Holiday Insurance claims

[betty]

Some insurance companies require that holiday medical claims are first made to the CPAM. All being well, they will then top up the difference. Be advised, the law has now changed (May 2010 apparently) no reimbursements will be paid by CPAM to non-nationals whilst they are overseas.

Not applicable to French citizens I understand.

BTW if your looking for a recommendation April Assistance is very good but expensive.

[Rabbie]

Is that allowed under EU rules if you are resident in France??

[Boiling a frog]

I do not quite follow. Do you mean that persons with an S1 registered with CPAM ie retired persons ,do not get reimbursed by CPAM? If so that is correct. It is the UK via your EHIC who reimburses you.

If that is not what you mean can you expand to give us a bigger clue.

[nomoss]

[quote user="Boiling a frog"]I do not quite follow. Do you mean that persons with an S1 registered with CPAM ie retired persons ,do not get reimbursed by CPAM? If so that is correct. It is the UK via your EHIC who reimburses you. If that is not what you mean can you expand to give us a bigger clue.[/quote]

 

I don't believe the EHIC is valid overseas, except in EU countries.

[Boiling a frog]

[quote user="nomoss"]

[quote user="Boiling a frog"]I do not quite follow. Do you mean that persons with an S1 registered with CPAM ie retired persons ,do not get reimbursed by CPAM? If so that is correct. It is the UK via your EHIC who reimburses you. If that is not what you mean can you expand to give us a bigger clue.[/quote]

 

I don't believe the EHIC is valid overseas, except in EU countries.

[/quote]

True, but why would CPAM reimburse a UK national ,who is using an S1 to gain access to the French system , but is not a la charge of the French system.

[Loiseau]

I think the OP might be referring to UK residents on holiday in France, who have obtained treatment during their holiday time and intend to claim using their EHIC.

Angela

[idun]

[quote user="betty"]Some insurance companies require that holiday medical claims are first made to the CPAM. All being well, they will then top up the difference. Be advised, the law has now changed (May 2010 apparently) no reimbursements will be paid by CPAM to non-nationals whilst they are overseas. Not applicable to French citizens I understand. BTW if your looking for a recommendation April Assistance is very good but expensive.[/quote]

 

Well as you said Betty, this was started in 2010 and one hands in the bills to Newcastle, whether it be the full paid bill or the 30% paid bill. The trouble is the that the hospitals can be very slow in issueing bills in France.

Still did you know that IF we do not put in a claim to Newcastle via our EHIC's, then if we have made an insurance claim, the insurance company does it on our behalf? And they get the money back. So why are they now wanting proof that a reimbursement is made..... that makes little sense to me.

 

Did you know that Newcastle will reimburse most of the cost of treatment abroad, and if you use an insurance claim, then you could perhaps end up paying an excess, which could be more costly and simply using the EHIC and waiting several months for the reimbursement to be paid.

 

I think that people really need to look into this before taking out expensive insurance policies.

[idun]

[quote user="Rabbie"]Is that allowed under EU rules if you are resident in France??[/quote]

 

French residents will not use an EHIC. As EHICs are not for use in France by french residents, so this would not apply to them. And if travelling to another EU country with their UK EHIC, then the bill would go to Newcastle for reimbursement.

[Frederick]

When it comes to staying in France . I have aways made sure we were covered with a Multy Trip Annulal cover policy ... In my case a 90 day one

I was wondering reading this  if many people   just rely on being in posession of their European Health Insurance Card should they be taken ill.?

How many on here just go to France  and stay for weeks /months in your  holiday home without bothering to get Annual Multy Trip  Health Cover. ?

I know it can be expensive ....... but so can being shipped back home on a streatcher .

[Russethouse]

We always take out travel insurance - as you say repatriation is very expensive...

[Benjamin]

I don't think anyone takes out travel insurance hoping to claim but it's worth it for the peace of mind it brings.

[Boiling a frog]

I do not believe that betty was talking about UK citizens with an EHIC.

She said

quote

Some insurance companies require that holiday medical claims are first made to the CPAM. All being well, they will then top up the difference. Be advised, the law has now changed (May 2010 apparently) no reimbursements will be paid by CPAM to non-nationals whilst they are overseas.

Not applicable to French citizens I understand.

BTW if your looking for a recommendation April Assistance is very good but expensive.

end of quote.

April Assistance is a French assurance coy dealing with French residents so hardly a recommendation for a UK resident visiting France.

PS

CPAM do refund costs to a UK EHIC holder non resident in France ,our neighbour visited local doctor 3 times last month then handed in the feuille de soin to CPAM along with bank details ,They were refunded at the appropriate rate the other day.

