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PUMA, AE and phasing out of 'ayant droit'


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I’ve been keeping an eye on posts about the new healthcare system because I’ve been wondering how it’s going to affect us, being a bit wary after the fiasco in 07 when CPAM started refusing to let early retirees enter the CMU, regardless of whether they were stably resident and had sufficient resources. I’ve got some thoughts on it so I thought I’d see what you guys think as I might just be being paranoid.

When the 07 fiasco was resolved and people were allowed to join the CMU again it was based purely on them being stably resident and having enough resources to not become a burden upon the state (so they had to prove a minimum income of the RSA level for their family composition).

A lot of people still found it easier to join by becoming an AE, which had been the favoured method during the period where entry to the CMU had been refused. Only one spouse of a couple needed to do this as the other would be provided healthcare as an ‘ayant droit’.

The PUMU seems to be a way of grouping everyone together under the same rules, whether EU or non EU. The same criteria of a stable residence and self sufficient income is there for non active people but I notice that the requirement to have a full health cover during the initial period has also been brought back into it. So does this mean you have to have private health cover during that first three months, if you haven’t brought jobseeker’s allowance over with you? Or maybe you can use the EHIC card because you’re not considered to be here permanently until after that three months? It’s just odd that it was taken off the criteria when access to the CMU was re-allowed but now it’s back again.

The next thing PUMA does is to bring in the phasing out of the ‘ayant droit’ system. This is billed as being better for spouses because they will be in the system in their own right and in the event of a change of circumstances such as their spouse changing caisse, divorce or separation or death of a spouse – they won’t be left in limbo with no health cover while their ‘couple dossier’ is being sorted out.

This is supposed to be a gradual change and I’d read it as only applying to new applicants or if a change of circumstances happens. However, it looks like people who are ‘ayant droits’ are being moved over to CPAM whenever their dossier is reviewed for any reason. This could be a good way of reviewing whether people currently in the system fit into the new rules and making sure that mistakes haven’t been made during the dodgy periods in the past where nobody seemed clear on the rules?

Now what I may be being paranoid about is what happens when someone who is an ‘ayant droit’ of an AE business operator is reviewed and moved to CPAM. Income wasn’t a question as an ‘ayant droit’ of an AE before and many people had only a small income from an AE business which got a couple or even a family into the system with very little cost. However, if an ‘ayant droit’ now becomes an applicant to PUMA in their own right and being self sufficient is part of the criteria to assess their right to join, what happens if they have no income? I assume a spouse could guarantee to support them but what if that spouse, even though operating as an AE, doesn’t have enough income for them both to be self sufficient? I guess we’ll find out soon as these people are being reviewed.

There had to be some reason for CMU to be stopped and the new PUMA brought in and I’m wondering if it’s a way of reassessing everyone and making sure that loopholes like using an AE business with very little income to get a household into the system very cheaply is one of the reasons.

What do you reckon?

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re your last para, yes; too many (dubious) ayant droit; imagine the extent to which an extended family with several wives could be in the system for one simple AE?

Now, if only the NHS could do that!

(a comparison just to please Norman - by the way, how goes the begging, old son? Has the idea of franchising pitches, renting out handicapped kids and pathetic looking doggies worked to make you a bit of extra pin money? Very Dickensian!)
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I thought the whole purpose of PUMA was to make each person have individual cover gained in whatever way possible, rather than people being allowed to 'piggy back' on another's contribution.

Options would be working, running a business, or having been legally resident for five years (which implies that they had health cover during that period ) and that residence was continuous. (La réforme s'accompagne ainsi de nouvelles modalités de contrôle

adaptées, en particulier pour identifier les personnes ayant quitté le

territoire.)

Another way is to pay into the system, but each person has to sort this out.

avec la réforme, toute personne majeure est assurée à titre individuel

dès sa majorité (ou dès 16 ans à sa demande). Elle pourra choisir de

percevoir ses remboursements sur son propre compte bancaire, recevoir

son propre décompte de remboursement et disposer de son propre compte

ameli

The ayant droit of someone si vous êtes vous-même ayant droit majeur d'un assuré, vous continuez à

bénéficier de la prise en charge de vos frais de santé sans aucun

changement.

