Holiday Insurance claims

[cooperlola]

It seems that Betty's case is not S1 related - she has already said that she's covered by the French state, not the UK - like Idun and me - so I think it's a red herring.

I'll have to look at the EU statute for the rest of the 5 year rule stuff but iirc, (and it's of course perfectly possible that I don't!) there's a little more to it than the stuff from the French right to reside info'.

EDIT : Fundamentally, the statute which Idun quotes suggests that yes, indeed, a French citizen is entitled to claim (although there are caveats to suggest that this might not be successful in all cases) for emergency treatment received whilst outside the EU.  However, as I read it, Betty - whose competent state for healthcare is France, she has nowhere said she's on any sort of S form that I can see - has been refused, or at least been told that she would be refused, such payments.  Now, to my mind, this discriminates against non-French EU citizens living in France and I'm not sure that France can do this under EU law.  At the very least, in her shoes I'd ask the EU commission (via Solvit, perhaps) the question.

http://eumovement.wordpress.com/2011/11/15/equal-treatment/#more-970

"The basic rule is this:   If citizens of a host member state have a right, an advantage, a benefit, or an responsibility, then so do resident citizens of other EEA member states (and their family members)."

It might even be worth her while asking April to look into it - they'd have more clout and more motivation since it would apply to all their EU clients based in France and thus affects their balance sheet.

[Boiling a frog]

Bettys case is S1 related

See the reply she received from CPAM

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’.

[cooperlola]

Quite so, Mr Frog.  Sorry - missed the vital bit.[:$] I've been sitting here for too long, obviously!

It's still a right that local citizens have but non-French EU ones don't - a bit of a conundrum.

Now all I need to find out is whether they'd pay for any emergency treatment I, Idun and those like us with CEAMs, might have outside the EU.  It would make a real difference to me as I cannot get insurance at reasonable cost.  This thread has at least unearthed some interesting info' I knew nothing about before.

 

[idun]

This is all very complicated as it has much to do with benefits when deciding which state is responsible for health care. State pensions are a benefit.

 

In the end it would boil down to where people had worked most as to who was the responsible state, wouldn't it?

 

No idea how that would work for permanent residents pre retirement age who are in the french health care system. I have a feeling though, that in spite of having been in the french system, once the british pension starts, UK issued S1(E121s) would have be asked for and all would change.

 

Is this the case?

[cooperlola]

[quote user="idun"]

In the end it would boil down to where people had worked most as to who was the responsible state, wouldn't it?

 

[/quote]Well that would be the sensible way of doing it but this is Europe.  France is my competent state for healthcare.  I haven't worked here but I do pay (a fair, not unreasobale amount, imho) into the system for the time being.  And yes, it's my belief that when Mr C gets his UK state pension, then it all gets paid for by the UK and thus this regulation shouldn't apply any more, even if it does now (still not established.)  Unless of course, one could make a case for its being a benefit which French citizens enjoy which other EU citizens are denied. 

 I imagine,  however, that all these little quirks were ironed out when the law changed last year and the competent state began to issue the EHIC/CEAM as opposed to the state of residence, as in the past.  I reckon this is the change which Betty's post referred to which has altered the way in which these rights are now due.

[Boiling a frog]

[quote user="cooperlola"][quote user="idun"]

In the end it would boil down to where people had worked most as to who was the responsible state, wouldn't it?

 

[/quote]Well that would be the sensible way of doing it but this is Europe.  France is my competent state for healthcare.  I haven't worked here but I do pay (a fair, not unreasobale amount, imho) into the system for the time being.  And yes, it's my belief that when Mr C gets his UK state pension, then it all gets paid for by the UK and thus this regulation shouldn't apply any more, even if it does now (still not established.)  Unless of course, one could make a case for its being a benefit which French citizens enjoy which other EU citizens are denied. 

