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This page was last updated 31 March 2008. |
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| CMU & Summary of Health Care in France | |
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CMU & Summary of health care in France
Government position January 2008 After many confusing articles on this subject, the official position from the French government was softened in December 2007 and updated on their site http://www.securite-sociale.fr/comprendre/europe/europe/cmu_inactifs.htm on the 14/12/07 and again on the 24 January 2008. Government position January 2008The new position is essentially the same as before, with the very important difference that expats who had already emigrated to France no later than the 23 November 2007 AND who have or have held an E106 may join the CMU on the same criteria as French nationals. This detail is explained in their FAQ question 6. Government position December 2007
The following is a translation of the stated government position in December 2007. This is the current position, except for the concession mentioned above. The circular of the Directorate of Social Security of 23 November 2007 has just detailed the measures taken by the decree of 29 March 2007 that transposes the EU Directive of 29 April 2004 about the lawfulness of residence into French law. EU nationals and assimilated who live in France particularly as inactive, students or job seekers can benefit from the CMU if they live lawfully in France. However, their right of residence, which is no longer formalised by obtaining a residence permit, depends on two conditions: Sufficient financial resources and a complete medical insurance. For persons having lived in France
continuously and legally less than 5 years in total, access to the CMU can only
be allowed when, after having obtained a right of residence, these persons
encounter a setback that causes a loss of financial resources or their medical
insurance. This circular applies from,the 23 November 2007. In order to make it easier to understand the circular, the Directorate of Social Security has a list of answers to practical questions EU citizens may ask. Government position September 2007The following is a translation of the stated government position in September 2007. The position has now changed, but this translation is still useful as reference. Concerning EC law, the EU citizens’ free movement and residence right are principles and a residence permit cannot be demanded. Nevertheless, a Directive from 2004 states certain criteria for inactive people as well as students and their family members: According to Directive 2004/38, it is a condition for the residence right of these people in another Member State than their own that: - they already have a medical insurance - they have sufficient financial resources to avoid becoming an unreasonable burden on the finances on the host Member State. The new Directive has been transposed into French law particularly by law 2006-911 of 24 July 2006 and by decree 2007-371 of 21 March 2007 http://www.legifrance.gouv.fr/WAspad/Visu?cid=802267&indice=1&table=JORF&ligneDeb=1. These 2 texts, that
accurately reflect these 2 criteria, lead to the consideration that an inactive
EU citizen coming to live in Concerning these 2 texts, here are the points that the social security administration wish to state regarding UK citizens: 1) French regulations have no specific measures for medical insurance for UK citizens. They receive the same treatment, what rights and obligations are concerned, as other EU citizens living in or coming to live in France. 2) There are no changes for people with a certificate (E106 or E121) for right to medical cover delivered by the UK administration. They can still register with their local CPAM and benefit from French medical services provided on behalf of the UK system, so long as these certificates remain current. 3) For inactive persons already benefiting from CMU because of earlier regulations, they are granted a 6-months’ period, starting 1 October 2007, to find a private medical insurance. During this period, they continue to be covered by the CMU. 4) For new demands, that is inactive people who arrive to live in France and claim the CMU benefit, the CPAM must refuse, because according to the EU Directive 2004/38 on the right of citizens of the Union and their family members to move and reside freely within the territory of the Member States (transposed notably in this aspect by decree number 2007-371 of 21/3/07), these inactive people must already have a medical insurance prior to becoming resident in France. 5) If an inactive person is not covered by the health care system in another Member State at the time of becoming resident in France, he or she must contract a private insurance before arriving in France. 