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Social Security - Sickness Insurance

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Sickness insurance - Beneficiaries and conditions for entitlement
The general health insurance scheme covers employees, the unemployed, students, performers and authors. Furthermore, if they are not working or are not covered themselves by a mandatory social security scheme, the dependants of the insured persons are also covered. Dependants means spouses, live-in partners, common-law partners under a PACS agreement, children (up to the age of 16, or 20 if they are studying). 

Under certain conditions, ascendants, descendants (in-laws and direct relations) and dependents living with the policy-holder may also be eligible as beneficiaries. Insured persons receive a ‘Vitale’ card from their local CPAM (Primary health insurance body), which must be shown when they visit the doctor in order to be refunded quickly for care received and, if necessary, for a third of the cost due.

The insured person must choose a GP whom they must consult in order to have their medical costs reimbursed. Only the GP can refer the insured person to a specialist where necessary. Treatment received from a GP other than the one with whom the person is registered or from a specialist consulted without a referral from the chosen GP will be refunded at a reduced rate, except in exceptional circumstances (e.g.: emergency care) and visits to certain specialists, i.e. gynaecologists, ophthalmologists, dental surgeons or psychiatrists (for 16 to 25 year-olds).

In addition, employees are eligible for cash benefits (payment of daily allowances) in the event of work-related sickness and accident (or occupational disease), subject to certain conditions. They must provide evidence of having worked a minimum number of hours as wage-earners or a having paid a certain amount in contributions, the exact figures for which depend on the length of time they are out of work.

Persons who are not eligible for the general scheme may benefit from CMU (Universal Sickness Coverage) if they have lived in France on a regular basis for at least three months. Depending on their financial situation, they may qualify for the basic CMU allowance and possibly also the supplementary CMU.

Text last edited on: 03/2007

Source: European Union
© European Communities, 1995-2009
Reproduction is authorised.

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AXA Agence Stoker
William Stoker, British Financial Adviser and Insurer in Nimes (30) for over 12 years, covering the whole region and further afield, offers Financial Advice, Banking and professional and personal Insurances(car, house, health). Call 04 66 29 63 52. Find out more...
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Cabinet Selles et Allard
Call your English-speaking insurer in Perpignan and the PO for a complete range of products with policy conditions in English. We are experienced in private and professional insurance. Call Ella Young for information and advice at 04 68 35 31 31. Find out more...

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