You can also get treatment elsewhere in EU

People have considerable freedom to travel within the EU to have healthcare procedures in a different country. 

An EU directive that was put into French law in 2014 clarifies that people living in France have the right to opt to have treatment in another EU country and to be reimbursed up to the usual rate by France as long as it is a treatment that France also provides. This is different from healthcare that becomes necessary while travelling.

The directive says prior authorisation from your Cpam is needed only where procedures require in-patient care or are “highly specialised and cost-intensive” or if there are serious, specific concerns over quality or safety of the foreign care. 

This should be the exception. It can be refused only in limited situations, such as if the treatment is quickly and easily available in France or there are doubts about the qualifications of the foreign doctor. Where a treatment is of a kind requiring authorisation, Cpams may take “reasonable time” deciding.

The Health Ministry says permission is needed where care requires heavy duty equipment like MRI or PET scanners but not for ordinary doctor visits, hospital out-patient care or seeing a dentist or eye specialist.

If a service not needing prior authorisation is paid for, you may present your Ceam in order to be covered to the levels of a person from the country concerned. If it is a private clinic you may need to advance the funds.

Or, on your return you can present invoices and an S3125 form for Soins reçus à l’étranger to your Cpam. You can also apply via your ameli.fr account under Mes démarches and soins reçus à l’étranger. 

You will be reimbursed according to the tariffs in the country you visited or, if you agree, on the basis of the French rates with the proviso that reimbursement cannot be for more than your actual out-of-pocket costs. Ask your own Cpam if you have specific questions. Another possible source of information is Cleiss, a service advising on cross-border social security matters.

The EU directive also called for more international compatibility on the sharing of patient information and for the recognition of prescriptions between member states. 

This was said to be especially helpful to people with rare conditions or who live close to borders and was not expected to lead to a rush of ‘health tourism’ as reimbursements are capped at usual home country rates and travel costs are not reimbursed. 

Certain procedures may be less costly elsewhere in the EU, thus making the low reimbursement (on return) less of a problem. Eastern European countries, especially Hungary but also Bulgaria and the Czech Republic, have been popular for dental work because standards were reported to be high and prices attractive. 

Having said which, France’s latest 100% Santé improvements in dental reimbursement now make this less attractive than it was formerly. Tunisia is also popular for medical tourism but in case you want to make follow-up visits, most people involved in the industry recommend going somewhere accessible.

Reimbursement by the Sécu for medical treatment within Switzerland and the EU is reasonably straightforward, in that, as stated, you have the law on your side; however to avoid any problems you may still wish to notify your Cpam of your plans, always bearing in mind the rights explained above, should there be any reluctance on the part of local ones. 

The usual way to apply for approval from your Cpam is to ask your doctor in France to notify the Cpam of your condition and the justification for your need to go abroad. After applying, if there is no response within two weeks, it is presumed there is no objection. If you have permission the Cpam can issue you with an S2 form, which certifies that you are authorised to be reimbursed for the named treatment.

We advise Britons in France with UK S1 forms, whose care is funded by the UK, to check with their Cpam rather than relying directly on the EU directive. 

Questions about healthcare in Europe can also be made to NHS England on 0300 311 2233 or england.contactus@nhs.net. 

You should present your S2 to the healthcare provider in the (EU/EEA/Switzerland) country you are visiting. Then, if you have upfront costs you may apply for reimbursement from the state health insurance body of that country. Otherwise you can apply to Cpam on your return. It is advisable to keep photocopies of invoices etc submitted to the Cpam, for yourself and your mutuelle.

Reimbursement by your mutuelle involves the same procedure as for the Sécu: the law is on your side but you should consult them before you go so as to avoid unpleasant surprises. You then send them your paperwork when you return.

Every mutuelle has a different policy and reimbursement tariff for elective medical treatment abroad but in theory living in the free market means that there are no barriers to buying medical care wherever you like. It is, however, always advisable to check your policy. 

Costs such as travel, accommodation and expenses during your stay abroad are not reimbursed.