6) Instructions will rapidly be distributed to the French health care administrations to remind them about these rules and point out to them that they apply to all concerned individuals. Only those already having the CMU will benefit from the grace period mentioned under 3) above. For further information concerning their personal situation, those concerned can contact the CNAMTS (English telephone service + 33 (0)8 20 90 42 12) or the CLEISS (+ 33 (0)1 45 26 33 41). Legal AnalysisThe references to the Directive 2004/34 http://eur-lex.europa.eu/LexUriServ/site/en/consleg/2004/L/02004L0038-20040430-en.pdf are correct. The EU freedom of movement depends for inactive persons on sufficient financial resources and medical insurance, as well when arriving as while living in another Member State. Only after 5 years’ continued and legal residence in another Member State would the person concerned obtain the right of permanent residence in the host country (Art. 16), and from that moment, restrictions on social security would cease. Also, the restrictions only concern people who have not been working in the host country at all. BUT: Art. 37 stipulates that “this Directive shall not affect any laws, regulations or administrative provisions laid down by a Member State which would be more favourable to the persons covered by this Directive.” In other words, if French law gives you better rights than this Directive, then this Directive has no effect on that French law. As for French immigration law:Art. L121-1 of the French Immigration Code (Code de l’entrée et du séjour des étrangers et du droit d’asile) http://www.legifrance.gouv.fr/WAspad/RechercheSimplePartieCode?commun=CENTGE&code=CENTGERL.rcv stipulates that an inactive person has the right to remain in France if he has a medical insurance (assurance maladie). It does NOT say that it has to be a private insurance. “Assurance maladie” is also the official term for the French NHS. As the CMU cannot be acquired during the first 3 months’ residence, it is necessary at least to have a private insurance covering the first 3 months. That could be a travel insurance. As for French social security law:The purpose of the CMU, when created in 1999, was expressly, as stipulated in the law, to assure that every person living in France could benefit from public health care: “Law number 99-641 of 27 July 1999 creating a universal medical cover. Article 1. It is created, for the residents of Metropolitan France and the overseas departments, a universal medical cover that guarantees for everybody the cost of treatment via a medical insurance system, and for persons whose incomes are amongst the lowest a right to a complementary insurance protection and exoneration from having to advance money.” Next, the Social Security Code http://www.legifrance.gouv.fr/WAspad/RechercheSimplePartieCode?commun=CSECSO&code=CSECSOCL.rcv itself: “Article L111-1 The organisation of social security is founded on the principle of national solidarity. It guarantees workers and their families against risks of every nature that could reduce or invalidate their capacity to earn money. It equally covers cost of maternity, paternity and family allowances. It assures, for every other person and for his or hers family members residing in France, cover for illness cost, maternity and paternity as well as family allowances. This guarantee is exercised through affiliation of the interested persons and their dependent family members to one or more mandatory systems.” « Preliminary chapter: Persons affiliated to the general system because of their residence in France Every person residing in Metropolitan France or an overseas department in a stable and regular way depends on the general [health care] system when he or she has no right to medical services from any other health care system. L380-2 The persons affiliated to the general system in the conditions stipulated in Art. L380-1 must pay a contribution when their income exceeds an amount defined by decree, revised every year to account for price evolution. This contribution is defined as a percentage of income.” The Social Security Code and the CMU law do provide better medical cover for all residents of France than the EU Directive 2004/38. Hence, that Directive cannot be used to cancel the effects of the Social Security Code and the CMU law for inactive EU nationals. The Immigration Code just says you must have a medical insurance. Art. R121-4 of the Immigration Code further says: “The cost on the social assistance system that a foreigner mentioned in Art. L121-1 can constitute is evaluated notably by taking into account the amount of non-contributive social services granted to him ...” As the CMU discussed here is a contribution based system for income over 7000 € a year, services provided by the CMU should be taken much less in consideration than other social services. Because of the Social Security Code and the CMU Law, once you ARE resident in France and have lived there more than 3 months, you DO have the right to join the CMU and to remain in the CMU until pension age, when an E121 will assure your rights. These texts have NOT been updated to reflect the intention of the government, as expressed in the notice. In order to refuse inactive Britons access to the CMU, the National Assembly would have to uproot the foundation of the CMU universal health care system, and they have NOT done that. Throwing you out of the CMU, or refusing you entry, would be a violation of the Social Security Code and the CMU Law. Such a violation could be successfully challenged in court. Low-income families can apply for partial or total legal aid to minimise legal costs. This is not the first time the government has tried to implement cost cuttings in a panic, and it would not be the first time they lost in court, as it recently happened when they illegally cut unemployment rights for those already accepted under the old rules. You don’t need a large legal machine to beat the government in court. My best recommendation is to systematically challenge any refusal to or throwing out of the CMU. The first thing to do is a simple letter of complaint to the CPAM. If that doesn't help, the Médiateur de la République - the French general Ombudsman - is one way of attack. Another is court. What are your options?
