French Healthcare for British Expats

[makfai]

[quote user="Ron Avery"]

marky wrote .....

   

"What if you pay 8% social charges on investment income can you be in the state system?  If you cannot join the state system do you still pay the 8% social charges". There is no connection whatsoever betweeen social charges and the health care contributions. Social charges are payments towards the provision of French social services and are based on unearned income declared on your tax return, not earned income. Healthcare charges are for healthcare and based on total income.  Payment of the former does not give any rights to the latter.  In fact if the level of income is such that you do not "earn" enough to have to pay for healthcare it seems from what is being said, you may now be excluded from the French healthcare system and have to pay for it or get insurance, but still have to pay social charges on unearned income.

 [/quote]

Maybe I am totally confused here [8-)] and if I am I don't want to confuse others so please feel free to correct this post but, as I understood it;  

under existing arrangements the 8% goes to the CMU which (as outlined below) 'was established by the Government in 2000 to ensure those all persons regularly resident in France were eligible for medical cover, whatever their circumstances.'

In which case you might well be contributing to the CMU even though you are 'not employed.'  

So, as 'The contribution of 8% is charged on all household income above the threshold of €7,083 per household/annum, a figure that is revised each October' then, depending on their household income it is possible for some non-employed persons to be paying more than someone who is employed.

 

http://www.french-property.com/guides/france/public-services/health/cmu/#3.1

 

3. Couverture Maladie Universelle (CMU)

The CMU was established by the Government in 2000 to ensure those all persons regularly resident in France were eligible for medical cover, whatever their circumstances.

Those from within the EU currently resident but 'non-active' in France, are affiliated to the CMU.

However, changes to the rules have been introduced in 2007. In future, if you are proposing to retire to France under the age of retirement, you will only be permitted access to the CMU whilst you have State insurance cover from the UK (or other EU country).

Once this insurance cover expires (normally after two years) you will not be permitted access to the CMU, which will be restricted to those of retirement age. You will need to take out private medical insurance.

If you take employment or start a business, and you subsequently lose your employment or business, then you will be permitted access into the CMU to provide your health insurance cover, whilst you seek new employment or business activity.

1. 3.1 Contribution Level into CMU

2. 3.2 Registration Process

3. 3.3 CMU Protection Complémentaire

4. 3.4 Voluntary Insurance Credit

3.1. Contribution Level into CMU

If you are of state retirement age, in receipt of a State pension, and from the EEA, affiliation to the CMU is free. Otherwise the contribution level is 8% of household income above a basic threshold.

The contribution of 8% is charged on all household income above the threshold of €7,083 per household/annum, a figure that is revised each October. So, you will pay 8% of your net income above this figure - your income after deduction of eligible allowances as determined by the tax authority.

 

 

[cooperlola]

Makfai you are right.  But in addition you pay the Social Charges (the tax to pay off the French national debt which Ron mentions) which amount to 8% of your unearned income and a smaller percentage of any non-state pension - sorry can't remember what this is but it's not huge.  I think it's the fact that the 8% figure comes into both that confuses everybody!

[Helen]

  We have lived here for six years and do not own a house in the UK. Since 2002 we have paid into the CMU. My husband is in receipt of a service pension so he pays income tax in the UK but declares his income here. We will not be in receipt of English OAP for another 7 years. 

Last week we received the cpam forms, the accompanying letter demanded more information than usual but when my husband went in to see them they only wanted to photocopy the tax forms and the edf bill . There was no mention of any possible problems. Indeed if it were not for an article in an unsolicitated copy of one of the English newspapers  we wouldn't know anything about this issue.

There is no way that I would get private insurance. Two years ago I developed Type 1 diabetes and need insulin for survival plus testing strips/lab tests help me control the condtion . Indeed I am supposed to be getting an insulin pump at the end of the month (and have to give it back the next day?) I am covered (at present )100% for an ALD. No insurance company would give me cover .  I am so very worried.

[cooperlola]

Helen, I think this is one of the big problems with all this speculation.  Certainly our CPAM, like yours, were only concerned about proof of stable residence here at present.  If the changes speculated about in these articles become law, then, yes, there is no doubt that people in your situation will be worst affected.  You will be forced to pay for any treatment which an insurance company would not cover, but as Clair has mentioned, if you can prove real financial difficulty, there is still help. But, as I and others have said elsewhere, you will only make yourself more sick by worrying.

As I mentioned elsewhere, when I spoke to the lady at Exclusive Healthcare yesterday (and they most certainly have a vested interest, so their advice can be taken with not a little salt), she said that some people at some CPAMs have been asked to return their Cartes Vitales, but it seems to be a very small percentage at present. 