 I imagine,  however, that all these little quirks were ironed out when the law changed last year and the competent state began to issue the EHIC/CEAM as opposed to the state of residence, as in the past.  I reckon this is the change which Betty's post referred to which has altered the way in which these rights are now due.

[/quote]

Wishful thinking. The mutuelles do not have a clue about competent states, just like all sorts of other things ,car insurance for one.

[idun]

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.

Coops, it isn't a 'right', it looks like a 'perhaps' to me and they say that they are not obliged to pay this AND people cannot appeal against their decision not to pay. I cannot remember seeing such a statement that is so open to a 'difficult' fontionnaire, saying NON! whenever they feel like it and not being able to do anything about it at all.

In these circumstances, I would always have travel insurance.

 

[Boiling a frog]

[quote user="idun"]

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.

Coops, it isn't a 'right', it looks like a 'perhaps' to me and they say that they are not obliged to pay this AND people cannot appeal against their decision not to pay. I cannot remember seeing such a statement that is so open to a 'difficult' fontionnaire, saying NON! whenever they feel like it and not being able to do anything about it at all.

In these circumstances, I would always have travel insurance.

 

[/quote]

This is irrelevant, we are talking about UK citizens now resident in France with an S1

[idun]

[quote user="Boiling a frog"] 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.[/quote]

 

Well really they should have taken these forms home and sent them in, and they would have got more money back. The CPAM don't have to pay out anymore and could in fact return them these days.

But heyho, you love to oter les lentes when I say anything at all.

[Boiling a frog]

From NHS direct

Your European Health Insurance Card (EHIC) will enable you to access state provided healthcare at a reduced cost or sometimes free. It will cover you for treatment that is needed in order to allow you to continue your stay until your planned return. It also covers you for treatment of pre-existing medical conditions and for routine maternity care provided the reason for your visit is not specifically to give birth.

How to claim refunds

Reimbursements are claimed from the local CPAM office (Caisse Primaire D‘Assurance Maladie) in France. You will need to provide the treatment form (feuille de soins), copies of receipts and prescriptions, a copy of your EHIC, your address of residence and your bank details, including IBAN and BIC. Confirmation of your refund will be sent to your home address.

If you have had to pay for the cost of your care and have been unable to claim a refund during your stay in France you should contact the Overseas Healthcare Team (Newcastle) on 0191 218 1999 (Monday - Friday, 8am - 5pm) on your return to the UK. However, this process will take longer than claiming for a refund in France.

[idun]

How unhelpful to post like that. I was talking about GP's, as were you, in your post about your neighbours. And that too was irrelevant, as far as the OP was concerned!

I could give you the links, but you know, I'm not going to. If anyone else cannot find them and wants them, please please feel free to PM me.

 

To anyone travelling, well, personally, I would always have travel insurance. And if you need to see a french GP for a holiday emergency, then bring the bills home and send them to Newcastle.

 

[Boiling a frog]

[quote user="idun"]

How unhelpful to post like that. I was talking about GP's, as were you, in your post about your neighbours. And that too was irrelevant, as far as the OP was concerned!

I could give you the links, but you know, I'm not going to. If anyone else cannot find them and wants them, please please feel free to PM me.

 

To anyone travelling, well, personally, I would always have travel insurance. And if you need to see a french GP for a holiday emergency, then bring the bills home and send them to Newcastle.

 

[/quote]

That is not what NHS direct says .NHS direct says to go to CPAM and claim the refund.

Again I quote

From NHS direct

Your European Health Insurance Card (EHIC) will enable you to access state provided healthcare at a reduced cost or sometimes free. It will cover you for treatment that is needed in order to allow you to continue your stay until your planned return. It also covers you for treatment of pre-existing medical conditions and for routine maternity care provided the reason for your visit is not specifically to give birth.

How to claim refunds

Reimbursements are claimed from the local CPAM office (Caisse Primaire D‘Assurance Maladie) in France. You will need to provide the treatment form (feuille de soins), copies of receipts and prescriptions, a copy of your EHIC, your address of residence and your bank details, including IBAN and BIC. Confirmation of your refund will be sent to your home address.

