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Should we pay for a mutuelle?


bubbles

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We both have our cartes vitales.

We are just over 60.

I have 100% cover on mine.

We put money aside (200euros) each month in case of expensive emergencies.

Does that sound reasonable or "does the panel think" we should really take out a mutuelle?

I know this has been discussed before but nobody seems to have mentioned the 100% cover factor.

Thanks
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Maybe Bubbles refers to "avoir le 100%" not just in relation to an ALD, but also because of receiving AAH (Allocation Adulte Handicapé) or UK Long Term Incapacity Benefit. If that is the case, then Bubbles is in the same position as someone who is a recipient of CMU complémentaire (i.e.  no longer  just 70%, but 100% of most things, except for the daily hospitalisation rate, which is usually extra - perhaps something to get private insurance for . Around 150-200 euros a year should provide a "hospitalisation only" top-up health insurance cover just for you, Bubbles, but not for your partner/wife/husband.

 

Edit: I see from your post in "New Year Resolution", Bubbles,  that you own property in England, in Spain, and in France. That would confirm that if you get "the 100%", it is not because you are receiving CMU complémentaire, to which you would not be entitled as it is designed for people who are close to destitution. You would not be receiving AAH either (same reason, since it is means-tested here). On the other hand, since UK Incapacity Benefit is only paid if you are below pensionable age,  I am now rather perplex. You should not be getting 100% of your health care, unless there have been "omissions" in your French tax declarations, or in the filling of other forms.

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Setting the 100% stuff aside for a moment and returning to your original question.  I have now been in hospital for over four months following a car crash - the kind of event which is certainly not covered by an ALD 100% consession.  I have had 15 hours of surgery in all.  I look like I'll be in hospital for another two months at the very least, after which I'll be an out-patient (possibly for four hours a day) for another six months or so.  I'll have to learn to drive an automatic car, and re-take a test.  For the 120 euros or so a month (less than your own "in case" fund) my o/h and I have been paying to our complementaire, we have total peace of mind and have got every cent back from either the state or said insurance company. 

At one point it was touch and go as to whether I would live/lose a limb/be permanently severely disabled.  How much more stressful the past few months would have been if my o/h had had to contemplate selling the house to pay for my treatment, on top of everything else.  I think you know I'm firmly in the pay up camp![:D]

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Hi!

what do you call 100% cover?

Do you mean that you have an illness which is recognized ALD ( Affection de Longue Durée)?

If that is the case the cover ( except franchises ) concerns only that illness, and nothing else.

If in general hospital costs in France for operation are covered by the CMU ( except Euro 16 per dat for upkeep) there are case where in hospital you can be confronted at costs over Euro 1440 a day at your sole charge, so if you can not afford a top-up, and you do not qualify for a free top-up ( means tested ), you would be ill counselled not to have at least a hospital top up.

See here the small program:

http://www.capisante.com/simulateur-remboursements-yahoo.php

You can test what a top-up will cover

See here what you can pay in specific cases, so hat you program entries are not theoretical.

http://www.ameli.fr/assures/search.php?q=tarif+consulation

Yours,

giantpanda

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Bubbles:  I think your partner should take out a mutuelle/complementaire, you probably don't need one. One complementaire will cost less than 200€ per month and will cover all evenutalities immediately.

My partner has the 100% cover** that you describe. I buy assurance complementaire.  When the provider looked at OHs paperwork

from CPAM they advised that 'when

you have this level of cover from securite sociale, it is not worth paying for a complementaire'

I totally agree with Coops; the purpose of insurance is peace of mind.

A devastating health issue can occur at any time, maybe before you have

saved up enough to cover it.  I hope that all my insurance payments are never drawn on, but I pay them, just in case.

**100%

cover via E121. It is not means tested. Treatment for all conditions,

including dental, is covered 100% and paid for by the UK.

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AAAAgh!

So, it's all been a big mistake - sort of bank error in my favour.

I certainly didn't lie on any forms.

We first got our Cartes Vitales while I was still on long term incapacity benefit - about 5 years ago.

That stopped of course when I reached 60.

Not sure what I should do now.

Just carry on as before?

Bury my head in the sand?

Take out a mutuelle anyway?

Go in and talk to CPAM?

Any ideas?

Oh, dear, almost wish I hadn't asked now.

Thank you everyone.

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[quote user="5-element"]

 

Edit: ............. 

  I am now rather perplex. You should not be getting 100% of your health care, unless there have been "omissions" in your French tax declarations, or in the filling of other forms.

[/quote]

Seems to be both   Other quotes from the OP "Our pensions are paid and taxed in England but I know we really ought to fill out a French tax declaration"  and  "The only other assets we have are modest savings in English Building Societies"  Obviously also not declared and taxed in France or not declared to avoid sociale charges and paying for their health care[:'(].

EDIT

Now the OP has stated she is on an E 121 it all becomes clear so no health care payments avoided just tax and sociale charges[:-))]

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Go and talk to the folks at CPAM.  Might be an idea to go and talk to the folks at the tax office as well.  With 5 years in France and  (as mentioned in your other thread) no tax declaration, you should get your tax situation sorted out at the same time as your health cover, otherwise you could well find yourself in a sticky situation.

EDIT, my post crossed with Ron's.

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[quote user="bubbles"]AAAAgh!

So, it's all been a big mistake - sort of bank error in my favour.

I certainly didn't lie on any forms.

We first got our Cartes Vitales while I was still on long term incapacity benefit - about 5 years ago.

That stopped of course when I reached 60.

Not sure what I should do now.

Just carry on as before?

Bury my head in the sand?

Take out a mutuelle anyway?

Go in and talk to CPAM?

Any ideas?

Oh, dear, almost wish I hadn't asked now.