If you look at the link at the top of this page, to the newsletter which one poster received, people are being asked to post if they have been refused.  I should keep an eye on that on a regular basis and see if anybody actually is affected. 

Edit : Still nobody, as I post.

 There has only been one person on here so far and it is not clear at all whether this has something to do with the small amount of income which they seem to be declaring here, or simply that they are not working.

Do not panic yet (easier to say, than to do, I appreciate).  Just do some homework, get some figures together, and consider all your options just in case.

[makfai]

[quote user="cooperlola"]Makfai you are right.  But in addition you pay the Social Charges (the tax to pay off the French national debt which Ron mentions) which amount to 8% of your unearned income and a smaller percentage of any non-state pension - sorry can't remember what this is but it's not huge.  I think it's the fact that the 8% figure comes into both that confuses everybody![/quote]

The French Health Service provides good service and we support a contribution system.  However, if the new criterion for access to the CMU is 'non-employed' as opposed to 'non-contributing' then it appears to create a dichotomy. 

We would still be contributing to the CMU (via the 8% is charged on all household income above the threshold of €7,083 per household/annum) but we would also be in the category of  'non-employed.'   This would create a bizarre situation where we would be contributing to the CMU but excluded from its services so having to take out personal insurance in addition to the contributions.[8-)]

[cooperlola]

This is why the speculation makes no sense.  My assumption is that we would not be allowed CMU  cover and would therefore not have to pay.  As the law at present stands, we (the "non employed") are obliged by law to contribute.  So how does that work?  Until it's clear what's going on - and indeed, if it's going on at all! - we don't really know.  The only way to get to the bottom of this is to find somebody who has been asked to return their Cartes Vitales and ask them if they're still paying - I bet they're not, why should they?

The social charges on the other hand, you pay, regardless.  They are a tax not a social security or healthcare contribution. (That nice little bill that turns up just after Christmas!)

[makfai]

I agree with cooperlola's approach here. 

I can't blame the French Govt for bringing in something which allows them to have a good look at who is contributing to the tax system in France be it for health or anything else.

It is quite clear from reading posts here and elsewhere that some people mistakenly think that because they pay tax elsewhere (e.g. in UK) they don't have to declare this income in a French Tax return.  There will be some who do this in error but there will be others who are prepared to try to avoid contributing to the French tax system but are happy to use the health etc services the country offers.  If these are flushed out by this process I will lose no sleep over that.

Clearly, we will have to wait and see what comes of this because the UK Press reports are clearly inaccurate in implying that the Health System is 'free' - in which case they may be building this up more than is justified.

It does seem prudent, however, to keep a close eye on this and to use it as a prompt to review alternatives.......whilst at the same time trying to keep the stress levels down!  Maybe a trip to the doctor for some medication?????[:)]

[Jazzer]

I have today received  a free copy of The Connection. In an article headlined "Thousands  of expats lose access to french state healthcare cover- new law removes right for early retirees to enter CMU.The article state that letters have been arriving with CMU subscribers in recent weeks informing them they should send back their Carte Vitales. People of state retirement age are not affected. Similar problems arose in Spain earlier this year.

 

According to exclsive   healthcare the new law followed a European Court of Jusitice decision last year. He advises people to continue to use their CV until told otherwise. They exstimate the cover offered by the state could not be matched, but that his best cover for a 60 year old would cost over €3000 a year with some firms charging 50% more/  a basic cover would cost a min of €500. Private ins also typically involves an excess of €120 on a claim.

The Dept of Health in UK said they were aware of the situation but once people left the UK and were not receivibg cover via an E form the matter of healthcare was in the hands of their host country.

[cooperlola]

Jazzer, this sounds like yet another re-hash of the Times article.   Even if that is not the case, the fact that the company giving the supporting quotes is once again Exclusive Healthcare (who supply my top-up insurance and from that point of view I have no quibbles with them) makes one smell a rat.  If you look at their website, the article is very similar to those from the press.  However, it is very telling that the only piece of legislation which is referred to on the site is this one:

http://www.exclusivehealthcare.com/item.php?ItemId=220

which is about proof of permanent residence only. They are still not quoting any laws which suggest that current CMU contributors are being kicked out.

Edit : if you are concerned, then have a look here

http://www.exeterfriendly.co.uk/interplan_euro.htm

They will give you an on-line quote and even the top level with no excess for us (53 & 59) was 4700 euros or so - not the scary figures quoted by Exclusive.  And bare in mind that you would no longer be paying either top-up cover or CMU contributions (the latter being an assumption as, since the legislation referred to isn't visible anywhere, one does not know for sure.)

