French Healthcare for British Expats

[makfai]

cooperlola;  You have certainly got a point here albeit I don't think the Brit expat lobby from France has much 'pull' in UK because - in part - our votes are fragmented throughout the country.  If we could all sign up for one constituency and put that member under pressure we may have more influence! We could, however, I suppose, if it reaches that stage, open a petition at http://petitions.pm.gov.uk/

I still keep coming back to the fairness in this and hope that commonsense will prevail.  (I know what you are going to say and share the same reservations!) If you want, in my view, an example of a non-commensense decision then look at the UK policy of paying Winter Fuel Allowances to people who are living abroad (for example in France). 

If we go back to the source authority for all this change then we have to look at the EC Residence Directive. (A simplified version can be read at http://www.cpag.org.uk/cro/wrb/wrb190/rights_of_residence.htm) Some pertinent points are below

EC Directive 2004/38 repeals all existing EU residence directives and amends EC Regulation 1612/68, the regulation governing the rights of EU workers. The Directive introduces a simplified system of conditions governing the right of residence for all EU citizens.

It gives all EU nationals a right of entry to any EU state and allows a right of residence for the first three months of arriving in a new member state. This right of residence is conditional on the person not becoming an unreasonable burden on the social assistance system of the host member state. Social assistance is generally taken to mean income support or income-based JSA in the UK.   [EDIT: Note there is no mention of this applying to the health service in UK]

To establish a right of residence after the initial three-month period, an EU national must fall within one of the following groups:

• employed (workers);

• self-employed;

• economically inactive people with sufficient resources to support themselves and insured against sickness;

• students who have sufficient means to support themselves at the start of their studies and who are insured against sickness;

• family members of any of the above who are accompanying or joining the EU national.

The point that I keep hanging on to is that the question of 'not being a burden' and 'insuring against sickness 'etc is a test of 'residence'.  I would argue (but what does that count for!) that for those who have already become resident 'the boat has already sailed' as far as any Government is concerned and no court would support a right of residence being withdrawn in these circumstances. To me (again...what does that matter!) it follows that it would be equally inequitable to expect a Govt to be able to apply rules of residency retrospectively.

There are lots of interesting articles on the more theoretical aspects of issues related to this (they can be read in lieu of sleeping tablets which might be too expensive[:)])

Here is one extract from an article of 'interest' as seen from the UK perspective:

'The new directive paves the way for further expansion of the rights of the non-economically active. The directive states that all citizens will have the right of residence (and are therefore within the scope of community law for the first time) as long as they do not become an “unreasonable burden” on the UK (current free movement directives talk simply about a “burden”). Legal experts have argued that it will be impossible to prove that any one person has become an “unreasonable” burden on a country.'

As Professor Hailbronner argues: “In any individual case it will hardly ever be possible to show the unreasonableness of a burden. The social system as such cannot be substantially affected by an additional beneficiary”. He argues that the clauses of the Directive “seem to follow the Court’s line of reasoning that there are no conditions at all but only restrictions which are subject to the principle of proportionality.”

Furthermore, in recent rulings the ECJ has interpreted the idea of avoiding “unreasonable burden” to mean almost the opposite of what it means in common speech. For example, the case of Grzelczyk found the court ruling that this formulation in fact implies that national governments accept that there is “a certain degree of financial solidarity between nationals of a host Member state and nationals of other Member states”.

Under the directive, a job seeker or economically inactive citizen continues to enjoy the right of residence in the UK after three months as long as they do not become a “burden” on the nation’s security system. However this requirement is effectively neutered by a clause which forbids member states from expelling EU citizens simply because they are claiming benefits.

The citizen would then be left in a situation where they no longer have the right to reside in the UK, but they can not be removed from the country. It is unrealistic to assume that the UK would be able to refuse to provide any assistance at all in this scenario. UK case law and the European Convention on Human Rights dictate that the Government would have to provide assistance equivalent to that given to asylum seekers on non-discrimination grounds.

The directive states that once an EU citizen has done any form of employment in the host state, including a short fixed term contract, then he will be entitled for at least 6 months to the same social security benefits as a home national.

Once an EU citizen has been employed for a year in the UK he will be entitled to equal rights to social security payments.'

