AXA Assurances
Agence 3B Assur
4, rue Alberti - BP 1736
F - 06016 NICE cedex 01
Tel +33 4 93 92 16 32
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Fax +33 4 93 13 48 67
E-mail: info@steenandersen.net
 
   

F A Q

 
< H e a l t h >
COMPLEMENTARY HEALTH INSURANCE IN FRANCE - QUESTIONS AND ANSWERS
 
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Who can take out top-up health insurance cover? 
 
  

Anyone who subscribes to a French mandatory health insurance scheme (“régime obligatoire”) can get additional cover through a top-up health insurance contract, also known as a “mutuelle”. There are no age restrictions and chronically ill persons as well as pregnant women can benefit from day one. In addition, AXA cannot terminate a contract with reference to deteriorating health.

   
   
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How do I get public health insurance?
   
 

All French residents are required to subscribe to a mandatory health scheme. French public health service is of high quality, but it is not free. Unless you receive a public pension (see below), you pay a general contribution depending on your income and, on top of this, you pay part of the cost every time you receive health care or medication. Only treatment of the most serious diseases and accidents are paid 100% by the health care system and even in these cases you will have to pay your stay in hospital (15 euros per day), part of the treatment before and after your hospital stay etc.

If you are an EU citizen and receive a public pension from your home country, you are entitled to an E 121 statement, which gives you the right to join the public health insurance scheme, CPAM (Caisse Primaire d’Assurance Maladie) at no charge. Application to join CPAM should be made through your local CPAM office. Check with your local town hall (“Mairie”) for address and opening hours. Quite often, CPAM has an office at the Mairie.

Persons employed and working in France should also join CPAM and pay part of their salary towards this. An E 104 statement will secure the right to treatment immediately upon joining CPAM, i.e. without waiting time.

Self-employed persons are required to join a mandatory scheme as well, but have the choice between a number of providers (not CPAM, though).

Others (e.g. persons receiving a private pension or persons with a sufficient amount of money in the bank) could and should join CPAM by paying 8% of their taxable income less a minimum allowance. This could be a considerable amount of money and consequently, some people prefer to stay outside the public health system and go for a fully comprehensive, private health insurance although this, strictly speaking, is not in accordance with French law.

For students, unemployed and French residents working in another country special rules apply.

   
   
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What is covered by a top-up health insurance?
   
 

The basic rule is that if your mandatory scheme pays part of a treatment, AXA will contribute as well. This means that certain treatments, which are often excluded by private health insurance providers, will in fact be covered by AXA’s top-up scheme, e.g.

  • Treatment and medication of chronic diseases
  • Glasses, contact lenses and hearing aids
  • Routine dental care
  • Sudden illness or accidents anywhere in the world
  • Accidents related to so-called “dangerous” activities or sports such as mountain climbing, scuba diving, parachuting, skiing, martial arts etc.
  • Consequences of drug or alcohol abuse including treatment of injuries incurred while under influence

In addition to treatment, tests and medication the following expenses are reimbursed:

  • Single room at hospital
  • Spouse or family member’s stay at hospital
  • Ambulance charges
  • Home nursing
  • Drug delivery following hospitalisation
  • Telephonic advice on health and nutrition issues
  • Worldwide emergency cover including repatriation for non-professionally related stays of up to 3 months
   
   
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What is not covered by a top-up health insurance?
   
 
  • Cosmetic surgery not related to disease or accident
  • Planned treatment outside France
  • Expenses covered by other insurance schemes
   
   
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Is my consumption of prescribed medicine covered?
   
 

Yes. Whichever solution you choose, prescribed drugs will always be free of charge. AXA will send you an attestation which gives you the right to retrieve prescribed drugs at the pharmacy without paying.

   
 
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If I have top-up cover, how much could I risk paying myself?
 
  

Top-up cover is not a 100% guarantee that you will never pay anything towards your health expenses, but if you are careful in your choice of health providers, your actual health expenses could, for all practical purposes, be limited to contributing to major dental treatments and glasses/contact lenses.

Your actual payment depends on two things:

  • · what the health provider (family doctor, specialist, hospital, dentist, test lab, home nurse etc) charges in relation to the agreed tariff with the French state
  • your choice of cover (at AXA you choose between 100%,125%,150% or 200% cover)

An example: You have chosen 125% cover. Your family doctor charges 25 euros for a visit. Your mandatory scheme and AXA reimburse you in full, as the agreed tariff is 20 euros and 125% x 20 euros = 25 euros. If the doctor charges more than 25 euros, you will still be reimbursed 25 euros, but you will pay the remainder yourself. (Please note that as of 1st July 2005, 1 euro will always remain at your charge. This is part of the government’s endeavours to reduce the enormous deficit for the national health system.)

Consequently, before choosing your coverage ratio, it may be an idea to check how much your family doctor, the relevant specialists and your local hospital deviate from the agreed tariffs.

   
   
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Do I need to wait for the complementary insurance to take effect?
   
 

No. The insurance cover applies from day one (with very few limitations). Chronically ill persons, pregnant women etc enter with the same rights as anyone else.

   
   
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Do I need to fill in a health questionnaire?
   
 

Clients applying for coverage up to 150% are not asked any questions about current ailments, previous hospitalisations etc. Only clients applying for 200% cover need to answer a few basic questions about planned treatments.

   
   
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How to choose coverage ratio?
   
 

Apart from the deviation between your preferred health providers’ prices and the agreed tariffs, you should take into account your need for major dental surgery and/or glasses/contact lenses. AXA contributes a fixed amount towards some expenses – on top of the percentage reimbursement:

Coverage ratio 100% 125% 150% 200%
· Glasses, contact lenses € 60 € 100 € 150 € 200
· Laser treatment for myopia 0 0 0 € 400 per eye
· Approved orthodontic treament € 60 € 100 € 200 € 300
· Hearing aids 0 0 0 € 100 per year +
€ 300 every 4 years
· Health hydro stays € 60 € 100 € 150 € 200
· Single room in hospital € 30 / day € 50 / day € 60 / day € 75 / day
· Welcome present for newborns € 60 € 100 € 150 € 200
· Vaccines actual expenses actual expenses actual expenses actual expenses

The 100% cover is also available without any of the above extras. In addition, a "hospitalisation only" option is available if you only want emergency cover.

In case of hospital stays, the coverage ratio is increased for doctors’ fees:

Contractual coverage ratio 100% 125% 150% 200%
· Actual coverage ratio for surgery and anaesthesia 300% 300% 400% 400%
   
   
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Do I need to fill in and send a lot of documents in order to be reimbursed?
   
 

No, not at all. One of the great advantages of AXA’s top-up health insurance is simple procedure. Reimbursement takes place automatically based on your use of the Carte Vitale. The money is credited your bank account within a matter of days. You need not send any form or receipts unless you do not use your Carte Vitale, i.e. purchase of new glasses.

Prescribed drugs are free of charge (as described above) and your hospitalisation expenses are settled by AXA directly with the hospital or clinic. Many doctors and laboratories are electronically linked to the main public health insurance providers as well as to AXA, in which case you need only settle the fraction, if any, not covered by your insurance schemes.

   

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