Health care during the holidays
The European Health Insurance Card for access to health care in France
Before you leave, you must apply for a European Health Insurance Card (EHIC) from your local health authority (or other competent health authority).
It guarantees access to health service providers based in France without prior procedures at the French institution of residence. Benefits will be provided under the same conditions as those provided for citizens enrolled in the French health insurance.
In the event of forgetfulness, loss, theft or lack of possession of the card (issue not fast enough or temporarily impossible), the ASLs may issue a “provisional certificate replacing the EHIC”. It may be used under the same conditions as the EHIC but will be valid for a limited period of time.
How to use the TEAM in France
Benefits in kind cover medical costs, pharmaceutical costs, costs of dental treatment and prostheses, hospitalisation costs, costs of laboratory tests and analyses, or transport costs.
Medical and dental care
Before going to the doctor or dentist, you should make sure that he or she has an agreement. There are two possible statutes among the contracted doctors:
- the status of convention in field 1: the health care provider fully adheres to the convention and respects the agreed rates;
- the status of agreement in field 2: the health care professional accedes to the agreement except for the tariff clauses and freely sets his fees.
In both cases, the reimbursement by the CPAM or CGSS of the place of treatment shall be based on the agreed tariff.
You can search for a health professional based on your place of stay.
Citizens enrolled in the health care system of another State who are temporarily staying in France are not subject to the provisions of French law relating to the course of treatment (appointment of the treating doctor, visit the latter before consulting a specialist).
In order to prove that you are not subject to the treatment process and to prevent the doctor (general practitioner or specialist) from requesting payment of an additional fee, you must present your European Health Insurance Card or provisional replacement certificate.
The doctor’s fees must be paid directly to the doctor, who will then fill in a reimbursement form (feuille de soins) and, if necessary, a prescription.
As they are not subject to the treatment process, citizens enrolled in health care in another country are free to consult specialists directly, without the commitment of the general practitioner.
Para-health care services provided by medical auxiliaries are only covered if prescribed by a doctor.
To obtain medicines, patients can go to any pharmacy by presenting the reimbursement form and prescription issued by the doctor. The price of the medication will be entered on the reimbursement form that the pharmacist will return with the prescription. The medications are to be paid directly to the pharmacist.
For those who have to travel to receive treatment, the transport costs prescribed by the doctor may, under certain conditions, be covered by French health care.
In case of emergency hospitalization, deliver the EHIC or provisional replacement certificate to the hospital admission office. The patient may be asked to prove his or her identity by means of a passport or any other valid document.
Outside of emergency hospitalization, you may receive health care in the hospital of your choice, whether public or private.
If a doctor is consulted prior to hospitalization, the latter may identify the institution or service appropriate to the patient’s needs, taking into account the quality of care.
It is advisable to enquire about the rates applied and the reimbursement provided for, since in some establishments the fees are higher than the agreed rate provided for by the Health Insurance; the amount exceeding the agreed rate, called “dépassement d’honoraires”, is not reimbursed.
It should also be noted that some – rare – private clinics are not affiliated with the Health Insurance. To find the details of the hospitals or information on the rates they apply, please consult the Annuaire santé website.
As a general rule, 80% of the hospitalisation costs are covered directly by the health insurance fund (100% in some cases). In this case, the patient who has presented the EHIC or provisional replacement certificate at the time of admission will not have to pay the costs in advance; he will simply be entitled to the participation which will be borne by the patient at the rate of 20% in the case of 80% health cover, plus a daily lump sum of € 20 for each day of hospitalisation.
In the case of 100% health cover, the daily flat rate of € 20 remains to be paid. In the event that the medical expenses are advanced by the patient, reimbursement is obtained from the competent health insurance fund depending on the place of hospitalization, after having sent to this body the “bulletin de sortie” (letter of discharge) issued by the hospital.
Significant services with a rate higher than or equal to Euro 120 or those with a coefficient higher than or equal to 60 are covered at 100%. However, a flat-rate fee of € 24 remains payable by the patient for services provided by the same medical practitioner during an examination, irrespective of the amount of the service. It applies both to benefits provided in private clinics and in hospital.
Some persons who benefit from 100% health cover may be exempted from either or both of these (beneficiaries of CMU-C complementary universal health cover, persons suffering from long-term illness, occupational illness, victims of accidents at work and pregnant women from the sixth month of pregnancy onwards).
For psychiatric hospitalization in a health facility the amount of the daily lump sum is fixed at € 15.
The daily lump sums are not reimbursed by the health insurance but may be reimbursed by health insurances such as “mutuelles” or other supplementary insurances.
Chronic and pre-existing diseases
In case of dialysis or oxygen therapy, please contact a specialist centre in the region of your future place of stay to ask for an appointment.
The reimbursement form (feuille de soins), dated, signed, accompanied by the prescription and a copy of the European Health Insurance Card or provisional replacement certificate, must be handed over to the CPAM (or CGSS in the French overseas departments) of the place where the patient received treatment.