Internal documents reveal that France has comprehensively outwitted the EU over health cover reforms.
France Sticks to Five Year Rule on Health Cover
Wednesday 01 February 2012
Internal documents reveal that France has comprehensively outwitted the EU over health cover reforms.
Despite the belief held by EU Commission that France had eased access into the health system for inactive early retirees, in fact documents obtained by us show that the five year residence rule remains in force.
Guidance sent to local health authorities last month by the health service national agency states that ''the expiration of an E106/S1 is not an automatic ground for granting access to the CMU, this event being foreseeable.''
The internal advice goes on to say that upon the expiry of their cover through an E106/S1 inactive early retirees should take out private health cover.
This directly contradicts the statements from the Commission that the whole pur.o. alt='search this word'>r.o./a>se of the new Circular issued last June was to ease access arrangements for early retirees.
Readers will recollect that the Commission brought infringement proceedings against France (which they have not abandoned) precisely because they were denying early retireess access into the health system.
However, the Commission can hardly be blamed for giving France the benefit of the doubt, for the June Circular explicitly withdraws the previous 2007 guidance, which prevented inactive early retirees entering the system, and nowhere is there mention of a five year rule.
Under European law European nationals legally resident in France for at least three months are entitled to be treated in the same manner as French nationals, including unfettered access to the health system, the Couverture Maladie Universelle (CMU).
By all appearances the June Circular seems to reflect this rule, stating as it does that the EU nationals enjoy continuity of rights as between one country and another.
Indeed, this is also reflected on the website of the CMU, which could not be clearer. It states:
''Pour pouvoir bénéficier de la Couverture Maladie Universelle de base, vous devez résider en France de façon stable et régulière.
La résidence stable est réputée acquise après 3 mois de résidence. Cette condition est applicable à tous, français ou étrangers.''
The fact that this declaration has remained stubbornly promulgated on the website over the past few years does suggest some tensions within the health service about the stance France has taken. The site is otherwise regularly updated for changes in law and practice.
But the content of the June Circular is really no more than an oxymoron, leading to confusion even amongst many CPAMs many of whom have remained unclear.o. alt='search this word'>r.o./a>f the policy in relation to inactive early retirees.
That is why they requested clearer guidance from the national agency, as part of which they submitted a series of questions, replies to which were included in the guidance that has been sent to them.
More generally, not only are many CPAMs confused, but it is clear from your reports at just how badly informed are some officials.
Tony Mason, of health insurance brokers Soficas, says he recently attended a meeting in Perigeux, organised by Angela Martyn (President North Eastern Dor.o. alt='search this word'>r.o./a>gne Women's Association), and attended by around 70 British expats and senior health officials from the local CPAM.
''The officials were completely unaware of the June Circular, and expressed disbelief when on a show of hands around one-third of those present said they had been refused health cover'', he says.
Now, of course, it may well be convenient for.o. alt='search this word'>r.o./a>fficials to deny knowledge of the problem, but there is widespread evidence that many local officials are simply ill-informed.
Medical Tourism
One of the other interesting aspects of the internal guidance is that it is clear the key factor behind the continued embar.o. alt='search this word'>r.o./a> is the fear by officials of ‘abuses’ of the health system, in particular, by those who relocate to France merely to obtain medical treatment. Officials seems obsessed by 'medical tourism'.
Accordingly, the guidance states EU regulations prevent the automatic refusal of early retirees, so each case must be examined on its merits, ''to prevent abusive behaviour and the need to consider in general the reasons for the transfer.o. alt='search this word'>r.o./a>f residence to France.''
If the 5 year residence rule is to be enforced, it remains unclear just what a 'case by case' consideration of all applications is supposed to do, except to try and demonstrate at least perfunctory compliance with EU rules.
Mixed Picture
Not unexpectedly, most of you affected by this rule are reporting difficulties in getting into the health system.
Greater success seems to be being achieved by those of you with a ser.o. alt='search this word'>r.o./a>us pre-existing medical condition that prevents you obtaining private health insurance. In most cases a letter.o. alt='search this word'>r.o./a>f refusal of insurance from a private health insurer does seem to be able to unlock the door.
Those of you claiming low-income as a reason for not being able to take out a private insurance policy are experiencing mixed success, as CPAMs seem to be making up their.o. alt='search this word'>r.o./a>wn rules about whether a private health insurance policy is 'too onerous'.
There are also other CPAMs who are simply ignoring the guidance from the centre (or seem blithely unaware of it) and continue to grant access to early retirees.
It is clear that a great deal of pressure is now being placed on the French authorities due to the high number.o. alt='search this word'>r.o./a>f appeals that are being made, and the number.o. alt='search this word'>r.o./a>f complaints that have been made to the European Commission.
Some of you are experiencing delays in the processing of your applications. This may not be due to intransigence by the authorities, but staffing pressures that are being experienced in many CPAMs.