Here's another one, thanks to AMS

http://www.vhi.ie/

[cooperlola]

[quote user="Puzzled"]

This could mean that ALL non French , non Workers have to find their own policy, end of story

[/quote]

Quite.  It could mean a lot of things... 

Calm down and watch what happens.  There won't be much you can do about it, whatever!

[westland]

Surely the end of acceptance into CMU would not only affect Brits but anyone from any EU country who has entered France, lived here for three months and completed an application form to join CMU;  possibly with little or no previous income if they are from one of the poorer EU countries.  They could be non-contributing and also be in receipt of RMI.  All this being possible as there has been no requirement for a Carte Sejour in order to remain in France.  

There must be many such habitants throughout France who definitely won't have the funds for private health cover.  Are they then to be asked to leave the country along with Brits who cannot afford cover.  This can't be workable for those who are currently resident without discrimination coming into play and people seeking redress in the name of "human rights". 

[cooperlola]

All too true, Westland.  I for one am in the happy position whereby I can afford private cover and, although it will be a bit of a stretch, it's not the end of the world - and it will only last until E121 time comes along.  However, it may not apply to those actively seeking work and I guess this will be the "human rights" get-out.  There was some advice in one of the circulars put out by another - for want of a better word - "ex-pat" organisation, which suggested that starting a small business or signing on, might be one way of getting back into the French state system. We shall see.  But I think that you are right - we are the "soft targets" in this process at present and many will humbly toddle off and subscribe to private healthcare.  The fun will start when those in real difficulty begin to be hit.

[BJSLIV]

Interesting that both the definite refusals we have heard of  fall into the category of "rentier". Its not a term often encountered outside Marxist polemics!

However this was a category specifically mentioned in the document I quoted earlier.

Un décret pris en application de la loi du 24 juillet 2006 en cours d’élaboration viendra préciser les conditions dans lesquelles les ressortissants communautaires ayant la qualité d’inactifs (rentiers,étudiants, pensionnés) disposent du droit de séjour en France. Ces inactifs doivent en conséquence, pour avoir droit au séjour, disposer de ressources suffisantes et d’une couverture maladie. A défaut de respecter ces conditions, le bénéfice des prestations de sécurité sociale peut leur être refusé.

Cette nouvelle réglementation conduit à une remise en cause - pour partie - de la pratique actuelle des organismes de sécurité sociale consistant à servir systématiquement les prestations de sécurité sociale à tout ressortissant communautaire quel que soit son statut au regard de son droit de séjour.

 

[cooperlola]

BJSLIV : One of those posters, however, apperently did not specify the source of their income.  Is the confusion then arising as to how each CPAM defines "rentiers" - which I always understood to be those of private means?

Puzzled : I do so agree.  Funny how things don't seem so bad when you're not alone!

Maybe we should start our own Ex-Pats and immigrants Friendly Society?

Edit : How's that, Tony?

[Tony F Dordogne]

Can immigrants join as well?

[cooperlola]

Appologies.  Post duly amended.[:)]

[loa]

So I guess the obvious solutions are either start a business that breaks even,  no profit , no contributions. or sign on.. As  the French system need qualifications I'm wondering what my chances are  of finding employment as  an economist and business studied lecturer.

No that's too simple, they must have thought of this ?

[Ron Avery]

So I guess the obvious solutions are either start a business that breaks even,  no profit , no contributions.or sign on.

Where did you get the idea from that no profit means no contributions?  This is France AFAIK as it stands you are looking at  a minimum 4000€ before you even start let alone get any income.  If those "non workers" who do not earn enough or declare enough to pay into the CMU have to pay for their healthcare in future surely that would be a far cheaper option than starting a business?

I think this was discussed earlier or maybe in another parallel thread and comes from one of the English papers here, maybe who ever wrote that should explain the economics of this.

[makfai]

I hate adding to the speculation but can't help getting drawn into this debate because of its significance![:$] 

So saying I have to hold my hands up to the fact that I know no more than the next person and what I am saying below is purely speculative.  What I am suggesting below might appear logical to me but that does not mean that the people who are making the actual decisions are thinking the same way!

I would have thought that the European Court - which has generally adopted the principles of fairness/equitability etc - would come down on the side of people who were already resident before the law came in and would rule that it would not be equitable to apply the rule retrospectively to those people.  The reasoning in part for this is that the effect of any rule applied retrospectively would have a disproportionate effect on a significant number of people who had relocated in good faith and in accordance with principles applying at that time.  However, as the court has already ruled on the principle that people should not be a burden (and I support the decision), there would be nothing to prevent the new health care rules being applied to 'new' residents.The Government would just have to sort out the policy on the current 8% contribution to the CMU paid by all over the basic threshold for household income

If such an attitude by the court was foreseen by a Government then the Government's first step would - before it introduced the health care rules on residents - be to mount an exercise to identify who was actually 'resident' .  From what I can see, this process seems to be akin to the one we are witnessing now where information is being gathered but, as cooperlola said...how many people who were already members of CMU have come forward to show that they have had their eligibility for health care rescinded?

