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H e a l t h >
COMPLEMENTARY HEALTH INSURANCE IN FRANCE - QUESTIONS AND ANSWERS |
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| Who
can take out top-up health insurance cover?
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Anyone who subscribes to a French mandatory
health insurance scheme (“régime obligatoire”)
can get additional cover through a top-up health insurance contract,
also known as a “mutuelle”. There are no age restrictions
and chronically ill persons as well as pregnant women can benefit
from day one. In addition, AXA cannot terminate a contract with
reference to deteriorating health.
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| How
do I get public health insurance? |
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All French residents are required to subscribe to a mandatory health
scheme. French public health service is of high quality, but it
is not free. Unless you receive a public pension (see below), you
pay a general contribution depending on your income and, on top
of this, you pay part of the cost every time you receive health
care or medication. Only treatment of the most serious diseases
and accidents are paid 100% by the health care system and even in
these cases you will have to pay your stay in hospital (15 euros
per day), part of the treatment before and after your hospital stay
etc.
If you are an EU citizen and receive a public pension from your
home country, you are entitled to an E 121 statement, which gives
you the right to join the public health insurance scheme, CPAM (Caisse
Primaire d’Assurance Maladie) at no charge. Application to
join CPAM should be made through your local CPAM office. Check with
your local town hall (“Mairie”) for address and opening
hours. Quite often, CPAM has an office at the Mairie.
Persons employed and working in France should also join CPAM and
pay part of their salary towards this. An E 104 statement will secure
the right to treatment immediately upon joining CPAM, i.e. without
waiting time.
Self-employed persons are required to join a mandatory scheme as
well, but have the choice between a number of providers (not CPAM,
though).
Others (e.g. persons receiving a private pension or persons with
a sufficient amount of money in the bank) could and should join
CPAM by paying 8% of their taxable income less a minimum allowance.
This could be a considerable amount of money and consequently, some
people prefer to stay outside the public health system and go for
a fully comprehensive, private health insurance although this, strictly
speaking, is not in accordance with French law.
For students, unemployed and French residents working in another
country special rules apply.
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| What
is covered by a top-up health insurance? |
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The basic rule is that if your mandatory scheme pays part of a treatment,
AXA will contribute as well. This means that certain treatments,
which are often excluded by private health insurance providers,
will in fact be covered by AXA’s top-up scheme, e.g.
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Treatment and medication of chronic diseases
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Glasses,
contact lenses and hearing aids
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Routine dental care
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Sudden illness or accidents anywhere in the world
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Accidents related to so-called “dangerous” activities
or sports such as mountain climbing, scuba diving, parachuting,
skiing, martial arts etc.
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Consequences
of drug or alcohol abuse including treatment of injuries incurred
while under influence
In addition to treatment, tests and medication the following expenses
are reimbursed:
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Single
room at hospital
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Spouse
or family member’s stay at hospital
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Ambulance
charges
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Home
nursing
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Drug
delivery following hospitalisation
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Telephonic
advice on health and nutrition issues
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Worldwide
emergency cover including repatriation for non-professionally
related stays of up to 3 months
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| What
is not covered by a top-up health insurance? |
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Cosmetic surgery not related to disease or accident
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Planned treatment outside France
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Expenses covered by other insurance schemes
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| Is
my consumption of prescribed medicine covered? |
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Yes. Whichever solution you choose, prescribed drugs will always
be free of charge. AXA will send you an attestation which gives
you the right to retrieve prescribed drugs at the pharmacy without
paying.
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| If
I have top-up cover, how much could I risk paying myself? |
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Top-up cover is not a 100% guarantee that you will never pay anything
towards your health expenses, but if you are careful in your choice
of health providers, your actual health expenses could, for all
practical purposes, be limited to contributing to major dental treatments
and glasses/contact lenses.
Your actual payment depends on two things:
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· what the health provider (family doctor, specialist,
hospital, dentist, test lab, home nurse etc) charges in relation
to the agreed tariff with the French state
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your choice of cover (at AXA you choose between 100%,125%,150%
or 200% cover)
An example: You have chosen 125% cover. Your family doctor charges
25 euros for a visit. Your mandatory scheme and AXA reimburse you
in full, as the agreed tariff is 20 euros and 125% x 20 euros =
25 euros. If the doctor charges more than 25 euros, you will still
be reimbursed 25 euros, but you will pay the remainder yourself.
(Please note that as of 1st July 2005, 1 euro will always remain
at your charge. This is part of the government’s endeavours
to reduce the enormous deficit for the national health system.)
Consequently, before choosing your coverage ratio, it may be an
idea to check how much your family doctor, the relevant specialists
and your local hospital deviate from the agreed tariffs.
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| Do
I need to wait for the complementary insurance to take effect? |
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No. The insurance cover applies from day one (with
very few limitations). Chronically ill persons, pregnant women etc
enter with the same rights as anyone else.
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| Do
I need to fill in a health questionnaire? |
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Clients applying for coverage up to 150% are not
asked any questions about current ailments, previous hospitalisations
etc. Only clients applying for 200% cover need to answer a few basic
questions about planned treatments.
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| How
to choose coverage ratio? |
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Apart from the deviation between your preferred health
providers’ prices and the agreed tariffs, you should take
into account your need for major dental surgery and/or glasses/contact
lenses. AXA contributes a fixed amount towards some expenses –
on top of the percentage reimbursement:
| Coverage
ratio |
100% |
125% |
150% |
200% |
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Glasses, contact lenses |
€
60 |
€
100 |
€
150 |
€
200 |
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Laser treatment for myopia |
0 |
0 |
0 |
€
400 per eye |
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Approved orthodontic treament |
€
60 |
€
100 |
€
200 |
€
300 |
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Hearing aids |
0 |
0 |
0 |
€
100 per year +
€ 300 every 4 years |
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Health hydro stays |
€
60 |
€
100 |
€
150 |
€
200 |
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Single room in hospital |
€
30 / day |
€
50 / day |
€
60 / day |
€
75 / day |
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Welcome present for newborns |
€
60 |
€
100 |
€
150 |
€
200 |
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Vaccines |
actual
expenses |
actual
expenses |
actual
expenses |
actual
expenses |
The
100% cover is also available without any of the above extras. In
addition, a "hospitalisation only" option is available
if you only want emergency cover.
In
case of hospital stays, the coverage ratio is increased for doctors’
fees:
| Contractual
coverage ratio |
100% |
125% |
150% |
200% |
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Actual coverage ratio for surgery and anaesthesia |
300% |
300% |
400% |
400% |
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| Do
I need to fill in and send a lot of documents in order to be reimbursed? |
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No, not at all. One of the great advantages of
AXA’s top-up health insurance is simple procedure. Reimbursement
takes place automatically based on your use of the Carte Vitale.
The money is credited your bank account within a matter of days.
You need not send any form or receipts unless you do not use your
Carte Vitale, i.e. purchase of new glasses.
Prescribed drugs are free of charge (as described
above) and your hospitalisation expenses are settled by AXA directly
with the hospital or clinic. Many doctors and laboratories are
electronically linked to the main public health insurance providers
as well as to AXA, in which case you need only settle the fraction,
if any, not covered by your insurance schemes.
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