[cooperlola]

It would be nice, Betty, if you could come back and clarify this (esp with the legal reference) - I've been all over the place on the web trying to find it.  Do you mean Non-French European CEAM holders living in France claiming for medical expenses whilst on holiday elsewhere in Europe, or British EHIC holders on holiday in France?

[Boiling a frog]

I believe that the problem is this.

UK retirees who are resident in France take their S1 ,issued by the UK, to CPAM in order to obtain cover .

If they have a top up assurance then ,using their cart vitale they are reimbursed by CPAM at the appropriate rate. CPAM then pass on the details to ones mutuelle who then reimburse up to the. remaining amount.

All nice and simple.

However if one goes on holiday to another EU country,Spain, for example one uses the EHIC issued by the UK.

One pays for the medical treatment but one cannot then claim CPAM for the amount, one has to claim via the National Health Service.

Ones mutuelle is therefor not notified of the amount refunded ,because it was not refunded by CPAM,so they refuse to reimburse the excess.

So despite the fact that ones mutuelle covers one for holidays to another EU country including repatriation(mine does others may not) the difficulty arises because there is no liaison between CPAM and the mutuelle, which would be the case normally for a French national in similar circumstances.

I asked my mutuelle about this ,as I could foresee difficulties when the changed the rules ,and the UK now issue my EHIC.

It took them several weeks to respond and basically I now will have to pay up front try to obtain a receipt from the Overseas Healthcare team and submit to my mutuelle for any refund. I have not ,luckily, had to use the system yet.

[betty]

I think I’d better explain.

I am a full time resident of France.

I took out an insurance policy for overseas travel (USA).

When I made a claim, the insurance company asked me to make the initial claim to the CPAM as stated in the policy small print.

Part of the CPAM’s reply was:

‘En effet, vous résidez et êtes immatriculé en France avec I'imprimé E121, délivré par la Caisse d'Assurance Maladie du ROYAUME-UNl.

Or, selon le nouveau règlement communautaire n'883/2004 qui a pris effet le 01/05/2010, votre couverture sociale se limite à la prise en charge des soins dispensés en France’.

So I would guess that my premium will now increase as this ‘concession’ is no longer available to the insurance companies and they will have to bear the full amount.

I hope this makes sense.

B.a.F.

I would have thought all UK residents would use a UK company, therefore:

My recommendation for April was for French residents only. I had a very hefty bill for accident treatment out of the EU and they paid up in full, promptly.

[cooperlola]

Ah.  Thanks so much, Betty, that makes sense now.  It seems very odd that any insurer would expect your country of residence to pay for treatment outside the EU, wherever you were born and thus, yes, travel insurance is a must (thus I really can't leave Europe any more being disabled and having had cancer as insurance companies won't touch me except for half the national debt.)

BaF, not all of us have reached UK state retirement age so some of us still get a CEAM from France.

[Boiling a frog]

[quote user="cooperlola"]

Ah.  Thanks so much, Betty, that makes sense now.  It seems very odd that any insurer would expect your country of residence to pay for treatment outside the EU, wherever you were born and thus, yes, travel insurance is a must (thus I really can't leave Europe any more being disabled and having had cancer as insurance companies won't touch me except for half the national debt.)

BaF, not all of us have reached UK state retirement age so some of us still get a CEAM from France.

[/quote]

True but I was pointing out that logically ,if one has an S1 issued by the UK then that only covers one for treatment in France because outwith France, but still in the EU it is the UK which covers you via the EHIC.

In your case I suspect that you have an EHIC issued by France therefor it is France who picks up your tab so the previous statement re S1 holders does not apply.

,

[Boiling a frog]

In respect of reimbursement

http://www.cleiss.fr/particuliers/retour_en_france_soins_a_l_etranger.html

It appears if you are a la charge of the French health care system, no matter where you are in the world(outwith the EU where different rules apply) you can claim from CPAM a reimbursement of the medical costs incurred. Hence betty's difficulty.

The UK system is different, but a handy post for all of us on an S1 wanting to go on holiday outside of the EU .Perhaps best to use a UK based holiday assurance coy rather then complicating matters using a French one.

[cooperlola]

[quote user="Boiling a frog"][quote user="cooperlola"]

Ah.  Thanks so much, Betty, that makes sense now.  It seems very odd that any insurer would expect your country of residence to pay for treatment outside the EU, wherever you were born and thus, yes, travel insurance is a must (thus I really can't leave Europe any more being disabled and having had cancer as insurance companies won't touch me except for half the national debt.)

BaF, not all of us have reached UK state retirement age so some of us still get a CEAM from France.