If you have had to pay for the cost of your care and have been unable to claim a refund during your stay in France you should contact the Overseas Healthcare Team (Newcastle) on 0191 218 1999 (Monday - Friday, 8am - 5pm) on your return to the UK. However, this process will take longer than claiming for a refund in France.

Please do not give out misinformation as it could mislead people.

Generally speaking the only time that one will need to seek a refund is if one visits a GP or a specialists.and the NHS website and advice is perfectly clear, as outlined above ,your initial course of action is to claim the money back from CPAM.To try and suggest that CPAM will not reimburse you is just plain wrong.

As for my post being unhelpful ,may I suggest that it is your post which is unhelpful because the correct procedure is as laid out by NHS direct.

[idun]

I will say this only once.

 

You can write what you want and print what you want. Just stop accusing me of misinforming................ when I am not.

 

I'll post no more about this to you. As I said, if anyone else cannot find the proper link and  wants it, please PM me.  I'll happily pass it on.

 

[Boiling a frog]

Here is the French advice to EHIC card holders.

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

Remboursement

La feuille de soins datée, signée, avec les vignettes des médicaments collées, accompagnée de la prescription et d'une copie de la carte européenne d'assurance maladie ou du certificat provisoire de remplacement devront être remis à la C.P.A.M (ou la CGSS dans les DOM) dans la circonscription de laquelle les soins ont été dispensés. Vous devrez préciser votre adresse permanente ainsi que vos références bancaires (nom de la banque, adresse, code SWIFT, n° de compte avec code IBAN ou BIC).

or in English

Reimbursement

Once you have dated and signed the feuille de soins and attached the vignettes, you should send the form to the local CPAM (or CGSS), together with the prescription and a copy of your European Health Insurance Card or Provisional Replacement Certificate. You should also fill in the feuille de soins with your permanent address and give your bank details (name of bank, address, SWIFT code, account number and IBAN or BIC).

So it appears that CLEISS and NHS direct are singing from the same hymn sheet,and are giving the correct advice, while your advice is incorrect.

There is no need to PM me for the link to the advice, as I have given it in this post..

[cooperlola]

All I can tell you is that a very good friend of mine spent a fortnight in hospital here when staying with us (well, that had been the plan.)  A couple of months later she got a bill for her stay - about 10k in all.  The UK coughed up the lot, including the "hotel" portion, which I know no CPAM would have done.

There seems to be evidence that both methods work (whatever the official line may be in both countries) but in general I would say that if you are in a hurry for the cash, go to the CPAM, but if you can wait you'll probably get more back if you use the UK for your reimburesment after the fact.

[betty]

I can now tell a little bit more.

My insurance company insisted that I must first claim from

the UK and they would then reimburse the difference.

Talking to the UK overseas healthcare team, I learnt the

following.

UK will reimburse for some expenses outside of the

EU, in some countries which are:

http://www.nhs.uk/NHSEngland/Healthcareabroad/countryguide/NonEEAcountries/Pages/Non-EEAcountries.aspx

No reimbursements for treatment in the USA.

Reimbursement for dental treatment anywhere even in the EU maybe

‘difficult’. They would not elaborate on this. I expect they have had too many fraudulent cases e.g.

cosmetic perhaps.

CPAM will reimburse most worldwide medical expenses

to French nationals.

 

Incidentally, although I have mentioned April Ins.  in an earlier post, they were not the insurers

in this instance, nor was it Trailfinders. If you do consider the latter, have

a careful look at their small print. The excess for example is high especially

if you are over 70.

 

[idun]

You have raised some very interesting points here. And illustrated how the various health covers vary in EU countries.

