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Free Top Up with Carte Vitale


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I have been asked by a friend in the Uk who is retiring to France soon to enquire about Top Up insurance when income is low. I think that if you are working and have a very low income you get "free" top up insurance (via CPAM??). The people concerned will be over 65 and qualify for a Carte Vitale. Does anyone know if this "free" top up can apply to a pensioner with a low income - say a slightly enhanced UK state pension and very little more?

If you can get "free" top up on a low income can anyone tell me what "low" means please? I think I have seen figures for "after tax allowances" (again when working) but am not sure what the gross income figure would be for a pensioner.

Many thanks

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I've never heard of free top up mutuelle insurance here for anyone whether poor or rich. A mutuelle is an extra to the state cover and is a private and personal insurance extra and not everyone takes it out or goes for the full percentage. I suggest your friend gets the right info from the CPAM because he may be refused a CdeS if his dept still demands it on the strength that he does not have enough health cover and is the wrong side of 60 and thus considered more of a risk. In fact if you read through recent threads there is one about the increase of monthly/yearly mutuelle costs so I doubt if it is free to someone coming from outside France.
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If you have a very low income you can enter the system on a 100% basis without need for top up insurance. The rules are complicated as usual but in essence if your income is at or below the income support level (SMIC) of France you will qualify. Find out what that currently is from government web sites. Sorry I don't know the web address.
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A free compementary insurance is possible but I have to say that there are all sorts of potential difficulties. If one has completed a French tax return and the "revenu fiscal de reference" (RFR) in respect of a couple is below 10197 Euros then you can apply for a free complementary policy. Thresholds are reviewed annually. The "revenu fiscal de reference" is the figure on which any tax is payable and is arrived at by deducting allowances from the gross income. Exactly what the allowances would amount to will depend on the nature of the sources of income. If all the gross income came from UK state/government pensions then you could expect to receive more allowances than, for example, if it was only investment income. Only an accountant could properly forecast what the "revenu fiscal de reference" would be.

But of course it will be some time before one fills in a French tax return and therefore receive a "revenu fiscal de reference". In these circumstances other reasonable proof would be accepted eg; pension statements. But you are then at the mercy of how CPAM would calculate entitlement to a free complementary insurance (in the absence of a RFR).

But even if a free complementary insurance is in place that is not the end of the story. First of all it still does not necessarily mean that all health costs are covered since a free complementary insurance will only pay up to the tarif. For example the tarif to see a specialist is 25 Euros (of which 70% is reimbursed by CPAM) But many can and do charge in excess of this tarif. A free complementary insurance will only pay up to 25 Euros. Also entitlement is reviewed annually and it would be a mistake to think that as long as the RFR is below 10197 Euros then the free insurance will remain in place. In these circumstances CPAM have considerable latitude in establishing entitlement. In short do not be surprised to be means tested.


Peter Owen
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