WORKING ABROAD FOR A FIXED PERIOD

Medical records

If you inform the DWP Contributions Department that you are going to live or work abroad for a limited period (eg, because you or your partner have been seconded), they will automatically inform the National Health Service Central Register. They will amend the Central Index of Patients which helps to determine funding for each Family Health Service Authority (FHSA). The FHSA will in turn withdraw your medical records from your General Practitioner about nine months after your departure. Your records will either be held until you return or re-register with a new doctor, or until they are destroyed. Records are normally held for at least six years. If you are going abroad for a limited period and plan to return to your current home area, it may be useful to inform your General Practitioner of both your departure and your anticipated return date. This will avoid your records being withdrawn unnecessarily.

Maintaining British social security rights

The DWP pamphlet SA29 explains in detail how to go about maintaining British social security rights whilst working abroad. It is very important that you read this pamphlet and take advice based on the information which it provides. This can affect your eligibility for state benefits upon your return to the UK, and your pension rights later in life.

Voluntary contributions can also be made in some circumstances, but these will not automatically entitle you to French social security benefits. They will simply guarantee your right to apply for British benefits.

IMMUNISATION

Standard immunisations are always worthwhile, although there are no particular dangers associated with life in France. Frequent contact with former French colonies in Africa may possibly mean that certain diseases are more common in France than in the UK or the USA, but the extra risks are minimal. All vaccines are available on prescription in France from chemists’ shops (pharmacies), and can be administered by qualified doctors. If you arrange immunisations yourself, you can ask your doctor to write you a prescription in order to obtain reimbursement from the Securite sociale. However you will generally have to pay a fee to the doctor, so it is best to ask him or her to write the prescription when they administer the immunisation.

GOING TO THE GENERAL PRACTITIONER

In France you are not limited to registering with one general practitioner in your area. You are free to consult as many doctors as you wish, as often as you wish, wherever you wish. The French frequently take advantage of this system to ask for second or even third opinions, but it is not really advisable unless you doubt the competence or approach of your doctor.

Sticking to one doctor allows him or her to know you and your problems better. The government is now actively encouraging doctors and patients to build ‘exclusive’ relationships, to cut back on the amount of money spent reimbursing multiple doctors’ appointment fees. Your chosen GP may also be designated as your médecin-référent, which means that he or she will coordinate all your medical cover and also prescribe generic medicines (see below).

Each time you visit the doctor, you will be asked to pay a consultation fee (honoraire)currently of €20. The price depends on the system the doctor works within (see page 311). The level at which you will be reimbursed for standard doctors fees is currently 70% for doctors who are conventionné.Prices increase for home calls (€30), night calls (up to €40 more, according to the time), Sundays and bank holidays. There are also small charges for medical acts such as cleaning and dressing a wound, administering injections, etc. For those doctors who now accept the Carte Vitale, an automatic registration of your visit activates an automatic claim for reimbursement from the Sécurité sociale.

GOING TO THE CHEMISTS

At the chemist’s shop (pharmacie), indicated by a green cross, hand over the prescription (ordonnance)to the pharmacist. Once your medicines have been prepared, you will be asked to pay in full. The level of reimbursement for medicines varies from nothing up to 100% if you have obtained an exemption certificate. Chemists’ shops provide a rota of weekend cover, which is posted clearly in shop windows along with details of late-opening chemists.

The chemist may advertise and/or ask if you wish to operate the tiers payant system. This means that you only pay the one third of the cost of the drugs which is nominally at your charge, with the balance being paid by the Sécurité sociale and your mutuelle. Some chemists are equipped for this system with Carte Vitale card readers. This option is only open to salaried employees within the French social security system, and not to self-employed workers.

Finding the medicines that you need

Most medicines are available in both France, but may be marketed under a different name. It is very worthwhile checking this with your regular pharmacy, or even the drug company, before moving to France. Another good idea is to take the packaging listing the ingredients with you, so that the doctor can check the components against a similar product in the ‘Bible’ he or she always consults before prescribing.

Over-the-counter drugs are available in more or less the same way as in the UK. Chemists will advise you as to cost and value of the products you require. Paracetamol and aspirin are both known under the same names.

In 1999 the Health Ministry introduced a ‘right of substitution’ allowing pharmacists to propose (but not impose) generic copies of the medicines prescribed. These medicines must contain all the same compounds and properties as the brand-named medicines marked on your prescription. If you accept these cheaper medicines (the average saving is around 30 %), then the actual medicine handed over the counter to you will be noted in writing on the original prescription beside the first-named medicine. Doctors are being encouraged more and more to prescribe cheaper generic drugs.

Parapharmacies

Parapharmacies are not allowed to deliver of sell medicines or prescription drugs. However, they do offer a wide range of homeopathic products, skin creams, etc. Some chemists also maintain a parapharmaceutical department.

Obtaining exemption certificates

If you have a disability or disease which requires regular and/or expensive medication, you may be eligible for an exemption certificate (prise en charge).Normally this will cover 100% of all fees associated with treatment, including medicines.