It is a worrying time but as cynical as I am I do not see this being applied retrospectively; OR if it is applied retrospectively,  without some provision being introduced to mitigate inequitable adverse effects on genuine residents.  I do of course reserve the right to delete this post and deny its existence if I am wrong![:D]

[AnOther]

Membership of the system is mandatory is it not ?

This from the Exclusive Healthcare site:

YOU SHOULD NOTE THAT IF YOU ARE RESIDENT IN FRANCE YOU ARE OBLIGED BY LAW [99-641 & 95-116] TO BE AFFILIATED TO THE STATE HEALTH CARE SYSTEM IN ONE WAY OR ANOTHER. THERE ARE SEVERE PENALTIES FOR NOT DOING SO AND THE COVER PROVIDED BY THE STATE MAY NOT BE REPLACED BY PRIVATE HEALTH INSURANCE POLICIES.

Surely this raises a conflict because if one is legally required to join the system and specifically prohibited from making private arrangements how can they refuse an application to join or cancel an existing membership ?  

[cooperlola]

Thanks Ernie, that's one of many "rubs" in all this.

Makfai, I don't think, sadly, that anybody who is already established here can ever assume that the laws of the land to which they have moved will never change.  It's a nice idea but I would not bank on it.

[BJSLIV]

Surely this raises a conflict because if one is legally required to join the system

This is the ruling that may well have changed, consequent upon a clarification of EU law. Instead of being required to join the current situation may be that one will be prohibited from joining. See mine and Will's posts elsewhere.

[cooperlola]

[quote user="BJSLIV"]

Surely this raises a conflict because if one is legally required to join the system

This is the ruling that may well have changed, consequent upon a clarification of EU law. Instead of being required to join the current situation may be that one will be prohibited from joining. See mine and Will's posts elsewhere.

[/quote]Finding the relevant and sensible, non-speculative posts is the fun part, BJSLIV!  I assume it's in the "Big Issue" thread.

[makfai]

[quote user="cooperlola"]

Makfai, I don't think, sadly, that anybody who is already established here can ever assume that the laws of the land to which they have moved will never change.  It's a nice idea but I would not bank on it.

[/quote]

 

I do, regrettably, share you reservation[:(]  That is why I tried to make it clear that I did not wish to raise false hopes.

So saying, while laws may change, there are tests of 'reasonableness' to be applied to their application.  It is this which I was trying to discuss.  The trouble is it is not unusual for Governments (and I don't mean necessarily the French) to ignore the 'reasonableness' test until compelled to do so by the courts. 

In this case I would like to think - but never like to give any govt too much credit for foresight and commonsense - that the administrators could foresee the possibility of a legal challenge supported by a lot of people who were already resident in France if this was applied retrospectively. Regrettably, however, the Govt may be prepared to run the risk because, I suspect, any such legal challenge would create a backlash of opinion from French nationals some of whom don't seem too keen on the Brits!

[cooperlola]

Makfai, this is especially true as I suspect that the new French president's election to office had something to do with the stance he was likely to take on immigration.  Our opinions are of little interest to the politicians here unless we all apply to become French nationals and have a vote and a voice here.  I cannot see that an outcry from us will hold much water.

However, I wonder if we are not coming at this from the wrong direction.  If, like me, you have paid (or are still paying) national insurance contributions in the UK which, had you been living there still, would have entitled you to free NHS care, then why isn't our governement - which we can and do still have the ability to vote for, or otherwise, supporting us still?   Especially if you have a government pension and still pay all your taxes in the UK also.

I can certainly understand the French government, and its people's, objection to people moving over here, declaring little income and not contributing much to the exchequer, at a time of life when complicated medical problems are likely to begin to appear, and taking advantage of what is, in a lot of cases, the excellent medical care which is provided here. 

After 2 years or so, we lose our rights to our E106s, and have to wait until pensionable age until we are entitled to E121s.  And yet, we do not lose our UK franchise - we still vote there unless we become French nationals.  However, the official stance from the UK is that within this gap "you are on your own", no matter whether you have fully contributed to the UK system or not.  I suspect this is the way in which many salve their consciences and - illegally - return to the UK for NHS treatment, long after their entitlements have run out.  They should in theory only accept NHS treatment if backed by an EHIC, issued in France.  We should not forget to lobby our own government in this case - we contribute to the NHS, we vote in the UK.  "Tough", is not an answer we should necessarily take lying down.