Si vous le souhaitez, vous pouvez dès à présent demander

votre affiliation en tant qu'assuré sur critère de résidence auprès de

votre caisse d'assurance maladie.

Pour cela, remplissez le formulaire Demande d'ouverture des droits à l'assurance maladie - n° 736.cnamts (PDF, 1,1 Mo) et adressez-le, accompagné des justificatifs demandés, à votre caisse d'assurance maladie.

with an AE will simply have to show that he or she meets the criteria

si vous êtes vous-même ayant droit majeur d'un assuré, vous continuez à

bénéficier de la prise en charge de vos frais de santé sans aucun

changement.

Si vous le souhaitez, vous pouvez dès à présent demander

votre affiliation en tant qu'assuré sur critère de résidence auprès de

votre caisse d'assurance maladie.

Pour cela, remplissez le formulaire Demande d'ouverture des droits à l'assurance maladie - n° 736.cnamts (PDF, 1,1 Mo) et adressez-le, accompagné des justificatifs demandés, à votre caisse d'assurance maladie.

The only people who might have a problem are those who haven't been here for 5 years and don't come under any of the ways in I mentioned above. I presume they woukd either pay into the CMU or take PHI

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It's still a requirement to be 'stable and regular' to join PUMA if you're resident here and that means having a minimum income that means you won't become a burden upon the state.

The more I look into it the more I think the new system is to catch out those who are paying very little to be in the system. If you are an AE/ME for instance and have income lower than 3861€ per annum then they will know from your tax return if you have other income which takes you above 9611€ per annum and then a cotisation will become due, to be billed from next year onwards based upon this year's income. If no income, then it's mentioned that assets and even benefits in kind can be taken into account, so maybe if your tax return shows you are still below that income, a further investigation will be done re your assets?

People who are 'ayant droit' are being moved to CPAM as and when and if they don't have that amount of income then they will still be allowed in if their spouse does. What happens if the spouse doesn't have it either? What if upon further investigation it's found that they are renting and have no other assets to be assessed upon? Are they then classed as being not legally resident and not allowed in the system at all, despite running a small business?
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See these links (sorry but I don't know how to make them clickable):

https://www.legifrance.gouv.fr/affichCodeArticle.do?cidTexte=LEGITEXT000006073189&idArticle

http://www.devenir-rentier.fr/t10817

https://www.urssaf.fr/portail/home/espaces-dedies/beneficiaires-de-la-puma-et-de-l/de-la-cmu-de-base-a-la-puma.pdf

https://monespaceprive.msa.fr/lfr/web/msa-alpes-vaucluse/protection-universelle-maladie?p_p_id=56_INSTANCE_6GDf&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&p_p_col_id=column-1&p_p_col_count=1&_56_INSTANCE_6GDf_read_more=3
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Still trying to figure it all out.

Does this bit mean those two figures get added together? That's what it reads as and the upper figure is the limit under which you pay no cotisations if you're not active so it looks like it's that the lower figure gets forgotten because you've already paid cotisations on that and the rest of your income has to be higher than that higher figure to ensure that you pay cotisations on that, just as you would if you were in the old CMU with no activity. Make sense???

'Le point sur la cotisation de la Puma

La cotisation de la Puma participe au financement du système de santé de manière équitable en complément des autres cotisations d’assurance maladie obligatoire. Elle est due par les personnes qui perçoivent des revenus professionnels inférieurs à 3 861€ et dont les revenus du capital sont supérieurs à un montant de 9611€.'

So your other income only gets taken into account if your business income is less than 3861€ and then you only pay the extra PUMa cotisation if your other income is higher than 9611€.

I’m getting boggled reading it now.
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What you can be sure of is that if thousands of low paid French people end up having to pay more for healthcare then it won't happen and it wasn't designed to 'punish' a few early retiree immigrants.