This is a brief summary. For more details, read the main page about health care in France. The principle of medical cover in France is that you must earn your
entitlement to cover in one way or another. Employment, Self-employment, Retirement, EU RightsThis is the main way of obtaining medical cover. 1. If you are employed by a French employer and have worked more than a certain period, you and your dependents are covered by the CPAM. 2. Self-employed and small business owners pay social security contributions. For the medical cover, they pay to the RSI scheme. 3. If you are posted temporarily to France by a foreign employer in the EU/EEA or Switzerland, or if you post yourself temporarily to France as self-employed, then you may be covered by your home country via an E101. The home country issues this, and you take it to the CPAM to obtain medical benefits. Dependent spouse and children are added to the cover by the CPAM. 4. If you are retired from another EU/EEA Member State, they should issue an E121 that you take to the CPAM to obtain rights. 5. If your home country has issued you with an E106 in cases where you are expatriated without working, you obtain cover during its period of validity by taking it to the CPAM. If each spouse in a married couple are entitled to medical cover under one of
these schemes, they remain covered independently. Pre-retirement and other inactivity6. If no one has a right to cover through the options above, the CMU can set in to cover the family under certain conditions. The CMU is in fact two distinct schemes: The CMU is intended to assure that all legal residents of France have a medical cover. To benefit, you must have lived legally in France more than three months, and in order to establish legality of your residence, you must already have been covered by a non-CMU medical insurance and have had sufficient financial resources. These conditions fall away after 5 years continuous and legal residence in France, after which you are entitled to the CMU under the rules applying to French nationals. As an exception, if you had already emigrated to France on or before the 23 November 2007, then you can remain in or join the CMU on the same conditions as French nationals. 7. If you are not entitled to the CMU and your income is below the limit for the complementary CMU, you can still apply to the CPAM for Aide médicale à l'Etat under Article L 251-1 of the Code de l'action sociale et des familles without fulfilling any residence criteria. You must have been in France more than 3 months, although dependent children are immediately covered. Claim form General information 8. If you are not entitled to the CMU and you are not a beneficiary of the Aide médicale à l'Etat, urgent medical intervention will be paid under Article L 254-1 of the Code de l'action sociale et des familles regardless of the duration of the stay in France or its legality. 9. If none of this works, you can take out a private medical insurance, but they may not accept you if you already have medical conditions. Contact us if you may be interested in this, or check out our list of some private providers of health care in France. 10. If you have not found a satisfactory way of obtaining medical cover, you can declare self-employment and obtain cover that way. You will be subject to a minimum annual charge of approximatly 800 € to cover heatlhcare, and a few hundred euros of other social contributions and taxes. Dependent family members will be covered. You can declare a micro-business exempt from VAT formalities and bookkeeping of expenses. No minimum turnover is required, only minimum contributions. There are no conditions for the duration of your stay. We are planning on providing a service to help you getting this set up. We expect the total annual cost including charges, taxes and fees to be close to the cost of private medical insurance for one person. However, self-employment would cover a dependent spouse at no additional cost. You can read more about this option in the article Mind the Gap in French Healthcare by Finn Skovgaard in the Daily Telegraph's expat section.
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