Thank you everyone.[/quote]

When you passed the 60 mark were you issued with another E121 by Newcastle changing the basis of cover from Incapacity to Retirement?

If not, then the E121 held by your CPAM has now expired and so has the 100% cover provided for all illnesses.

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[quote user="bubbles"]...Not sure what I should do now...[/quote]

Talk to DWP to find out if it is an error. OH has a letter stating that the UK will cover his healthcare for life.  Perhaps this changes at 60/65 but if that is the case, it is a very poorly worded official letter.

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[quote user="Âme"]

**100% cover via E121. It is not means tested. Treatment for all conditions, including dental, is covered 100% and paid for by the UK.

[/quote]

 

NOT SO.

 E121 from UK state pension does not give you 100% cover.

It gives you 70% cover, like other French residents and French citizens. Which is why anyone with an E121 should take private top-up insurance for the remaining 30%, as eloquently demonstrated by previous posters.

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I agree 5E.  An ICB E121 covers you 100%, a retirement age based one does not.  It has always seemed ludicrous to me as clearly you don't lose the handicap/illness/condition just because you get old....

Re my previous posting.  It's been pointed out elsewhere that car insurers reimburse expenses following an accident.  However, it was just an example - any devastating accident could have the same consequences as I describe.

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As I have previously posted on other threads there is another reason to get a good Mutuelle, as well as the ones already mentioned.

There is an increasing tendency towards 'privatisation' in French medicine with 'dépassement des horaires' becoming more common, and many things become non-reimbursable.

So not only do you need a Mutelle for the 30% not covered  by the E121, but also for the future as more and more costs are pushed their way.

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[quote user="cooperlola"]

I agree 5E.  An ICB E121 covers you 100%, a retirement age based one does not.  It has always seemed ludicrous to me as clearly you don't lose the handicap/illness/condition just because you get old....

[/quote]

As I've pointed out above because, if you remember sometime before your lorry skirmish, this also happened to Mrs Benjamin and we quickly had to get onto Newcastle and get them to issue a Retirement E121.

As far as losing the 100% cover but not the incapacity, you could look at it from the other direction and count the 100% cover for an Incapacity as being a bit of a bonus.  [:D]

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You have to look on the bright side, Benjamin.[:)]

Norman, I agree with you also.  Although for this reason, complementaire payments are likely to rise the more the onus falls on them to bail the French health system out of its financial black hole.  It will make more and more people question whether top-ups are affordable.  Sadly it's likely to be those who are the worst off who'll be the first to dump them.

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Thanks, everyone.

Have been checking out costs and will have a good think ablout what is best to do.

Coops, I think the Incapacity thingy stops at 60 because, by that ripe old age we are meant to expect to be incapacitated! that's the only reason i can think of.

Glad you are recovering well, by the way.

And did you give up smoking permanently?
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Bubbles, in the old days, the CPAMs seemed to be quite happy to continue to pay out on the basis of the ICB E121s after retirement age and everybody kept stum.  These days they are getting their acts together more and more and, as Benjamin found out some months ago, are checking up and making sure that people exchange them when reaching retirement age.

Not permanently but thus far I have not started again.  I think it unwise to make any commitments on the smoking front, but at least the haitus has helped to ease the exchange rate problem a little - we're probably saving nearly 50 euros a week!

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[quote user="cooperlola"]

Bubbles, in the old days, the CPAMs seemed to be quite happy to continue to pay out on the basis of the ICB E121s after retirement age and everybody kept stum.  These days they are getting their acts together more and more and, as Benjamin found out some months ago, are checking up and making sure that people exchange them when reaching retirement age.

Not permanently but thus far I have not started again.  I think it unwise to make any commitments on the smoking front, but at least the haitus has helped to ease the exchange rate problem a little - we're probably saving nearly 50 euros a week!

[/quote]

Who knows what the situation is regarding this poster. They have been asked several questions to try to clarify their situation but seem hell bent on not giving any answers. I admire your doggedness in ploughing on cooperlola.

As far as the smoking is concerned you know that eventually you will have/need to stop smoking so start thinking in your own mind that this is that occassion. Would you want to start all over again and then go through the same pain in giving up some time in the future?

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[quote user="bubbles"]We both have our cartes vitales.

We are just over 60.

I have 100% cover on mine.

We put money aside (200euros) each month in case of expensive emergencies.

Does that sound reasonable or "does the panel think" we should really take out a mutuelle?

I know this has been discussed before but nobody seems to have mentioned the 100% cover factor.

Thanks[/quote]

Hi,

   For an interesting view on this, google: le particulier , archive, issue 1014, page 64, "se passer de mutuelle;:un calcul rentable"

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[quote user="parsnips"]For an interesting view on this, google: le particulier , archive, issue 1014, page 64, "se passer de mutuelle;:un calcul rentable"[/quote]

http://www.leparticulier.fr/theme/Se-passer-de-sa-mutuelle-un-calcul-rentable-5-assurance-3405.html (in Google English HERE)

http://www.leparticulier.fr/theme/Reduire-son-assurance-sante-a-ses-stricts-besoins-5-assurance-11322.html (in Google English HERE)

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Sorry.

I didn't realise I hadn't answered questions.

I hate being told off.

I will answer anything you ask.

I certainly wasn't trying to evade or avoid anything.

I have come to the conclusion that my situation must be the same as Mrs. Benjamin's was - when I reached 60 nobody changed my incapacity E121 to a retirement one.

I don't remember getting any letter from Newcastle at the time.

I have found all the replies very useful and am grateful for everyone who took time to explain things.

I have been looking at comparison sites (thanks again) for mutuelles and will call in at our Generali office when I am back in France in the New Year.

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