The main thing was to give everybody their own individual right to healthcare, rather than them having to dependent on others. This then avoids the scenario of couples separating, or being widowed, and then having to jump over all sorts of hurdles to establish their right to healthcare independently. That to me, seems a good thing, although I'm sure the process of changing over will be painful. When OH and I arrived we could have had one of us work and the other claim ayant droit but right from the start we could see potential problems with that, and decided it was better that we both had our own cards, independently assessed.

The other aim was to make it fairer for all people to access healthcare. For example, to avoid that pitfall where you work, but it is just under the amount required to enable you to get healthcare, so you have to apply for what was CMU. That also has to be a good thing.

I would guess that there actually aren't that many people on the microentrepreneur scheme that really earn so little that they would be penalized. Even on my small earning last year, my cotisations reached the minimum that I would have to pay under a minimum contribution scheme.

The five year rule was done away with for EU citizens after it as ruled illegal by the EU courts, and stable residence is now defined as 3 months continuous residence. Of course if the UK does leave the EU, which wouldn't be until 2 years after a no vote, then that may well become important. In fact I think a lot of things might change dependent on how the UK renegotiates its relationship with Europe and how it treats Europeans currently in the UK.
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There seems to be some confusion over this 5 year rule.

The five year rule is that after five years of continous legal stable residence you have the right to stay here and you have no criteria to meet.

That rule still remains. It was never ruled illegal, AFAIK it has never been challenged.

Until you've been here for five years you do have to meet the criteria for legal and stable residence, and that too is unchanged.

The fuss was about whether or not France was obliged to provide healthcare for people who had been here for less than 5 years and who met the criteria. It was ruled that the were obliged. So between 3 months and 5 years, people were then allowed to join CMU and are now allowed to join PUMA, but only on the condition that they can prove they meet the criteria, and the criterion that sometimes causes them to be refused is the income threshhold. After 5 years they no longer have to prove this year after year. But in order to prove 5 years continuous legal residence and therefore qualify for ongoing entitements, they have to either prove that they've met the criteria and been covered by CMU/PUMA for 5 successive years, or that they've had full private health insurance for those 5 years (or I guess a mixture of the two). You can't just sit below the parapet for 5 years and then pop your head up and claim to qualify just on the grounds of having been here, just forgot to tell anyone.

Linda, yes that is how the government is presenting PUMA - loads of advantages for everyone. I somehow don't think that is the whole story, given that the main driver behind the reforms was that state is looking to bring in more cotisations nationally to keep the system afloat, and also to make the system fairer. So, obviously some people are going to end up paying more otherwise how would more money flow in. However you have to read the small print to see exactly who these lucky people are, because when governments all over the world launch new schemes they never make a lot of noise about the losers and the downsides, they only talk about the upsides and the winners.
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I don't know of anyone being refused access to CMU /PMU recently on the grounds that they haven't had enough income though. People have been asked to show bank statements and details of past salaries but many would not have current income.

The other way of proving 5 years health cover is to either be employed or be covered by your microenterprise?

Yes, I'm sure contributions for some may go up, but it won't be for those on low incomes or there will be a revolution. Think of all those low paid French farmers living in the family farm, so paying no rent..do you really think they will be asked to pay more based on the value of their house or the few thousand Euros they have stacked away to cover contingencies?
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I don't think it is actually the value of your house so much as income from property, transfers of property and capital gains that are taken into account along with savings and investments interest and benefits in kind. I don't think anyone truly on a low income will be affected.

I've heard of people being refused entry to the CMU because their income isn't high enough - that's an EU rule. It's the 'regular' part of 'stable and regular residence' that says you have to have enough income to be self sufficient to be allowed into the health system.

