How do thermal spa treatments for health work in France?

Thermal spa treatments are a popular choice for healthcare in France with around half a million people treated each year. 

France has more than 100 thermal spa resorts, known as stations thermales, offering therapeutic treatments that can help alleviate a range of health conditions. 

Treatment costs up to 65% may be reimbursed by the French social security system if you have a recognised condition that would be considered to benefit. 

Depending on your financial circumstances, some travel and accommodation expenses may also be reimbursed and your mutuelle top-up health insurance might also help cover costs depending on your policy.

What are thermal spa treatments?

Thermal spa treatments in France are used for both curative and preventative purposes. 

For example, the waters at Gréoux-les-Bains in Alpes-de-Haute-Provence, rich in sulphur, calcium, sodium, and magnesium, are often recommended for conditions like rheumatism and respiratory infections. 

The aim of these treatments, known as les soins, is to alleviate pain and reduce dependency on medication. 

They are generally prescribed for chronic conditions and involve a series of water-based therapies over an 18-day period.

How to access spa treatments

In France, only a doctor can prescribe a thermal spa treatment plan or cure thermale. 

If your doctor believes that a cure thermale will benefit your specific condition, they will issue a prescription and may suggest a suitable spa for your treatment. 

They will need to sign you up for the treatment plan via an official form.

With a doctor’s prescription, your thermal spa treatment may qualify for state reimbursement, provided the spa is government-approved (établissement thermal conventionné). 

Your dentist might also be qualified to write a spa prescription if you have a mouth disease that would benefit from treatment.

Note that a cure thermale uses fresh water whereas thalassothérapie uses seawater and is not eligible for reimbursement.

Treatment plans last 18 days and run over three weeks, with six days of therapy per week.

You must complete the entire course of therapy to receive reimbursement and it is your responsibility to ensure that your medical coverage will be sufficient to pay for all the various costs and options you choose.

State reimbursement and financial assistance

State reimbursement for thermal treatments is available for specific medical conditions including rheumatological disorders, respiratory conditions, digestive problems and after bypass surgery. 

Reimbursement typically covers 65% of the fixed cost of the treatment, known as the forfait thermal.

Additional costs, such as transportation, accommodation, and certain medical consultations, may also be reimbursed based on your income level. 

For example, if your income is below €14,664.38 per year, state reimbursement covers 65% of the cost of a second-class train ticket for travel to the spa, as well as 65% of a fixed sum for room and board.

For those with long-term illnesses (affections de longue durée) or those under the Complémentaire santé solidaire (CSS) scheme, reimbursement will be 100%.

Practical steps for thermal spa treatments

There is necessary paperwork to complete prior to your spa treatment. You will need to fill out and sign a Cure thermale – questionnaire de prise en charge, plus a declaration of your financial means. These should be forwarded to your Cpam (caisse primaire d'assurance maladie). 

They will send you a form divided into three parts: one for the doctor overseeing your care at the spa (honoraires médicaux), one for the spa admissions staff (forfait thermal), and one for you to send to Cpam upon your return if you are eligible for assistance with transport and accommodation costs (frais de transport et d’hébergement).

Accredited spas operate le tiers payant, meaning there is no upfront charge to pay for reimbursed amounts. 

If you are on sick leave during the treatment, you may also be entitled to daily compensation, provided your income does not exceed a certain threshold.