If ever we decide to say travel to the USA, then as we are fully integrated into the CPAM (handing in S1's to Newcastle) although not french nationals, we should in theory be covered for such a journey. Although I have always taken travel insurance when visiting the US and Canada.

So for a UK french resident.......... would, for example they be able to get free hospital treatment in Australia? no longer being a UK resident?????

Essential documents

• Evidence of UK residence (e.g. NHS medical card or UK driving licence and temporary entry permit).

What's free

Public hospital treatment, including renal dialysis. You must arrange this before leaving the UK. Contact your NHS renal unit for further details.

What you'll need to pay for

• Treatment at most doctors' surgeries.

• Prescribed medicines.

• Ambulance travel.

• Dental treatment.

More information

You will need to enrol at a local Medicare office, but you can do this after you've had treatment. Some treatment charges may be partially refunded by the Medicare scheme. Try to make your claim while you're still in the country. 

 

The pity about this is that you took insurance in good faith and now they are not covering you properly, when you required cover, they should have known and understood that some clients are in your situation and covered accordingly, well that is how I look at it. And going through the small print..... personally I struggle with legalise small print in english, never mind french.

EDIT, so having reread what you have said, as the UK won't pay up, I daresay you will need that in writing, will your insurance company reimburse the lot????? I do hope for your sake that they do!

Incidentally many years ago we handed hospital bills from Austria into our CPAM and they turned them down, it would seem that things have much changed in the meantime.

[betty]

Idun,

Looking at my post again it was not very clear, I tried to

edit, could not and even logging back on has been a marathon task.

The insurance company told me today that they will pay up in

full. I wait.

If they pay, having the insurance has made it all worthwhile

but all this aggravation, writing to the CPAM then NHS. Was all this really

necessary? Your typical wriggling insurance co. I initially made the claim last

April!

The amount is small, around 100 € in this instance but I had

to pursue it as a test case as the next time the bill maybe €€€.

Just to clarify, the CPAM will only reimburse  French citizens,

not French residents.

The UK would not put their ‘conditions’ in writing to me as the

insurance co. wanted but I managed to persuade them to make do with looking at

the link I posted earlier.

[Hereford]

Quote:    Just to clarify, the CPAM will only reimburse  French citizens,

not French residents.

CPAM refunded the costs of anti-biotics and a consultation in China for someone we know - UK citizen but resident in France -  18 months or so ago, but probably they were fazed by the chinese!

[Chancer]

They dont discriminate on the grounds of race, all people with CPAM cover get treated equally.

However they ought to use racial profiling regarding the millions that are fraudulently taken from them before they even realise that it is happening, €12 million via a small one room clinic in les isles comores IIRC.

[Boiling a frog]

[quote user="Hereford"]

Quote:    Just to clarify, the CPAM will only reimburse  French citizens,

not French residents.

CPAM refunded the costs of anti-biotics and a consultation in China for someone we know - UK citizen but resident in France -  18 months or so ago, but probably they were fazed by the chinese!

[/quote]

I agree it has nothing to do with being a French Citizen, it is about how one is affiliated to the system

When I was affiliated via CMUB I had a French EHIC and was reimbursed for treatment I received in a non EU country by CPAM. I now have a UK EHIC so the rules for reimbursement outside of France are the UK rules. Nothing whatsoever do do with ones nationality.

[idun]

Betty, when I read your post again, I realised that there might be a possibility that they might pay up. I'll be delighted to hear that you have had your money back.

It isn't just french residents, as we are under the CPAM and they issue us with S1's, we are, as far as they are concerned, completely in the french system. Eventually, our ties to the CPAM will stop when the UK pension kicks in, as we are UK residents now. If we had remained in France, we would have remained completely in the french system in spite of the UK pension.

 

I don't know whether people realise, but sometimes mutualists will not pay up for certain health bills, because what ever the medical thing is, it is not covered by the CPAM. Good idea to check thoroughly on the mutualist contract, especially as the CPAM is wriggling out of much at the moment.