There are a lot of people who only started an AE because it was cheaper than paying into the CMU based upon all of their income (or back in 07, they didn't even have a choice as it was the only way in). I've seen people switch to be 'ayant droit' when a spouse opened an AE rather than stay in the CMU as that meant paying cotisations based upon all of their income. Those are the people who will be caught out. They're only making sure that you pay contributions on all of your income above the PUMa threshold. Who is going to argue with that?

Before now, income thresholds have only affected inactive people. This is the first time they've been mentioned in relation to active people. It still seems to be only in relation to what cotisations they will pay and doesn't seem to be saying that there would be a test if they are eligible to join the system at all, as there is for inactive people.

I'd like to think that with it being billed as a way in for everyone, they won't use it to exclude truly low income active people from access to healthcare. But this is France - and it could be a grey area that takes a while to sort out if someone gets it into their head that it should be used in that way.

Obviously even if they don't use it that way there is also the question of whether such monitoring would affect one's right to permanent residence after five years, if active but with income deemed not to be enough to be self sufficient.

Paranoid maybe - but again, this is France and I've lived here for a while now.
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quote lindal1000: 'I would guess that there actually aren't that many people on the microentrepreneur scheme that really earn so little that they would be penalized.'

Are you really saying you're unaware of all those people who run a very low income business so they get cheap healthcare and don't have to pay cotisations on their various other incomes? People run one gite under the AE scheme when they don't have to as they don't meet the limits that make it necessary and could just declare the income on their tax return - but then they'd have to be in the CMU and pay cotisations on all of their income. People run small businesses with very small turnover for the same reason. It's rife. It's also been common advice given on many 'expat' forums, for a long time.
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"doesn't seem to be saying that there would be a test if they are eligible to join the system at all, as there is for inactive people."

How could they because if you earn anything at all you pay cotisations, and they can't accept your cotisations no matter how small and then say that you are not in the system.

I don't suppose they have even considered Brits who might work here and earn a low income. This being France the legislation has been designed around the French. If they are paying less than they should then they will have to pay more and if they are on a low income then they will get support, the question of whether they are entitled to be here or not does not arise.
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Does anyone know whether proving your 'droit de sejour' over a five year period when applying for a permanent resident card includes proof of a self sufficient income level during the five years if you are 'active', as it does for those who are 'inactive'?
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quote EuroTrash "This being France the legislation has been designed around the French. If they are paying less than they should then they will have to pay more and if they are on a low income then they will get support, the question of whether they are entitled to be here or not does not arise.'

It does for foreigners though and I'm sure they're well aware of that. It's whether it will be used just to collect extra cotisations or to prevent people from getting into the system or getting permanent resident status that I'm wondering about but as I asked above, I'm not aware of whether income level is taken into account when assessing an active person's right to a permanent residence status or not.
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I have to say it's not just foreigners who have taken advantage of the cheap cotisation level of AE/ME though. I read a thread where French people where talking about declaring a fictitious turnover just above the lower limit for their AE/ME business to avoid their rents and other income being assessed for extra cotisations.
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A couple could still earn just above 7722 € evenly split between two enterprises and have comparatively cheap healthcare if they have a lot of other income, compared to inactive people who join PUMa. Or similarly, just above 9611€ with one enterprise.
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[quote user="Debra"]Does anyone know whether proving your 'droit de sejour' over a five year period when applying for a permanent resident card includes proof of a self sufficient income level during the five years if you are 'active', as it does for those who are 'inactive'?[/quote]

Only in the minds of people who keep spouting it and the other old chestnut "you must have had full private health cover" on forums.

 

When the mantra becomes omni-present like that of global warming people start believing it and worrying needlessly.

 

It is only right and proper that people whatever their nationality should pay healthcare cotisations on all their income not just a small part declared as AE, re the gîte income, the French are currently advised not to declare it as AE earnings under any circumstances as they will pay healthcare cotisations on it whereas declared under revenus BIC non pro they wont, they are only advised to declare under AE if they have no social cover.

 

I also feel that it is not right that S1 holders should be able to reclaim their social charges on UK income, the French cannot and to me its no different.

