - and what happens to chronically sick E106 expirees in the meantime because by my calculations, they only have about 12 working days to apply - even if the statement is issued this week?

[Ron Avery]

[quote user="Jazzer"]

If this is the system that is adopted would I be right in assuming the following

  For someone who has an E106 expiring in January, one party in good health the other with pre-existing condition.Social contribution of 8%, PHI premiums for the healthy person and €7272 for the other plus top up insurance?

[/quote]

This is all speculation, but you aren't half confused aren't you?

The 7272€ figure is the income threshold above which you don't get assisatnce, not what you pay...  and don't confuse social contributions with payments for healthcare, they are not the same thing. Contributions sociale are paid on unearned income and are in addition to any healthcare charges based on total income.

[woolybanana]

Am I not right in thinking that an income below this level will not permit one to stay in France?

[Pommier]

I would have thought (though I don't know) that people whose E106 expires would have to take out phi. If one (or more) person in the household has a condition which the insurance won't cover then they'd still have to have phi for everything else, and the fallback French scheme would be purely to cover the condition which the insurance company won't cover.

Does that make sense? 

[krusty]

cheryla ,as I have already pointed out people may have PHI but if their income is above the limits they will not be allowed into the fall back scheme.

[Pommier]

[quote user="Cat"]

 

It can also sometimes be issued on humanitarian grounds (as a possibility, not an automatic right).  These grounds are..

If you are living in France and are not eligible for health cover paid for by your country of origin, nor private insurance, nor CMU, and your state of health is such that you need health care for illness or after an accident.

 

[/quote]

i wondered if it would be granted using the above criteria rather than the income limits

[krusty]

I do not know for sure,  but would not like to be on an op table waiting while they decide who pays.

[cooperlola]

[quote user="krusty"]I do not know for sure,  but would not like to be on an op table waiting while they decide who pays.[/quote]Touché!

[BJSLIV]

I'm pretty sure that the fudge disclosed by yesterdays brief exposure from the DHSS is that anyone already in the CMU would be allowed to remain provided they met the income criteria IE no free CMU.

Those still on E106 would be required to take out private insurance.

Those with a pre-existing condition would still take out private insurance, but would be covered by the (emergency) AME for things excluded from their PHI.

That would provide continuing cover from January for most things, but, and this is where the squabble no doubt arises, lots of aggro for the AME department which, outside the main cities, is probably pretty minute, and in no way staffed up for a large and sudden  increase in their workload.

The fudge has the bureaucartic beauty of be able to be presented as a clarification of the previous announced policy, rather than a complete U turn.

 

[Lenht1951]

[quote user="BJSLIV"]Those still on E106 would be required to take out private insurance.Those with a pre-existing condition would still take out private insurance, but would be covered by the (emergency) AME for things excluded from their PHI. [/quote]

So presumably someone with a long term illness would not only have to contribute to the state system if their pension was over the AME threshold but also have to pay for  heavily loaded PHI...And believe me it will be heavily loaded. [8-)]

[krusty]

sounds like we are coming around to what my doctor told me 2 months ago , although not CMU but AME

http://www.completefrance.com/cs/forums/1048827/ShowPost.aspx

[woolybanana]

So, to turn it round for my feeble brain, what  private cover does not do the AME will/or will have to?

[makfai]

People interested in this topic are advised to look at page 54 of http://www.completefrance.com/cs/forums/ShowPost.aspx?PageIndex=54&PostID=1105610

[EBME]

NEWS FROM HOLLAND: LOOKS LIKE GOOD NEWS IS ON ITS WAY:

[:)]

Check out the following:

www.frenchhealthissues.eu/latest_news_from_holland_13-12.htm

[EBME]

Sorry link incorrect should read;

www.frenchhealthissues.eu/latest_news/news_from_holland_13-12.htm

 

[seb47]

[quote user="EBME"]

NEWS FROM HOLLAND: LOOKS LIKE GOOD NEWS IS ON ITS WAY:

[:)]

Check out the following:

www.frenchhealthissues.eu/latest_news_from_holland_13-12.htm

[/quote]

 

Sorry EBME: still no official statement. Also, it may be good news as you anticipate the CMU situation, but spare a thought for us E 106ers.

[krusty]

how come the Dutch government can get a reply so quickly even it if it is only verbal ?

can they let the British government know how to do it [:)]

[Sunday Driver]

The British government had to do all the work.  The Dutch have arrived when the job's nearly done...[;-)]