France has a lot of things to be proud of, including but not limited to a great education system, a long, rich history, and culture, but France also has a pretty decent healthcare system. One of the many great things about living in France is that for legal residents, a great deal of the healthcare costs are very heavily subsidised by the government. Many foreigners who are considering a move here might notice that the tax rates are a little bit higher in France than they are in some other countries, and you’re not wrong. Sure the taxes here are a bit higher but that’s the reason why education is mostly free, and if you break a leg you won’t end up having to file for bankruptcy.
All legal residents in France are covered by the national health insurance, which is called Caisse Primaire d’Assurance Maladie or CPAM for short. There are other cases where residents who have never paid social taxes in France for different reasons, like if they are the spouse of a French person through a system called ‘Protection Universelle Maladie’ or PUMA (not to be confused with the sports brand).
So what exactly does the National Health Insurance pay for? What is top-up insurance? Who should get it? Read on to find out more.
Does the National Health Insurance in France Pay for Everything?
Even though the healthcare services in France are heavily subsidised, there are still cases where the entire amount isn’t covered. For example, it’s not uncommon to have small out-of-pocket expenses when visiting a doctor or getting some medicines.
To give you an example, if you see a General Practitioner for something simple like a check-up and their service fee is €25, the national health insurance will cover around 70% of this, which will mean that there’s still about €6.50 that needs to be paid. This is normally taken care of by the patient. So although the majority of the consultation fees are taken care of by the government, there is still a small portion that isn’t covered.
There is another form of insurance that can take care of these small out-of-pocket expenses, and it’s a must-have for anyone who wants to make sure they have the best possible health coverage in France, and this is called Mutelle.
What is Top Up Insurance (Mutuelle)?
If you are a legal resident in France, you can also have an additional Top Up insurance policy, and this is called ‘Mutuelle.’
The general idea of Mutuelle is that it pays for the out-of-pocket amount, or at least some of it. It’s basically a form of private health insurance that is designed to fill in any gaps with the national health insurance. People in other countries with socialised healthcare would be familiar with similar kinds of insurance.
Do I Need a Carte Vitale to Get Top-Up Insurance?
You don’t have to have the French Carte Vitale to get a mutuelle, but it’s highly recommended because this allows for the electronic transmissions of refunds directly to you. Some service providers will bill the government and mutuelle insurer directly, but there are cases where the patient will need to pay first and then receive their refund later. If you have a carte vitale, refunds are automatically sent to your designated bank account within about a week of the service. Without a carte vitale, refunds need to be pursued manually, which can be an absolute nightmare.
Who Should Have a Mutuelle in France?
Every worker in France who receives a salary is legally required to have a mutuelle insurance policy, and it is mandatory that their employer pays for 50% of the insurance premium. However, the employer is only obligated to pay this amount if the employee stays with the employer’s group policy.
Some employers do actually pay for the full amount, and it’s also common that spouses, children and dependents can be added to an employee’s mutuelle. In fact, if you are in a couple and one of you happens to have a better mutuelle, you can actually choose to go with their plan instead of the one offered by your employer.
It’s also worth mentioning that the largest market for mutuelle insurance policies is actually retired people, so even if you’re enjoying the twilight years, having a mutuelle is worth it.
Do I Have to Get a Mutuelle if I’m Not a Salaried Employee?
If you’re not a salaried employee, you don’t have to have a mutuelle, but there are still some circumstances where it is highly recommended to have one, like for self-employed workers or those who are starting small businesses.
A great example of why you should aim to have a mutuelle in these situations is in the case that you are ever hospitalised. Without a mutuelle, you could be liable to pay fees upfront even if they are in the thousands of euros and even if it’s an emergency. Now it’s very rare in France that a hospital would refuse emergency services without receiving payment upfront, but having a valid Mutuelle policy fixes any of this.
If you live in France but don’t work here, you also don’t have to have a mutuelle, but, like with most insurance-related things, it’s better to be safe than sorry. Just remember that you do need to have a French social security number to get a policy.
What do I Need to Apply for a Mutuelle?
Applying for a mutuelle is actually very easy, and the documentation required is pretty minimal compared to a lot of other things in France. To take out a mutuelle policy in France, all you need is:
A document called ‘Attestation de Droit.’ This is proof of your affiliation with the National Health Insurance scheme (CPAM).
Do I Have to Disclose Pre-existing Medical Conditions?
The great news is that in France, there is a very strict code of ethics when it comes to health insurance. Mutuelle health insurers in France are not allowed to refuse coverage or charge extra premiums for people with pre-existing health conditions. This means that you don’t have to disclose any medical history at all; it’s simply not required.
What Should I Look For in a Policy?
Since you don’t have to stress about finding a mutuelle insurer depending on your existing health conditions, finding a policy that’s right for you is as simple as looking at what different companies offer and deciding what fits your health needs and budget.
It’s impossible to predict what health concerns you might be facing in the future, and this can be even more overwhelming if you happen to live abroad. Because of this, mutuelles really are worth it. There are even new regulations in France that make having a mutuelle even more attractive.
There was a recent regulation introduced called 100% Santé (100% Health). This regulation ensures that there must always be a service option for extras that is taken care of by both the national health insurance and mutuelle, leaving no out-of-pocket expense to the patient. Basically, this means that even with a cheaper policy, you should be covered. For example, if you need to have a filling done at the dentist, you will be able to get it done for free as long as you have CPAM and a mutuelle. It might be the old-fashioned metallic kind, but you can leave the dentist’s chair knowing that all of it was taken care of.
Take it from a fellow immigrant; having a mutuelle is a must. Believe me when I say that there’s no better feeling than waking up with a toothache or some weird new health problem and knowing that you can probably get it taken care of without it costing an arm and a leg. So if you don’t yet have one, now’s a great time to check it out.