E121 - Top-up choices

[ali-cat]

I've been reading through as many post as I can find about what is refunded by CPAM, as we are organising our top-up insurance.  At the moment we're both on E121's (in receipt of incapacity benefit) & are receiving 100% cover for doctors fees, medication etc.  What I don't know (as we haven't needed it, yet) is, will we also receive 100% cover for e.g. dental or eye-care?

We've been quoted for two different policies - the first one covers 400%  & "Actual Cost" on all hospital fees & charges -  the second quote also covers 100% dental surgery, sight correction (frames, lenses), hearing correction, x-ray, psychiatrist consultations, etc. 

I've read posts talking about 70% refunds (from people I presume are, or were on E106's) but as I've got pretty dodgy teeth (!) & my eyesight's certainly not 20/20, I would be grateful if anyone knows if we're already covered 100%.

Hope that all makes sense & thank you!! [:D]

[Clair]

Ali-Cat,

This thread might help in the first instance:

http://www.completefrance.com/cs/forums/994559/ShowPost.aspx

[ali-cat]

Thanks Clair, 

The thread confirms why we may need 300% plus, for hospital treatment (it took me ages to get my head around that, when we first arrived!) but I'm just worried that we're possibly about to pay for 100% dental & eye treatment etc. that we already have! [8-)]

[cooperlola]

My understanding is that you only get 100% for things which are related to the condition, or which might be conceived to be a result of it.  If you broke your leg due to a fall, for instance, you would get the around 70% cover which everybody else gets, and a much smaller percentage for eye and dental care through the French system

Was that what you meant?

[Llwyncelyn]

My understanding and only my understanding is that the E121 covers a specific illness and those illnesses which occur from having that illness.  Thus they are covered 100% but that is only 100% of the agreed standard charge.  If say a specialist is outside the agreed financial limit (par example say a surgeon in Paris) then one does not get 100% of his fees.

Again just because one enjoys (and that is not the right word) 100% it relates solely as I say to the illness and thus dental and eye costs are not covered 100%.  Indeed to cover eye and dental stuff in France is something else for the costs in my considered opinion certainly dental wise are much greater than those in the UK.

Thus you have to take out complimentaire for the add ons!

The decision is like a piece of string.

We are with one of the recognised 'suppliers' but the advice must be to shop around.

 

[ali-cat]

Thank you for your replies - & sorry it's taken so long to thank you!

Just when I thought we were getting to grips with all this ..... we went to CPAM, in Saintes, yesterday.

The lady was very helpful & updated our Carte Vitals, on the spot, for another year.  We asked her excactly what we were covered 100% for (assuming she would say our pre-exciting medical conditions) & when she checked the information, on screen, she said "everything" - including eye care, dental treatment etc.  We showed her the quotes we had for top-up (one which included 100% eye & dental cover) & she said we were already covered for that & she recommended the policy for 400% hospital cover, as it would cover more costly treatments.

Thinking about it ..... I'm on an E121, as I have 6 torn discs in my back, but so far have  received 100% back on all my doctors visits & all the medication I have received - even though some of them have nothing to do with my back problems. [8-)]

[Polremy]

I dont think our dentist here in France is more expensive than our old one in England. Recently one of our visitors had toothache and I managed to get her an emergency visit. Our French dentist took x rays, diagnosed wisdom tooth trying to erupt, wrote her a prescription for antibiotics and painkillers and charged the princely sum of 20euros! The visitor was given a peuille de soins to take back to England so will presumably be reimbursed 70% of that in due course.

[Washy]

Thank you Living France Forum again........I have been battling my way through a great many postings on this tetchy subject and think I am not being served properly by my E121. Maybe the rule change from departement to departement?  I live in the Aude and initially was told I would be covered 100 per cent and my husband 70 percent on my E121.  I did not receive 100 per cent in any way even for precription charges, all of which are related to the condition for which the E 121 was awarded. So we have taken out a top up, paying 92 euros for the two of us through AXA.  We have been very happy with this as our prescriptions charges come to over 120 euros per month and AXA have paid out on dental care and eye care, not 100 per cent but a proportion.

So do these rules and amounts of cover differ from area to area?

I am getting together all my paperwork for CPAM and E121 copies for the moment when we are sent a letter by CPAM which I am sure will come....be prepared!!

[cooperlola]

An E121 per se does NOT cover you 100% for all your conditions.  Ali and Mr Cat are covered 100% because of the nature of their conditions, and with agreement from the French authorities.  All that an E121 entitles you to, in and of itself, is the same treatment - ie re-imbursement - that a French citizen would get.

[Tony F Dordogne]

Sorry Washy, I'm not sure whether I've read your message correctly.

Your E121 actually gives you nothing except access to the system in the same way that an E106/8/9 would.

There are national regulations covering 100% which do not change Dept to Dept.  To get your 100% you have to see your generaliste and then you have to make your case to CPAM and it's usually - though not always - a result for you.  If you haven't been getting 100% on your prescriptions it's because you're not in the system properly which, from what you say, seems to be the case.

I'm also on an E121 but had to make the case for my chemo and other drugs for the other conditions longue duree with the support of my GP.

And for Washy and in response to a previous message in this thread, 100% is 100% of what you have and conditions directly stemming from the condition that renders you unable or incapable of work.  Broken legs, teeth, flu injections, newly developed piles - all have to be paid for 70% (unless directly linked to your E121 condition) and then reimbursed through your top up.