(page 7ff http://www.openeurope.org.uk/research/freemovement.pdf)

So I reckon that rather than open this can of worms, if I was setting the policy, I would cut my losses and make sure that the new rules applied only to people who were 'en route' to residency NOT already in residence.

Having said all this we all know that nothing is predictable with politically tainted decisions.  As I have said, I support the policy but not it being applied retrospectively. However, applying it retrospectively would probably not be an unpopular move in the eyes of the majority of French residents. Maybe the question of the application retrospectively could be the foundation of any petition on the website?  http://petitions.pm.gov.uk/

 

EDIT: Sorry about the weird change in font above - it wont do what it is told for some reason!

[cooperlola]

That is very good news, Puzzled.  One person who will sleep well tonight. [:)]

Any chance, without giving too much away, obviously, you could let us know which your CPAM is and roughly what your circumstances are ie, company/government pensioner, how long you've been here etc?  It would be good to know how these decisions are being made.

[makfai]

[quote user="Puzzled"]

Paid my CPAM a visit today and was told that my cover would continue without doubt. They even worked out the new amount that I would have to pay and checked and double checked with the relevant office when I mentioned the new 'reforms'. Obviously, I have had nothing in writing yet but they said they would write to confirm this, this week. [:D][:D][:D]

[/quote]

Nice to see a bit of good news!

[Cat]

Here, perhaps,  is some more...

I don't know if anyone has already posted this link http://timescorrespondents.typepad.com/charles_bremner/2007/09/france-cuts-bri.html

But in it the journalist says that ...

The change was well known, but it appears that some regional authorities may be acting with Sarkozy-style rigour and cancelling Cartes Vitales (the entitlement card) held by Britons already in the French system. The Paris Social Security ministry tells us that this is impossible since the change applies only to new applicants.

 

[Will]

"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? "

I think when one decides to opt out of living in a country, one opts out of the benefits as well as the lack of prospects, crime, alcoholism, Labour government, immigration and the 101 other reasons people give for leaving Britain. Unfortunately opting out is not a selective process. It's no longer your goverment. Even though one may still pay taxes in one's home country, this is more a quirk of the dual taxation agreement than anything else.

The more I look into this whole question, it seems that those who live (and maybe work) in France legally and have done the right thing as far as declaring income is concerned, have little or nothing to worry about. It's the duckers and divers on the edge of the system who are likely to find themselves ineligible for French residence.

[cooperlola]

Wise words as ever.  It was more of a rhetorical question than anything else, as a counter to the idea that "the French government" is suddenly laying into (some of) us.  And we are still expected to vote in the UK.

Looking at Cat's info' it seems you may have it bang on and as such, I say, hoorah.  My nose gets severely out of joint when those who don't bother to comply with the rules which don't suit them, but happily take what they fancy from the system, end up doing better than those of us who try to do it "by the book."  Even so, it will not trap those who  keep an address in England for the sole purpose of using NHS facilities and others when it suits them, and because they do not wish/are too lazy/ whatever to pay their dues where they should.  There are very few Brits around here whom I know but at least 2 couples do not pay taxes here and keep UK registered cars although they live here for at least 10 months of each year.  And yes, when they want treatment (including a major, forseen, op' in one case) they go back to the UK.  They've never bothered with Cartes Vitales and use their UK issued EHIC's for emergencies here.  Will they ever be caught, I wonder?

[chessfou]

[quote]the change applies only to new applicants[Cat][/quote]

That leaves the question of what is a "new applicant:"

- someone who applies for CPAM attestation without so much as an E106

and/or

- someone who applies for CPAM attestation with an E106 in the dossier;

or

- someone whose CPAM attestation needs to be "updated" on the expiry of the E106.

(plus any other circumstance I haven't thought of).

Personal position: "inactif" retired couple, both 58, CPAM attestation to be "updated" in Jan 2008 (termination of E106).

Financially it may not make much difference to us what the outcome is (we would be contributing nigh on €4,000 p.a., inc. mutuelle, so not vastly different to insurance) but the inconvenience would be substantial: pre-existing conditions; having to stop/start both carte vitale and our mutuelle sub (with, presumably, another "stage" or waiting period), especially since it would probably be a shortish period, my wife qualifying for an E121 after 15 months which, on current practice, would likely see me being an "appendage".

