Official confirmation came today, December 14, from the French government that "inactive" expats affiliated to state healthcare via the CMU before November 23 can remain in it.
The information has been posted in French at http://www.securite-sociale.fr/comprendre/europe/europe/cmu_inactifs.htm
The long-awaited “circular” from the Direction de la Sécurité Sociale also confirms that five years’ residence confers the right to join the CMU.
However, it says that inactive newcomers to France do not have an automatic right to state healthcare. This also holds for people already living in France and using an E106 form which expires and they do not immediately move on to take an E121.
All those not allowed access to state healthcare – previously usually made through payment - must take out private health insurance.
There are two exceptions – those on very low incomes who fall ill may be able to apply for a benefit called the Aide Médicale d’Etat. Others may be allowed to join the CMU – on a case by case basis - if they face a sudden life change – such as an illness which hinders them taking out private health insurance or possibly a marriage separation making it hard for them to pay for or obtain private insurance.
The text at the site above is in two parts – a part for the public and a part in the form of a detailed circular intended for health authorities (CPAMs.)
We advise that readers wait a week or so before visiting CPAMs for more information. This is to allow sufficient time for workers to be briefed on the changes. We
also advise taking details of this circular with you.
A translation of the public part of the announcement is provided below.
Information point:
CMU affiliation for inactive EU citizens, students and jobseekers [also citizens of Switzerland and the European Economic Area]
The Social Security Directorate circular, dated November 23, 2007, has now clarified the dispositions taken by the March 29, 2007 decree which transposes into French law the 29 April 2004 EU directive on residence rights.
EU residents living in France, notably as inactive residents (under state retirement age and not benefiting from an E106), students or jobseekers, can benefit from the CMU if they are living in France legally. However, their residence rights in France, which are no longer formalised by the obligatory holding of a carte de séjour, rest on two conditions: having sufficient resources and having comprehensive health cover.
For those who have not totalled five years of regular, uninterrupted residence in France, access to the CMU can only be granted when, having acquired the right to live in France, these people can only access the CMU if they have a change of life circumstances which causes them to lose their financial resources of health insurance.
However, those people who have been benefiting from the basic CMU (CMU de base, as opposed to CMU complémentaire, a means tested top-up to basic state health insurance cover) up until November 23, can continue to benefit from it.
This circular is applicable from November 23.
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In order to facilitate understanding of the circular, we are offering a list of likely questions and answers:
Q&A
Why are the rules being modified?
Like other EU countries, France is obliged to conform to the EU directive no. 2004/38/CE of April 29, 2004, which fixes rules relating to residence rights for EU citizens.
These rules have a direct bearing on CMU affiliation in France. This directive was transposed into French law by the July 24, 2006 law on immigration and integration, then by the March 5, 2007 decree. This transposition was also completed by the March 5, 2007 law on lodging rights in order to address the situation of those who have come to France to seek work. Finally, the November 23 Social Security Directorate circular no. DSS/DACI/2007/418 completes the transposition of the directive by clarifying certain points concerning access to the CMU. This takes effect from November 23, 2007.
How does this impact on right to the CMU?
By fixing new conditions to residence rights, the EU directive has direct consequences on access to certain kinds of social security in France. This is notably the case both for the basic CMU and the complementary CMU, to which access is based on a condition of stable and legal residence in France.
What are the new conditions which the EU directive fixes for residence rights?
Under the directive there are two conditions covering the legal right of EU citizens to live in France:
- having comprehensive health insurance, and
- having sufficient resources so as not to become an unreasonable burden on the finances of the host state.
In other words, an inactive EU citizen who comes to live in France cannot legally become a French resident if he or she does not already have health insurance.
What happens if an EU citizen doesn’t fulfil these criteria and becomes ill?
If these conditions are not, or no longer, fulfilled, this person is no longer living legally in France. If this person becomes ill and has been living in France for less than three months, they can benefit from the dispositif soins urgents (urgent healthcare measure). If they have been living in France for longer than this, they can benefit from Aide Médicale d'Etat (State Medical Aid), or AME, on certain conditions (in particular they must have a low income).
Who is affected?
EU citizens, EEA citizens and Swiss citizens, and their family members.
In particular, those concerned include inactive residents and jobseekers who have recently come to France, and who were not in the CMU on November 23. In future all people in these categories wanting to come and live in France will be concerned.
“Inactive” refers to people who do not work – workers gain healthcare rights through their work.
Can E106 holders join the CMU automatically when it expires?
No. These people, who have never benefited from the CMU, do not have an automatic right to join it.
Who is not affected?
Those who were in the CMU on November 23 can stay in it because at the time they joined it, the requirement for residents to be in France legally was considered to be fulfilled without conditions.
These people can stay in the CMU after their cases have been studied by their local CPAM.
What about students and retired people?
These people also come under the directive and must have health cover. In practice, students will either benefit from healthcare cover from their home country or, if they are under 28, from French student social security.
In the vast majority of cases retired people will benefit from healthcare cover from their original country if they get a state pension, and this pension has healthcare rights attached.
How long does an EU citizen have to be in France to obtain to automatic right to the CMU?
The 2004 directive states that after five years of legal and uninterrupted residence a permanent residence right is obtained. This right allows people to benefit from the CMU.
This right should be verified by the foreigners’ department (service des étrangers) of the prefecture of the department concerned.
Under what circumstances can inactive EU citizens gain access to the CMU before five years have elapsed?
If an inactive EU citizen no longer fulfils one of the conditions of legal residence (sufficient resources or health insurance) they do not automatically lose their right to live in France.
If certain circumstances are present – in particular, if the person is confronted by an unforeseeable change in life circumstances, the person and their family will be allowed to remain resident, and access to the CMU will be possible.
Examples of this are when the person is faced by unexpected circumstances making it problematic for them to access to health insurance for financial or health reasons such as separation from, or death of, a spouse; divorce; or being refused health insurance because of a serious existing illness which could not have been predicted when the person came to France.
For more information contact: CNAMS’ English-speaking helpline (the national umbrella body for the CPAMs) on 08 20 90 42 12 or CLEISS (the international social security helpline) on 01 45 26 33 41