Do keep us posted at editor@french-property.com.
This article was featured in our Newsletter dated 01/02/2012
David Yeates, Editor at www.french-property.com/news
The EU is stepping up pressure on France over reports that expats are still being refused health cover.
In order to try and get into the French health system, it seems some of you are applying for a residence permit, but it is a game of chance.
Health Cover and Residence Permits
Wednesday 05 October 2011
In order to try and get into the French health system, it seems some of you are applying for a residence permit, but it is a game of chance.
Over the past few weeks we have received dozens of e mails from readers relating your experiences of trying to get into the French health system.
Some of you have relayed very distressing chronicles to us, including some living in France without any health cover at all, while there are others who are paying a very substantial proportion of their income in private health insurance contributions.
We are grateful to you for telling us of your experiences, for they are invaluable to us in trying to get a full understanding of just what is happening.
As we anticipated in our last Newsletter, a very variable picture has emerged across the country in the application of the new Circular N°DSS/DACI/2011/225 concerning the admission of inactive early retirees into the system.
While some local health authorities are now admitting early retirees, some continue to rigidly apply the five year residence rule.
The European Commission has been alerted to the continuing problems being faced by many of you, and they have expressed to us their concern that some local health authorities have continued to fail to implement European legislation.
A spokesman told us that, ‘The Commission is monitoring carefully how this new Circular is applied in practice by the French authorities and is in contact with the French authorities on this issue. We are, of course, surprised by reports that the French health authorities have said the new Circular doesn't change anything, which, if confirmed, would be a source of concern.’
It is important that the EU is provided with the evidence that some health authorities in France continue to ignore EU regulations. So if you are being refused access into the health system, then we urge you to make a formal complaint to the European Commission, which you can do so at EU Citizen Complaints.
Appeal Procedures
One thing that is becoming clear is that intransigent local health authorities (CPAMs) are sometimes yielding when pushed hard by those who are aware of their rights and the procedures.
Accordingly, it is important you do not give up on your application if you are rebuffed by a local official.
You need to make use of the appeal procedure we outlined in our last Newsletter, and if necessary take the matter to the local tribunal.
We recommend you quote European Regulation (EC) No 883/2004 of 29 April 2004, which grants a right of equal treatment to EU residents who are legally resident in another Member State. Elements of the new Circular quoted in our last Newsletter would also be useful to include in your appeal letter.
Residence Permits
A small number.o. alt='search this word'>r.o./a>f you have also written to us about the provisions in the Circular which grant access into the health system for those who hold a residence permit, a carte de séjour.
Your mails on this point seem to be prompted by advice you have received from the English speaking CPAM help-line that this is the approach to take.
Although EU residents no longer need a residence permit to live in France, there is a provision in Circular N°DSS/DACI/2011/225 that grants those who hold a particular type of residence permit an automatic right of access into the health system.
Thus, the Circular states: ‘Les citoyens de l’Union bénéficiant de la qualité de résident permanent, appréciée par les préfectures et matérialisée par la détention d’une carte de séjour portant la mention « CE-séjour permanent-toutes activités professionnelles », ne sont plus soumis aux conditions exigées des inactifs (ressources suffisantes et assurance maladie complète) visées à l’article L.121-1 du CESEDA. Ils peuvent être affiliés à la CMU et, le cas échéant, complémentaire (CMU-C), dans les conditions de droit commun.’
What this means is that an EU resident who has a residence permit that indicates they have business/employment in France does not have to comply with either the requirement of existing health cover.o. alt='search this word'>r.o./a>r minimum income in order to be entitled to access the Couverture Maladie Universelle (CMU).
Now, of course, if you run a registered business in France then you are automatically affiliated to the health system, and a carte de séjour is not obligatory, although it is available on request.
However, there is anecdotal evidence from you that some préfectures are prepared to issue such a carte de séjour without the need to prove the creation of a business or salaried employment.
In short, what seems to be being said is such a permit grants the right to start a business or take employment for those that may have the intention to do so.
We do not believe that this broader interpretation was ever the scope of such residence permits, but it is clearly a game of chance, and all we can say is that if you have exhausted all other.o. alt='search this word'>r.o./a>ptions, this is one option that may well be worth pursuing.
If all you are being offered is a carte de séjour ‘non-actif’, then it is unlikely that this would take you much further, although it would of course confirm that you were legally resident in France.
In order to obtain a residence permit you need to make application to your local préfecture, the main governmental office that is located in each department of France. You will need to provide a range of documentation, whose list may vary, but you would be well advised to go along with your passport, utility bills, income tax notice, taxe d’habitation, marriage and birth certificates.
David Yeates, Editor at www.french-property.com/news
We would be most interested to continue to hear from you on this issue. You can contact us by mail at: editor@french-property.com
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