[Tony F Dordogne]

I think Will has expressed it very succinctly - if you're 'under the radar'; 'living on the edge' or just basically here illegally, watch out because if you're anywhere in the system, the French government is likely to get you eventually and rightly so.

For those here, part of the system, paying their way or legitimately declaring their income, not a problem.

[mint]

I have heard a lot about people who are below retirement age and are in somewhat of a dicey situation.  I can see why this might be so.  On the other hand, many seem to assume that people over retirement age have "nothing to worry about."  That's ok and bully for them and all that.  BUT, the cheats are not confined to people of the younger generation by any means.  I know of people who are past retirement age, have got their cartes vitales, keep houses back in the UK which they let and do not declare to ANYBODY (French or British) and use the French services for routine things like anti-flu jabs and the NHS for things that they cannot deal with in France (no French please, we're British) such as anti-depressants.  Will any of the processes that are taking place weed out the likes of these?

[chessfou]

[quote]Will any of the processes that are taking place weed out the likes of these?[sweet17][/quote]

I think it is reasonable to suspect that this may be the beginning of a concerted attack on the "levitationists" (those without visible means of support).

[AnOther]

This couldn't have come at a worse time for us just having made the move with me just aged 57 and the OH coming up to 56 and been refused an E106 for lack of sufficient NI contributions. There is a glimmer of hope in that I'm currently still working and paying tax & NI in the UK and, prima facia at least, HMRC have told me that I'm probably entitled to an E109 which I'm applying for straight away. The situation is further confused by the fact that we have private health cover with PPP via my job which will of course cease when I do eventually pack it up.

The real downside though is that I think I will almost certainly now have to postpone my retirement plans to at least when the OH turns 60 when I may be able to piggy back onto her E121.

I'm think I may start looking into starting a business which we really didn't want to do and hitherto hadn't even contemplated but it may prove to be the course of least expense and the only realistic route to my retirement much before 65.

Whilst I have no real sympathy for the "levitationists" (nice choice of term BTW) it does seem that this is a bit unfair on those who are repared to play by the rules and pay their way but if there is no longer any benefit from playing it straight then surely it becomes tempting to join their ranks and concentrate on looking after No.1 

[Russethouse]

Ernie, have you actually got quotes for health cover in France yet ?

 

[AnOther]

No, not yet.

[mint]

ErnieY

I understand what you say about the temptation of joining the ranks of the cheats but I suspect that you will play it straight anyway.  You seem to me to be far too honest a person to do otherwise.

Cheating, lying to officials or in writing on forms?  Who but a fool would do that?  What they don't realise is they are not just losing integrity and sleep (worry about being found out), they are losing something much more precious - their soul AND I DON'T MEAN THAT IN A RELIGIOUS SENSE as I am an agnostic.

I am sure you'd find a way out of your problem and it will be in such a way that will bring you happiness and fulfilment.

All the very best, ErnieY, in what must be a very worrying time for you and your OH

[cooperlola]

Ernie, don't despair.  R/H's point is salient.  I've been having a good look at private plans and although they would be a real trial for anybody who earns very little and/or worse, has an existing condition, for those with reasonable pensions the difference in cost is not quite as scary as you think.  Here's a hypothetical : If you earn a pension of - between you - say 30,000 euros a year, you currently would have to pay 8% of that into the CMU.  After around 7,000 in allowances, that's 1840.  On top of that you'd be paying for a top-up insurance, which wouldn't be far short of 1200 euros a year for both of you.  So you're already talking 3,000 euros a year for the CMU.  I've found some quite reasonable plans for us (53 and 59) for under 4,000 euros - although I admit they don't cover you fully and have big excesses.  The more comprehensive ones come out at more like 5k.  So somebody in that position (and I've made up the salary figure but it's probably a reasonable one as there will be a lot of people on £20K or so) would have to find about another 100 euros a month until they reach E121 age.

Many of the companies I have looked at do better deals for existing customers, and may even cover existing conditions. So if you are with a company through your work, it may well be worth finding out if your own company can organise for your history with the existing provider to extend to a new policy on your move to France.

I'm steadily compiling a list of different providers here

http://www.completefrance.com/cs/forums/1017162/ShowPost.aspx

One poster on here has been told by her mutuelle here, that there are plans, also, to introduce full cover schems by some French providers, so these may make useful addtions to the list when they come on stream.