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Yes, that link I posted seemed to say that you only have to have been working with not too many breaks to have a droit de sejour if you're active and doesn't seem to mention income level.

As I said above, there will still be people who won't be paying cotisations based upon all of their income.
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Being employed and on a low income in France, whatever the nationality would not affect this as far as I can see. The cotisations would automatically be linked to getting health care and these days, there is also mutuellist cover involved too.

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[quote user="Chancer"]

[quote user="Debra"]Does anyone know whether proving your 'droit de sejour' over a five year period when applying for a permanent resident card includes proof of a self sufficient income level during the five years if you are 'active', as it does for those who are 'inactive'?[/quote]

Only in the minds of people who keep spouting it and the other old chestnut "you must have had full private health cover" on forums.

 

When the mantra becomes omni-present like that of global warming people start believing it and worrying needlessly.

 

It is only right and proper that people whatever their nationality should pay healthcare cotisations on all their income not just a small part declared as AE, re the gîte income, the French are currently advised not to declare it as AE earnings under any circumstances as they will pay healthcare cotisations on it whereas declared under revenus BIC non pro they wont, they are only advised to declare under AE if they have no social cover.

 

I also feel that it is not right that S1 holders should be able to reclaim their social charges on UK income, the French cannot and to me its no different.

[/quote]As I understand it and please correct me if I am wrong people on S1 have their health care paid for by the country issuing the S1. The French health care system will issue a bill for the costs of treatment to the relevant authority in the other country. If this is the case then I can see no reason why S1 holders should pay cotisations /social charges as they are not costing the French State for their treatment.

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Debra said "Are you really saying you're unaware of all those people who run a very low income business so they get cheap healthcare and don't have to pay cotisations on their various other incomes? People run one gite under the AE scheme when they don't have to as they don't meet the limits that make it necessary and could just declare the income on their tax return - but then they'd have to be in the CMU and pay cotisations on all of their income. People run small businesses with very small turnover for the same reason. It's rife. It's also been common advice given on many 'expat' forums, for a long time."

But in practice there are very few and I think to be honest the French aren't interested in them. People were encouraged to become AE's because at the time, being economically active was the only way you could get cover. As it turned out, for many people it actually worked out cheaper than had been allowed to join CMU..but that was hardly their fault. You pay a fair percentage of your income if you are an AE/ME, regardless of how little it is. You also pay tax and CSG on unearned income, regardless. I live in gite land and I don't know anyone who does what you suggest but then most of them started before the CMU restrictions and so just applied to that and paid a percentage of their income over 9000 euros. Most of them pay considerably less than we do as AEs and don't have to do the extra work! That said, being forced to work, even in the limited way that we do, has really helped us with integrating and getting our head round the system, so I'm not complaining. However, I will keep an eye on our turnover and make sure we don't earn too much, if this looks like it is going to affect us..especially as my pension will kick in in a couple of years, taking my unearned income up to more than my earned income.
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The other issue related to the situation that Debra described is that some early retirees who started an AE purely as a means to getting healthcare, are now reaching UK retirement age and reporting that they've been refused an S1 by the UK on the grounds that France is the last country where they worked and contributed, not the UK, therefore France and not the UK is responsible for their healthcare during retirement. If that's the case they'll have saved a penny and lost a pound, as the saying goes. Or even, several pounds.
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That's always been the case though and is not specific to these changes. Most of us that became AE's did it because we didn't have any other option, other than private healthcare, not as a money saving exercise. You have to pay something somewhere, and I believe that the French government are now claiming that CSG is a tax and not social charge, so Uk pensioners will be liable for it anyway, regardless of who pays for their health.
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Refused an S1 by the UK. Well, the rules have always been as they are.

ie IF we move back to France, then in spite of receiving a UK pension, the last place worked was France, and so no S1 from the UK for us. And if there is a brexit, then we have considered Ireland as a destination and we would need a french S1 there, even though we have UK pensions.

I thought people knew the rules. NH has mentioned how it works for him often enough.

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