Healthcare in France - the key things that you need to know
Introducing the French healthcare system
France is generally well regarded for its healthcare, spending a higher proportion of its national income compared to many other countries. Healthcare is provided by an integrated network of public hospitals, private hospitals, doctors and other medical service providers. The French are proud of their universal healthcare provision – with strong public support for hospitals and community facilities.
Funding however is different to countries such as the UK, with a mix of state finance and obligatory private insurance contributions. Because France uses a system of co-payments, patients are required to meet the cost of some or all of the treatment before being reimbursed.
Since Britain left the EU, how UK nationals access French health services (as well as other European countries) has also changed. It is important therefore to understand how French healthcare works in practice for tourists visiting France or spending more time living in the country – and find out what you need to do before crossing the Channel.
Visiting France for a holiday or short stay
If you are a UK national make sure that you have either a valid Global Health Insurance Card (GHIC) or a European Health Insurance Card (EHIC) before travelling. The GHIC is a replacement for the EHIC: you can though continue to use an EHIC if it remains in date. Both these cards entitle you to medical treatment and routine maternity care in public hospitals on the same terms as the French. Important note: expect to pay all or some of the costs of your treatment and claim a refund afterwards. You are not entitled to reimbursement for the cost of any private treatment.
In addition to carrying your GHIC/EHIC ensure that you have an appropriate level of travel insurance cover for the entire period of your stay. Whilst the GHIC/EHIC cards generally cover you for emergency and routine medical treatment, it is not intended to be comprehensive. For example, if have a serious injury and require long-term treatment, or require special transportation to take you home, you could receive an expensive bill! So taking out travel insurance is essential.
The GHIC/EHIC cards cover you for up to 90 consecutive days in France. You will not need a visa though if you are visiting the country for a holiday or short stay of that duration or less.
Preparing for a move to France
France remains the dream destination for many of us, as a place to retire, enjoy a less active life in semi-retirement or to work.
Before planning a move to France it is critically important to understand what you need to do in terms of healthcare provision. Now that the UK has left the EU, UK nationals must apply for a residency visa if they wish to stay in France for longer than 90 days. There are different types of residency visas available: click onto the French government’s Visa Wizard to find out further information.
There are some exceptions to this, for example if your spouse or direct family member is an EU/EEA citizen. Furthermore, if you are in receipt of a UK state pension you may be eligible to apply for an S1 form. The UK is continuing to issue S1 forms; these documents enable people of pensionable age seeking to retire to France to transfer their entitlement to state health insurance to France. The recipients of an S1 form also benefit from exemption from French social security charges – although this income is still liable for income tax. If you wish to apply for an S1 form contact NHS Overseas Healthcare Services.
Generally, in most cases UK nationals will not be covered by the EU Withdrawal Agreement and will not have an automatic right, as previously, to live in France as a permanent resident [Note: if you wish to research in more detail the residency visa application process, this article illustrates the four main stages step-by-step].
One key element of any residency visa application is proving that you have an appropriate level of private healthcare insurance (PHI) covering the entire duration of your stay. There are strict requirements regarding the type of policy: it must have a minimum coverage of €30,000, include medical repatriation and emergency/hospital treatment. The policy should also stipulate that it includes the Schengen zone. There are a number of banks and insurance companies who provide this cover. It is worth obtaining several quotations; check that the cover meets the residency visa requirements.
If you are not retired and are looking to work in France on a contract, as a salaried employee or to set up your own business, the French government does offer different types of residency visas. These include visas for students and graduates, researchers and scientists, highly-skilled workers (EU Blue Card holders) and other categories.
Living in France
If you moved to France prior to 31 December 2020, UK nationals’ rights are covered by the EU Withdrawal Agreement. Post-Brexit, the French government has been issuing residency permits – called the Carte de Séjour. As part of the application process, residents must prove that they have healthcare insurance in place: i.e. private healthcare or ‘Top-Up’ healthcare insurance provided by France’s network of mutuelles.
UK nationals living in France (i.e. if you become a French resident or your stay exceeds 90 days) can apply for a Carte Vitale, a key document that allows residents to use the French healthcare system. The Carte Vitale allows you to be reimbursed for things like doctor or specialist appointments, prescriptions at the pharmacy, or hospital visits.
Once your stay in France exceeds the three months qualifying period, you can apply for cover under PUMa - Protection Universelle Maladie. This is France’s system of universal health protection and applications are made online using the Ameli.fr website.
As part of your application for a Carte Vitale, you will need to supply the following:
- Your birth certificate. This must state your parents' names on it - avec filiation
- Your ID / passport
- Your French social security number: numéro de sécurité sociale
- A copy of your Long-Stay visa
- Proof you have lived in France for more than three months (i.e. proof of residence - justificatif de domicile - or an employment contract / payslips)
- Your RIB from your French bank
It is common practice to require official documents such as birth certificates etc. to be translated into French. For this, you will need a certified sworn translator – ask your local Mairie to see if they have a list of approved translators or check online.
Once you have your Carte Vitale, you can apply for complementary healthcare insurance – most French people opt for a ‘Top-Up’ – often referred to as the ‘mutuelle.’ Top-Up Health Insurance is a policy in the form of a health care insurance plan which pays the difference between the cost of the medical and health treatment and the contribution from the social security system (caisse nationale de l'Assurance Maladie : Cnam).
Top-Up insurance comes with various levels of cover. Therefore, you can select the policy that suits you and your budget; opting for a basic healthcare plan or a more comprehensive policy.
If you are a resident in France and have limited resources, once your Carte Vitale is in place you may be eligible to financial assistance to help you pay for your mutuelle through the Aide au Paiement d’une Complémentaire or possibly have access to the Mutuelle Solidaire. Enquiries should be made online via ameli.fr.
For certain illnesses deemed to be long-term illnesses you may benefit from 100% cover for any treatments/prescriptions linked to these pathologies. In order to have this exemption of payment you need to speak to your French GP or specialist who will inform the social security of which treatments are covered by this level of cover.
English-speaking advisers are available to help deal with enquiries. Go to the specific Ameli.fr web page for details. The site includes telephone numbers for the French Health Insurance Advice Line and FAQs.