FRENCH SECURITE SOCIALE

The French health-care system is seen as one of the best in the world since it was ranked No. 1 by the World Health Organization in 2000. Since its inception, it has focused its efforts on universal cover, early detection, and improving benefits following the seriousness of the sickness.

As a result, most French are very proud of their system, and have very high expectations when it comes to health care standards. We will explore here how the French Healthcare system works, its origins and principles, and focusing on its international facilities catering for French citizens living abroad together with access to those facilities for non-French expatriates.

THE FRENCH HEALTH-CARE SYSTEM

Sécurité Sociale Principles
The French Healthcare is one of the four branches of The Sécurité Sociale - known as Sécu. The Sécu as we know it was established in 1945 for the purpose of providing financial assistance to those deemed most socially vulnerable. As a result, the healthcare branch is required to provide all French citizens and foreign residents with good cover to meet most of their medical needs, and total help when it is serious.

Coordinated Health System
General practitioners are the central component of the French health care system, and you need to choose and register with a licensed general medical practitioner in order to qualify for Sécu Healthcare benefits. Upon needing medical care, you need first to consult your medical practitioner who would then refer you to the relevant medical specialist or facility best able to treat your needs. This process represents substantial streamlining and information-flow to ensure you reach the right specialist very quickly.

Defined reimbursement
Each treatment reimbursement follows the Sécu Benefits Schedule of fees as defined by the government. As a result, the reimbursement base for outpatient and other treatments are set by the Sécurité Sociale. Medical practitioners have the liberty to opt for higher rates, but must inform you beforehand – with the difference paid by you, or your private insurance.

  1. In-hospital treatment – The Sécu covers 80% of the cost of all in-hospital treatment. The cover is extended to 100% if your illness is serious (e.g. pregnancy and chronic illnesses).
  2. Hospital stay –  The Sécu does not cover your hospital stay if less than 30 days – the charge is usually 16 Euros/day in a public hospital, or higher for private hospitals.
  3. Out-of-hospital treatment – Each act has a participation cost of 1 Euro, and all of them are covered for 60 to 70% of the cost defined by Sécu Benefits Schedule. Two exceptions here: a) Once again, the cover is extended to 100% if your illness is serious (see above example) or if you are claiming social welfare; and b) Where you chose to be treated outside of the Coordinated Health System your reimbursement rates will be lower.
  4. Medicine – The Sécu Benefits Schedule categorises four levels of reimbursement, with a colour-based system in Pharmacies
    • White Stripes for very costly medications or those that treat chronic conditions. 100% of     the cost is covered
    • White for most prescribed drugs, and covers 65% of the cost;
    • Blue for drugs used for short-term conditions that are “neither major nor important” – covers 35% of the cost;
    • Orange for “comfort” drugs or medications not specifically prescribed by doctors – not covered.

Funding
The Sécu is an independent organisation, managed and financed by the “social partners” (employers organisations and employees' representation) with an oversight from the state. In terms of budget and financing, it means that the Sécu strives to be financially balanced, while achieving it assigned goals.

Originally, it was financed almost entirely by contributions based on workers' wages. But over the years, the “social partners” introduced new funding policies to take into account an individuals’ household income– their acronyms are CSG, CRDS and PS. Today, contributions still represent the lion's share of the funding with 50%, the new policies account for 35%, and the remaining 15% comes from different taxes and duties which are mostly financed by the states. In practice, these figures put together represent about 10% of household income.

“Private” Insurance
To make up the difference between what the state pays/reimburses and the cost of treatment; about 90% of French residents operate an insurance policy. These policies can be managed either by a private insurance provider who usually ask for a medical examination and may set exclusions before accepting a policy, based upon medical history; or a Mutuelle (non profit organisation) who do not put such an emphasis on medical risk but may charge higher premiums. Once the policy is on risk, not only do you get reimbursements for the percentage of practitioner fees and medicine cost which the Sécu does not cover, but you also enjoy (1) the peace of mind to know that your hospital stay will be covered; (2) wider choice of hospital accommodation such as semi-private and private rooms; and (3) ancillary treatment to cover care such as dental, optical, chiropractic etc for which the Sécu has limited cover if any.

Sécu Abroad
Since 2005, the Sécu does reimburse French residents who received treatment and medication while on a temporary visit to another European Union member country. Unfortunately, no other international agreements are in force at the moment of writing this article, and French domestic insurance policies usually do not cover healthcare costs incurred while outside of French. Therefore French residents are strongly recommended to arrange travel insurance for their travel period. If they are moving abroad, French expats have other options.

CFE FOR FRENCH EXPATRIATES

Thanks to its independent status, the Sécu has introduced options that would not usually be found in other national healthcare systems. One such option is that it offers the facility for French expatriates to continue enjoying Sécu benefits when working abroad under the CFE – Caisse des Français de l’Etranger .  

This Sécu branch was set up in 1978 to handle French expatriates’ social security needs, and ensure a smooth transition from resident status to expatriate and vice versa. As a result, it works hand in hand with the national system, and ensures a continuity of cover for expatriates moving regularly, changing jobs, or those coming home after a period of expatriation. It does offer options for the four risks covered by the Sécu - i.e. health, professional, unemployment and retirement. French expatriates can choose to be covered against one or several of these risks.

French companies sending their employees abroad are required to register them with the CFE, and shall cover the Sécu contributions as they would in the national system. Individuals can also register personally, but they then have to pay their own contributions. As in France, premiums are calculated based on income and family resources, which mean reasonable premiums for lower-income families, and expensive premiums for a high-earning expatriate. The CFE website provides an easy way to calculate your CFE premiums here . Note that subscribing to the CFE does not exempt you from paying mandatory contributions in your country of residence.

The reimbursements follow the Sécu Benefits Schedule, and some private insurers and Mutuelles do offer international cover on top of the CFE.

YOUR INSURANCE OPTIONS

As we saw previously, the Secu is a great system to cover very serious illnesses and spread the cost of healthcare across a wide population. At the same time, it is one of the few national healthcare systems which is flexible enough to offer an option to its national expatriates to keep enjoying their benefits when living in a foreign country thanks to the CFE.

In the end, French expats do have three real choices they can make:

  1. The CFE
  2. The CFE + French  insurer offering international benefits on top
  3. A private insurance


SECU-LIKE BENFITS FOR NON-FRENCH EXPATS

French international Insurers base their reimbursement tables on the Sécu Benefits Schedule, and together with accessibility for non-French expats to these healthcare cover provisions, these International French policies can be viewed as providing Sécu-like benefits to non-French expatriates.

If you have questions, or need some guidance, give us a buzz .