[/quote] True but I was pointing out that logically ,if one has an S1 issued by the UK then that only covers one for treatment in France because outwith France, but still in the EU it is the UK which covers you via the EHIC. In your case I suspect that you have an EHIC issued by France therefor it is France who picks up your tab so the previous statement re S1 holders does not apply. ,[/quote]The fundamental problem was that I misunderstood Betty's post - I thought she was talking about European holidays!  I think I have it straight now but was somewhat put off by the notion that an insurance company would expect a French resident of any nationality to claim for treatment needed when on holiday outside Europe, from the CPAM.

EDIT : Thanks, Baf (posts crossed) - I never knew that.

[idun]

Si vous avez reçu des soins en Suisse ou dans un Etat non membre de l'UE-EEE

Textes de référence :
art. R.332-2 du code de la sécurité sociale

Dans la mesure où vous êtes affilié auprès du régime de protection sociale français, vous pouvez, après un séjour temporaire (à l'occasion de vacances, de séjour professionnel ou de séjours linguistiques par exemple) dans un de ces Etats demander à votre caisse primaire d'assurance maladie, sur présentation des factures acquittées, le remboursement des frais de santé. Sont concernés uniquement les soins inopinés hospitaliers et les soins inopinés non hospitaliers, qu'ils aient été dispensés dans le secteur public ou privé dans un de ces Etats .

En pratique, vous ferez l'avance des frais et présenterez à votre caisse française d'assurance maladie les factures acquittées.

La caisse vérifiera en particulier que les conditions prévues par la réglementation française en matière de remboursement sont satisfaites. Elle procède ensuite, s'il y a lieu, au remboursement forfaitaire des soins dispensés sans que celui-ci puisse excéder le montant du remboursement qui aurait été alloué si les soins avaient été dispensés en France.

Il convient de remarquer que la caisse d'assurance maladie a la possibilité de procéder au remboursement mais non l'obligation. En cas de refus, aucune contestation ne sera possible.

 

 

So for example for someone who is properly in the french health service.... me for example....... then as long as it was emergency treatment in another country, which from what I see here then CPAM will reimburse up to their usual plafonds? Has my french really gone to pot, is that  not what it says? It also says that they do not have to make these payments either.

 

The problem with taking UK holiday insurance out, would be that much of it is for residents only and french residents, would not be covered. I would hope that some companies do take on overseas residents.

[betty]

Yes it all sounded a bit odd but the insurance company were adamant that I must first make the claim from the CPAM as per their contract. They were obviously unaware of the rules and the contract was out of date.

Hopefully, we can now be aware that without this ‘aid’ from the CPAM one could come into financial difficulty with some hefty medical bills which may not be sufficiently supported by the Ins. Company.

[cooperlola]

All very interesting.

Idun, I know that you are fully in the sytem having worked in France for so long.  I, on the other hand although paying into the French health system am not, as far as I know, in the social security system per se since I don't pay any other cotis and never have and cannot get unemployment benefits or any other state aid afaik.  Could that be the difference?  It's not something I've ever looked into properly as I don't qualify for anything on the basis of my income so have never tried.

A further thought - under EU law we must be treated as French citizens once we've been here for five years thus I wonder if the French authorities could legally refuse to pay a UK national who has been resident here for that long, for medical expenses outside the EU, when they would not refuse a French citizen in similar cirumstances, as your link appears to imply.

[betty]

Good further thought Coops. I have resided here continuously for 11 years but it didn’t work for me.

[cooperlola]

[quote user="betty"]Good further thought Coops. I have resided here continuously for 11 years but it didn’t work for me.[/quote]And knowing how these things work, I'm not convinced that I'd like to give the theory a go.  But it might be worth asking the EU commission what their take is - especially if you work here .

Idun, Trailfinders are a UK insurer who will cover you wherever you live in Europe.

[Boiling a frog]

The fact is that it is the United Kingdom that pays for S1 holders medical needs, not France and that is why S1 holders afilliated to CPAM are only entitled to reimbursement via CPAM in France. Outwith France it is the UK who reimburses ..

The 5 year rules only relates to a right of residence without the requirement to have medical insurance or be a burden on the state. It does not give us the same rights as a French citizen(we are still unable to vote for instance in national elections.)

Après 5 ans de séjour

Droit au séjour permanent

Le citoyen européen ou suisse, qui a résidé de façon légale et ininterrompue en France pendant les 5 années précédentes, obtient un droit au séjour permanent.

À l'issue de cette période, il n'a plus besoin de prouver les conditions de son séjour (ressources par exemple). Il peut demeurer définitivement en France, à condition de ne pas représenter une menace grave pour l'ordre public.