Healthcare in France
I help people deal with their health care paperwork pretty much every week. Why? Well, this is one of the processes that takes the longest and is one of the most important. Having difficulty knowing where to start? This is where we come in.
When living in any country as a resident, you are obliged to have healthcare cover either via the country you are living in, via a reciprocal agreement or privately.
As many of you may know, I’m very passionate about helping people with their seamless transition to France. I’ve made it my job to help people like you who are coming to France to get the most up to date, current information & support. Many of my consultations with people not yet living their dream life in France are around healthcare and how to access it.
Before going into the sickness benefit side of it, I want to just touch on the healthcare in France side of it. Remember that when living in France, there’s the healthcare access and the carte vitale. You need to separate both. The most important part is to get access to healthcare in France.
Unfortunately, it’s not always that easy, because healthcare in France is not free, it is a paid service. It is a good service, but it is paid. I’m not saying that it’s never free, but if it is, your resources need to justify this.
Really, you fall into a few categories.
1. If you’re a salaried person: make a request for your social security via the CPAM once you have 3 salary slips
2. Business Activity: make a request for your social security number via the SSI once you have a Siret number if it doesn’t come automatically
3. Retired and of retirement age: make a request via the CPAM ensuring you have your pension notifications with you
4. Early Retiree or inactive: make a request via the PUMA once you can prove 3 months of continual residence in France.
ADDING DEFENDANT BENEFICIARIES (husbands or wives)
If you applying via the PUMA (point 4 above), each adult person will need to apply in their own right. If you are applying as a retiree and have a dependant spouse, they would need to apply via the PUMA if they have no pension income, yet.
If you are applying as a salaried person or business owner (points 1 & 2 above) and you have a partner that you would like to add, you need to contact your healthcare provider and ask to attached your spouse to your healthcare rights. This only works if your partner is dependent upon you financially as they have no job or business. They will receive their own social security number but will have their rights opened because of your contributions into the social system.
One lady this week had difficulty with healthcare for her husband and accessing sickness benefits. It really brings all to the forefront, really, because here we are all in our businesses or in our jobs. But when it all goes wrong and somebody gets ill, what do we do?
SICKNESS BENEFITS AS AN EMPLOYEE
If you’re salaried, it’s really straightforward. You get what’s called an ‘Arret de Travail’ which is a document that’s given to you by your doctor. You have two days to give that to your employer and to your local CPAM healthcare office. You will then be given an ‘Attestation’ which will be given directly to your employer. They will tell you how much you will be getting paid back. How do you get paid? Well your daily rate is worked out basically out as an average over the last three months of your salary. The employer and the CPAM communicate the amounts based on your previous 3 months’ salary
There is three days of non-payment, known as a ‘carence’, which that means for three days you will receive no sickness benefits, even if you were only sick for four days. Note that there are certain criteria to respect, ie what hours you can be out of your home. Check this with your doctor.
SICKNESS BENEFITS WITH AUTO-ENTREPRENEUR
If you’re an auto-entrepreneur and have been active for a minimum of one year then you could access sickness benefits via the RSI (Regime Social d’Independents). The RSI is the equivalent of the CPAM but for businesses. These are your local health care representatives. It’s a very similar system to the salaried in that you have to get your doctor’s form ‘Arret de travail’ and then you have to give that to your local RSI office. You need to get this form back to them within 48 hours.
If you’ve been hospitalized, you will be given a document at the hospital. It’s called a ‘bulletin de situation’, which is really a detailed document of when you have gone in and come out of the hospital. They will give you this document, which you also have to give to the RSI who will calculate your reimbursement rate but it will be actually reimbursed via your health care service ie RAM, Mutuelle de Soleil etc.
HOW MUCH WILL YOU BE REIMBURSED? If you have been earning an average of €3,806 calculated over the past 3 years as an auto-entrepreneur, you have access to sickness benefits. They obviously then calculate the daily allowance based on percentages of what you’ve earned. The minimum amount you receive on a per-daily basis is €5.21. You really can’t buy more than a coffee here in the South of France with €5.21, and the maximum is about €53.74! So either way, it’s not great to be on sick as a business. If you are hospitalized, you have a 3 day ‘carence’ ie no payment during these first 3 days. If its sickness or a work accident, then this is 7 days.
If you have been earning under €3,806, well its very doubtful that you will get anything!.
LIBERALE ACTIVITIES The bad news for auto-entrepreneurs who have a consultancy type activity and are connected with the CIPAV there is no access to sicknss benefits. I’m hoping that will change in the new system with Macron, but we’ll wait and see.
MICRO ENTREPRENEUR IN THE CLASSIC SYSTEM ‘REEL’
For people who are independent workers, ie those people who are not in the auto-entrepreneur system but are the ‘réel’ system for their fiscal and social contributions, it’s a similar system again. You have to get your ‘arret de travail’ from the doctor, the ‘bulletin de situation’ with the hospital, take it to the RSI office, and they’ll validate it with the RAM for your reimbursements and daily allowances.
There is a minimum earnings level also for independents and also a 3 days ‘carence’ where no sickness benefits will be paid. From a calculation perspective, they will work out over the past three years what you’ve earned and they’ll do a daily amount. The minimum amount for independents, (not auto-entrepreneurs), is €20, and the maximum amount is around €53. Again, based on the last three years, they will work out your payments.
That’s a kind of overview on what you need to do and where you need to go. I would say for those people who have the serious illnesses, there are handicap benefits that you can get through the Caisse des Allocations Familiales (CAF) and the very first thing to do is get a social worker involved because it does take a long time. It can take up to six months to get those benefits in place, so if you are going to be incapacitated for a certain amount of time, don’t waste time, do the documents I’ve just told you about. Then get in contact with a local social worker who will then help you through the process and get you those benefits that you will so badly need while waiting to recover.
Hope you benefit from this information. There is a lot of it and its just an overview but it will point you in the right direction. If not, feel free to contact LBS via email to help you with your paperwork