It would be worth your while to look at them and get estimates, before throwing the baby out with the bathwater and postponing your move.

[AnOther]

You're correct of course sweet 17 that there is only one way to do it and that's the right way, I was playing devils advocat in my comment.

What is highly frustrating is that having struggled to understand the system and formulated plans for the medium and long term future based on that understanding, only to have it all turned on it's head in an instant and find oneself effectively back to square one, or possibly worse in fact because the situation is now so unclear that it's almost impossible to make alternative plans.

The one thing I know without a shadow of doubt is that I WILL NOT be working to 65, no way Jose...[:'(]

Coops:

It's not a question of postponing the move because it's done, we effectively moved in at the beginning of August.

Your comment "they would be a real trial for anybody who earns very little and/or worse, has an existing condition" has hit the nail bang on the head because we both have these; I need frequent and long term monitoring for a cancerous condition and OH is type 2 Diabetic, both of which I'm presuming would be excluded in a private scheme.

If I do get an E109 then it's only valid for 1 year but renewable as long as I'm still paying UK NI, which means whilst I'm still working of course and, as I've already said, we're also covered by PPP, so essentially it's the choice of when to retire which has been snatched from me. I'd planned to do this within the next 2 to 3 years roughly at age 60 but now, at very best if I can piggy back onto OH's E121, I have to wait until the end of 2011 to find out if even that is going to be possible [:(]

Given the circumstances I think that, despite the costs, starting up a business could be a cheaper option so something definately worth looking into.

The only bright spot is that because I was going to carry on working for a couple of years anyway I do have some time for the whole situation to settle down and to reconsider my options once it has.

I hope that some sort of full cover private plans do emerge because it seems to me to be simply morally indefensible to cast significant numbers of innocent people, who have paid their dues in their native EEA member country, and who are quite prepared to continue contributing here, out into a health wilderness, otherwise what has the union got except a common currency ?

One final point: as this all supposedly kicks in on sept 30th. do you think that there is any point in my OH trying to get in now at the 11th hour with her E106 refusal ?

[makfai]

[quote user="ErnieY"]

One final point: as this all supposedly kicks in on sept 30th. do you think that there is any point in my OH trying to get in now at the 11th hour with her E106 refusal ?

[/quote]

I think the principle is 'give it a go'... after all there is nothing to lose

 

Have you also tried this?

When you get forms E106, register the forms by giving them to the authorities who run the sickness insurance scheme in the country where you live. If you have family members who cannot be issued with form E106 in their own right, they may be covered as members of your family on your own form E106, but this is a matter for the authorities in the country where you reside. Ask them if they can include your family members when your form E106 is registered.

http://www.dwp.gov.uk/international/sa29/medical_06.asp

 

I think cooperlola may have some experience of this

 

[cooperlola]

Ernie, is there any future, do you think, on applying for any sort of disabiltiy allowances - is your condition severe enough?  I have a friend who has cancer, who benefits, and you may try this route.  The important point is that those on disability qualify for E121's, regardless of age.  Speak to your doc' and Newcastle.  I'm not in this category so don't know how it works but maybe your company could help if they could declare you unfit for work at some time. Then your o/h could piggy-back on to you.

Does your E109 continue even if you pay voluntary contributions?  I assume not; again, it's not something I know too much about.

The existing conditions clause only applies to new policy holders.  It is for that reason that I suggest you talk to PPP who do a plan for ex-pats/immigrants.  Because you are currently covered by them under your company policy, they may be willing to transfer your history and keep you on with existing conditions.  But again, you would need your company's help in doing this.

On your last point I would say that absolutely anything is worth a try.  Go for it, you cannot be worse off.

Edit : As long as you are returning to the UK to work, then you pay tax there and can continue to use the NHS when you're there of course - so your wife might be able to get her drugs etc if she accompanies you over there.  I don't think that could be considered by anybody to be "bucking the system" or cheating.  Once you retire, the "disability" route may be possible for you.  Dunno.

 

[AnOther]

Coops, I'm shocked you could suggest such a thing...but don't worry, I'll get over it...[:-))]

Fortunately my "condition" is relatively minor as "Big C" goes and not at all debilitating (though some might argue the point [+o(]) http://www.completefrance.com/cs/forums/912082/ShowPost.aspx however it does need close monitoring for the next 6 years and is presently covered under my PPP plan. If it were anything remotely approaching grounds for disability then believe me I wouldn't be allowed within 100 miles of an offshore oil installation which is where I work as I think you know.

