Healthcare Update September 13, 2007

France ‘will allow healthcare affiliation to continue for British early retirees.’ Last week no, this week yes

Latest reports indicate that France will allow early retiree Britons living in France to continue to be affiliated to its national healthcare system (CMU).

Last week the French Health Ministry and the national health authority (CPAM) said that CMU affiliation, based on payment related to income, was to be denied to those already in the system and newcomers to France irrespective of their financial situation. At least one official letter has also been sent to a Briton in France saying his affiliation to CMU is now denied and he must return his carte vitale.

The news - yet to be confirmed by the French Ministry of Health – was announced in a release from the British Embassy in Paris on Wednesday September 12. It came after a meeting between the ministry and the British Embassy in Paris on Monday September 10.

The Embassy statement reads:

“The British Embassy are in close touch with the French Ministry of Health to clarify the situation regarding healthcare provision for EU citizens who are inactive and below retirement age in France. The French authorities are applying strictly the EU Directive (2004/38) which will mean modifying the healthcare coverage available to some inactive people, including early retirees, from other EU countries who will be taking up residence in France. However, the French Ministry of Health have assured us that the provision of healthcare to people already resident in France will not be affected.”

The Embassy stressed that this was not an issue specific to Britons but applied to all EU citizens who come to live in France.

The ministry is said not to have changed policy but to have suffered from “communication errors.”

Yesterday French Health Ministry spokesperson Ophelie Rota declined to confirm the information. Ms Rota said: “We cannot comment. I can only confirm that a meeting took place between the ministry and the British Embassy on Monday.”

Last week Ms Rota said affiliation would be lost to all Britons living in France who were not in receipt of an E106, an E121, or who were not working. This advice was also being given out by operators at the national English-speaking helpline for CPAM – and still is by some operators. The change, they said, would be irrespective of the applicant’s financial situation.

At the beginning of September, The Connexion highlighted the case of Briton Charles Mochan who received the following (translated) letter from his regional health authority:

“As per the new 21/03/2007 decree*, all non-working EU residents on our territory who cannot benefit or cannot carry on benefiting to European rights on presentation of documents such as the E106 or E121 cannot benefit from Social Security but must instead contact a private health insurance provider. Consequently, you must return your cartes vitales to us.”

Our article was followed by reports in several British national newspapers. The case of Mr Mochan was also later reported in Le Monde who claimed early retiree Britons affiliated to CMU should not have gained access in the first place. It described the situation as a “shambles.”

In response to the importance of this issue and the high volume of reader inquiries to our office, The Connexion forwarded a list of questions to the French Health Ministry for clarification. The ministry said it would reply but could not do so before Tuesday September 11. The Connexion also contacted officials at the British Embassy for clarification who asked us to forward our questions to the ministry to them in advance of their meeting on September 10.

It is still unclear when the changes for new-comers will come into effect.

Readers concerned about this issue are being advised by the embassy to contact:

1. CPAM national English-speaking helpline.

The number for the helpline is 0820 904 212. However, yesterday this line was still giving out mixed messages. Some operators were saying that affiliation to CMU would not be available to new-comers to France and would be withdrawn from those already affiliated. Another operator said the situation was changing and more news would be announced soon. There may be a wait as operators told us they were receiving many calls from concerned Britons.
2. The DWP Overseas Medical Benefits line . The number for this is (00 44) 191 218 1999.
However when The Connexion called this number on September 12, spokesman Michael Wilson told us: “This has got nothing to do with the UK. Once a person has finished paying UK contributions, if they are not working then we will issue limited cover with the E106. After that people have normally been able to join the French system voluntarily or take private insurance, but we understand the French are saying they won’t accept people into the CMU now and you need private insurance. We have no more information from the French authorities or British embassy and we are suggesting people get more details from their local CPAM.”

Mr Mochan this week told The Connexion that he has received a “generous” apology from his local CPAM director for the abruptness of this letter, and had been told informally he may be able to stay in the CMU as he is not a recent arrival in France. He is waiting for written confirmation.

Connexion Editor Sarah Smith said: "If a communication error has taken place it is clearly at many levels - from the ministry as well as nationally and regionally within CPAM. We advise people to check with their local CPAM. We are awaiting an official statement from the French Health Ministry and will update our website when it arrives. We ask anyone with further information about the matter to contact us."

Larry Fulton, a health insurer who runs a free helpline for British expatriates and who alerted The Connexion to Mr Mochan’s case, said: “I would like to thank everyone who contacted us about this problem. The information was passed on to official sources and we are now awaiting clarification following the latest news.”

* From our research it appears this relates to the “Décret (decree) no. 2007-371 relatif au droit de séjour en France des citoyens de l’union européenne.” In its wording, this document refers back to a 2006 law, which is part of the “Code de l’entrée et du séjour des étrangers,” specifically Article L121-1. This (2006) article says EU citizens have the right to live in France for a period longer than three months only if they work or “if they possess: - enough resources to support themselves and their family so as not to become a burden on the social security system - and health insurance.”

This 2006 law does not seem to have taken effect, as relates to foreigners using the CMU, until after the clarifications provided by the March 2007 decree which stresses that these alternative health insurance arrangements (whether private or via an E106 or E121) should cover everything usually provided in the state system.

The decree was signed by the Prime Minister after its compilation by the then interior minister Nicolas Sarkozy.

The March 2007 decree also states that it has taken into consideration a 2004 EU directive [2004/38/CE of the European Parliament and of the council of the 29 April 2004] which relates to residence of EU nationals in other EU states. This EU directive contains the same wording as Article 121-1 of the French “Code de l’entrée” – people only have a right to stay in other EU states under the circumstances described above. It appears this relates to the minimum that states must offer. To date it would seem France has offered more than this through the possibility of joining the CMU. The 2006 law and Sarkozy’s 2007 decree seem to have been aimed at tightening up the French system so no more is offered to foreigners than strictly required by the EU.