Explainer: the CSS, France’s free or low cost top-up health insurance

Most people in France choose to ‘top up’ their healthcare cover through a private insurance provider but a system called complémentaire santé solidaire pays for this in some cases

A free top up system is available to those in France on lower incomes

Alongside their basic rights under France’s state health system, which comes with membership of French social security, most people opt to pay for top-up insurance to pay for any costs not covered by the state.

This is called a mutuelle or complémentaire santé and is provided by either a not-for-profit body or an insurance company.

However, France has a ‘free top-up’ system to help those on modest means.

The current scheme, complémentaire santé solidaire (CSS) has existed since late 2019 and replaced two previous programmes.

These were the Couverture maladie universelle complémentaire (CMU-C) and the Aide pour une complémentaire santé (ACS). Both the CMU-C and the ACS helped with those medical costs exceeding the basic state reimbursement threshold that is normally recovered with a carte Vitale.

The CSS programme aims to be an improvement over the two older assistance regimes by expanding the existing aid system to a larger number of people on low incomes.

Read more: Explainer: French healthcare terms that are useful to know

Where does the CSS apply?

As with the previous programmes, the CSS applies to doctors’ appointments, pharmacies for prescribed medicines, blood test labs etc and also to hospital stays.

CSS beneficiaries are exempted from having to pay fees to doctors, dentists and health auxiliaries (nurses, physiotherapists, etc.) and they are also not required to pay the forfait hospitalier daily fee in hospitals.

Drugs and medicines in pharmacies as well as medical devices (canes, wheelchairs, bandages, prosthetics, etc.) are also covered and beneficiaries now also have free access to most glasses, dentures and hearing aids.

How does the CSS system work?

Under the new CSS system, eligible beneficiaries must still register with a government-approved complémentaire santé, and the government will pay for the company to cover your costs.

You will not be required to make any upfront payment and doctors may not charge you any dépassements. The latter refers to a part of fees charged by certain doctors that goes above the state fixed tariff.

Read more: What are the costs of hospital stays in France?

Note that not all health insurance providers are approved to manage your CSS benefits; to find a list of government-approved insurers in your area who are allowed to take on your application, refer to the searchable database available here.

Who is eligible for CSS?

Eligibility to the CSS is determined on the basis of your income level and membership of the French healthcare system.

Unfortunately, last year the French stopped eligibility for CSS for people (mostly pensioners) whose healthcare is paid for by another EU state, or Britain, under the S1 health certificate scheme. There has been speculation that scrutiny of the rules post-Brexit may have played a role in this being enforced at this time whereas it was not in the past.

An association helping foreign people in France suggested that the change could be argued to be discriminatory and suggested people concerned who apply and are refused should seek to contest this. However, we have so far heard of no change to the policy.

Otherwise, for those eligible and earning the lowest incomes, the CSS is free, for others whose incomes are not deemed to be sufficiently low, a financial contribution will be required but lower than the full cost of taking out an ordinary mutuelle.

The calculation for this contribution takes into account the claimant’s income level and age.

People who have the RSA income support benefit will now automatically be attributed the complémentaire santé solidaire (CSS) as it was found that too few people were taking it up.

Access will also be ‘facilitated’ for pensioners on the Aspa pension top-up, who will automatically be sent documents allowing them to sign up.

Beneficiaries of the government’s CSS programme are required to pay a modest contribution if their income reaches a certain level. If so, contributions are calculated on the basis of income and age levels.

The CSS contribution is guaranteed not to exceed a maximum amount of €1 per day and per person.

Extra costs may not be covered by the CSS if you choose to consult with your doctor outside the regular business hours, if your doctor pays you a house call or if your doctor determines that your consultation is unjustified.

What are the income ceilings to benefit?

A single household with an annual income of €9,571 or less will receive CSS coverage at no charge while a single household earning up to €12,921 can receive CSS coverage at a cost.

Meanwhile, a household of two people with an income of up to €14,357 can receive CSS coverage at no charge and couples with an income of up to €19,381 are eligible for coverage at a cost. The ceilings rise accordingly for larger families.

These figures relate to members of your household including spouses, civil partners, unofficial long-term partners and dependents.

Entitlement is based on actual amounts of money received in the previous 12 months before the application is made but does not include some forms of income such as certain social welfare benefits (see the form link below for more on this).

How can I apply for CSS?

You can apply for the CSS online through your Ameli account under Mes démarches or in person at your local Cpam.

To apply for the CSS, you should fill out the Cerfa form nº 12504*08 which describes your household and your family income.

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