You're correct that voluntary NI contributions do not qualify one for an E109 as it is based on the obligation to pay rather than the act of paying.

The PPP route may be worth exploring and I will follow this one up.

Circumstances permitting returning to UK is of course an option and indeed our former GP practice have said that they would leave us on their books until we asked them to do otherwise although this is a far from ideal for obvious reasons.

'er indoors is going to give it a shot getting in before Sept 30th because as you say, there is nothing to lose by trying. Even though we have really only just moved over we have owned the house since January and been paying the bills etc. so could legitimately claim to have been there since then.

Lets see what happens. Are the CMU offices open on Monday's and what else are they likely to want to see apart from the obvious:

Passport

E106 refusal

Birth & Marriage certs

Proof of Residence

 

[Tony F Dordogne]

Couple of points - would the cost of cotizations for the first three years be more or less than paying for health care?

And be careful about working/disability and E121, you may end up being tripped up, especially in the next few years if you continue to work in the UK system and try to claim health cover through an E121.  And as far as I understand things it wont cover your wife, she will need her own E121.

[AnOther]

I don't know enough yet about the cost of setting up a business and the cotizatioins etc. to say but if I couldn't get a private plan to cover our pre-existing conditions then as I said earlier it's either work to 2011 until my OH's E121 kicks in and then try to piggy back onto that or work to 65 (2015) which is definately NOT in the game plan !

Frankly the disability thing is a complete non starter anyway but thanks for the heads up.

One step at a time I think is the way forward, lets see first if 'er indoors can blag her way in, she can be very persuasive....!

[cooperlola]

I am just trying to think of every possible way to skin your particular cat!

A further thought.  As far as private healthcare plans are concerned, pre-existing conditions seem to be OK for existing customers.  Top up insurance (which most of us have at present) is nothing like as picky in this regard.  Ergo : if your wife succeeds in joining the CMU now and gets top-up insurance, then in the case of any withdrawal in the future, if you upgraded to full cover with an existing provider, you pre-existing conditions should be OK.  But this varies with each company's rules so you need to look very carefully at all their small print.  But then, when don't you....

Edit : Sorry, Ernie, forgot about your list.  My CPAM is open on Mondays, but then it's even open at lunchtime - don't know about yours.  Opening hours are on the CPAM websites.  I'll find the link.

That list looks OK, but my advice is to take every single bit of paper that you think might conceivably, and inconceivably - be needed.  Phone bills and electricity bills for the time you've been here are good.  She'll also need evidence of all her income so they can calculate what she'll pay.  As I was on an E106, I had done a French tax return by the time I started paying in - I don't know how this is done for the newly arrived with only an income in £.  Somebody will....

Edit :The payments are worked out based on gross annual income for the previous year, so at a guess, I would say, take along all payslips/other evidence of income for the calendar year 2006, and add it up and have the conversion into euros with you.  The official exchange rate for last year is here

http://www.completefrance.com/cs/forums/940739/ShowPost.aspx

[Hagar]

[quote user="ErnieY"]

This couldn't have come at a worse time for us just having made the move with me just aged 57 and the OH coming up to 56 and been refused an E106 for lack of sufficient NI contributions.

The real downside though is that I think I will almost certainly now have to postpone my retirement plans to at least when the OH turns 60 when I may be able to piggy back onto her E121.

[/quote]

Ernie - I really hope I am not giving you further bad news BUT - if your OH is not yet 56 she will not be entitled to an E121 at age 60. It is more like 61 years and 6 months. You can check it out here.

http://www.thepensionservice.gov.uk/resourcecentre/statepensioncalc.asp

rgds

Hagar

[cooperlola]

Ernie, the CMU website is here

http://www.cmu.fr/site/index.php4

Pop your postcode in the green box, top right, here

http://www.ameli.fr/assures/index_sarthe.php

and details of your office should pop up

[AnOther]

Thanks Coops, saved my next question [kiss]

She has no independent income BTW (outside a €100 monthly allowance from me - receipts and change please..[Www]) so should she produce my UK pay slip instead ?

To Hagar, damn your eyes sir or madam, I had forgotten it's graduated now depending on DOB so good news this is not !