Entitlement to French Healthcare

Country:  France

Until recently, access to the French state healthcare system (the CMU – Couverture Maladie Universelle) was available to everyone resident in France, regardless of nationality and whether working or retired.  It was available in the following ways:

• Through the payment of social security contributions (cotisations) by employed or self-employed individuals, or
• Through various ‘E’ Forms such as the Form E106 (available if you have made National Insurance Contributions in the two years before you leave the UK) or E121 (available when you are in receipt of a UK state retirement pension), or E109 (available to family members living in France of a spouse working in the UK), or
• If neither of the above applied, through payment of ‘healthcare charges’ amounting to 8% of your taxable income, over a certain allowance.

It is this last point that has been the subject of recent changes in France.

It all stems from an ECJ decision in March 2006, which Sarkozy brought into French law.  The decision sets out the two conditions required for residence in an EU country: 

1) Firstly, the right of residence of such citizens, as granted by the Maastricht Treaty, is a fundamental, personal and immediate right. 

2) Secondly, only two conditions are required of such citizens in order that they may reside in a Member State other than their own:

• They must have health cover, and
• They must have sufficient resources to support themselves without recourse to the social system of the host Member State.

Sarkozy brought the decision into French law in March 2007.  An extract from Article L121-1 of this Decree is as follows:

“Except if his presence constitutes a menace to public order, every citizen of the European Union, every national of another State party to the agreement for the European Economic area or for the Swiss Confederation, has the right to stay in France more than three months if he satisfies one of the following conditions:

1. If he exercises a professional activity in France;
2. If he has, for himself and members of his family, sufficient resources in order not to become a burden on the social system, as well as having health insurance.”

It should be noted that the normal subscription to be paid under the provisions of the CMU (the 8% charge) falls far short of the actual costs to the French state which exceeded €3,000 per capita in 2005 and is probably much higher by now. 

According to the French government’s published statement the position is:

• All inactive EU citizens already accessing CMU healthcare coverage will continue to do so until 31st March 2008, after which they will be required to have their own personal medical insurance, unless their inactive status changes in the meantime.
• All inactive EU citizens under retirement age i.e. those already resident in France and those planning to move in future (who are not entitled to healthcare reimbursement through the E106 or E109 Forms) will be required to have their own personal medical insurance until they reach UK retirement age and therefore qualify for entitlement to the E121 Form, or until they qualify as a French resident (which is after five years of regular uninterrupted residence). 
• People already over retirement age who are holders of an E121 Form which is registered with the French authorities will remain unaffected.”

Inactive (non-actif in French) means economically inactive prior to retirement age (age 65 in France). Below retirement age you will be inactive unless you are working, unemployed (and so presumably looking for work) or a student.

Therefore, to summarise, you will be entitled to cover under the CMU in France if you fall into one of the following categories:

• You hold a Form E121, E106 or E109.
• You work in France and pay French social security contributions.
• You have been resident in France (and filing French tax returns) for five continuous years.
• You are a ‘family member’ of someone covered under the CMU by any of the above.  A ‘family member’ is a spouse or partner and any dependant child under 21).

If you already live in France and you do not fall into one of the above categories, you can continue to access the French CMU system until 31st March 2008.  After this date, you will require private health insurance. 

Future early retirees to France who are not in possession of a valid E-Form will also be required to have private insurance until they can qualify for Form E121.

The author, David Franks of Blevins Franks, is a specialist in the expatriate financial sector.

First published in January 2008.
Some information contained within this article may have changed since it was first published. Homes Overseas strongly advises you to seek current legal and financial advise from a qualified professional.

See Also:   France, Tax law

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