You will need to speak to your general practitioner or hospital specialist to arrange this. It is not an easy process, and can take a long time. There is a list of 30 diseases recognised as automatically offering exemption. The minimum length of period for treatment is now considered to be six months.

You will need thorough medical documentation, a recommendation from a French doctor, and will be summoned for an examination by a local health authority doctor (médecin conseil).Exemptions are also sometimes granted for a limited period after an accident and during the convalescence period.

REIMBURSEMENT OF MEDICAL FEES AND PRESCRIPTION CHARGES

The Carte Vitale system includes automatic reimbursement of medical fees and prescription charges.

If you receive a brown feuille de soin because the practitioner is not equipped for the Carte Vitale, once you have a complete feuille de soin, fill in the personal details, including social security number and means of payment (direct debit or cheque), and send it to your local caisse where your file (dossier)is held. Keep a copy of each feuille de soin sent. In either case, after several weeks you will eventually be reimbursed, and will receive a statement of how much you have been reimbursed for each expense.

You will also need to send a completed feuille de soin to your local caisse if you have lost your card, and are waiting for a new one.

The completed feuille de soin should include the details of your doctor’s fee, signature and surgery details; and the details of the prescription drugs you have received, including the vignettes (stickers) from the drug packaging. Without these vignettes, you will not be reimbursed for the medicines.

Form El 11 available from British post offices will provide British citizens with emergency healthcare cover for up to three months from the date of issue.However, the level of cover is limited to emergencies. Reimbursement can take place in either France or the UK. Private health insurance will provide a fuller cover for a visit of several months.

COMPLEMENTARY HEALTH INSURANCE

The remaining part of your expenditure on treatment or medicines can be reimbursed by joining a mutuelle, which is the standard French private health scheme. If you are in paid employment, you will almost always find that you are automatically included in such a scheme. Contributions are deducted each month along with regular social security contributions, and will be indicated on your pay slip.

Almost every trade and profession has its own mutuelle, and it is very worthwhile belonging to such a scheme. Benefits can also include extra sick pay, and the ability to attend private clinics if necessary or you desire. In principle, mutuelles will cover the remaining costs incurred. They will also cover some dental and eye-care costs.

Some mutuelles offer the possibility to link your reimbursements from the Secu directly to the reimbursement system offered by your mutuelle. For further details of this kind of service, you will need to make enquiries with your own mutuelle. Otherwise, you will need to send each statement of reimbursement from the Sécu to the mutuelle, along with your mutuelle membership details.

Students are required by law to join one of the special student mutuelles. See Chapter 13 for further details.

LOOKING AT HOSPITAL TREATMENT

Every large town has at least one hôpital conventionné which acts as the local general hospital, and includes the casualty unit (urgences).You have a free choice as to whether to enter a public hospital (providing you do not arrive in emergency!) or a private clinic. However, there are certain differences as regards reimbursement for the cost of your healthcare.

Private hospital treatment will only be reimbursed by the Sécurité sociale at the same rate as treatment in a hôpital conventionné. If you chose a private clinic, you will be given a form which must be validated by your local health authority centre, where your file is held. Once this has been validated, you hand this back to the clinic at your admission.

Your local caisse d’assurance maladie will settle the largest part of your hospital bill (80%) if you are in a public hospital. Remember that private clinics will charge more for their services, and that you will only be reimbursed on the basis of a stay in a public hospital. The outstanding 20% (or more for private treatment) is at your cost. Hospital treatment is thus the moment that you will most appreciate financially the benefits of a mutuelle.

In all cases you will be asked to pay the forfait journalier (about €11), which is basically a ‘board and lodging’ fee. You will normally also be offered the chance to hire your own telephone, and sometimes also a TV. Rooms are normally shared, except for those cases which require isolation.

There are numerous situations where your entire medical bill (ie, not just the usual 80%), except the forfait journalier, will be paid entirely for you by your local caisse. For instance:

• important surgery
• if you are in hospital more than 31 days
• delivery of a baby (for 12 days)–nor are you obliged to pay the forfait journalier
• if your admission is due to a work accident – once again, the forfait journalier is not charged
• if you are receiving invalidity payments or benefit due to a work accident
• if you are suffering from a serious illness which requires expensive medical care (as recognised by your local caisse).

You may also find that certain minor operations and clinical tests will take place during the course of one day, in which case you will be assigned a bed and admitted only for the day (hôpital du jour).

DENTAL AND EYE CARE

The same rules apply for visits to the dentiste or the opthalmologiste (optician) as apply to visiting a general practitioner. The optician will simply provide the prescription for your glasses or contact lenses, and you must then go to one of the many specialist shops in order to choose your frames or lenses. Conventionne dentists are reimbursed at the same levels as doctors’ fees in the same category.

Points to remember

• 1.It is very important to check if the medical practitioners and services you use – doctor, dentist, optician, hospital, physiotherapist, etc – are conventionné. There is nothing to stop you using private medicine, but you must be able to bear the cost.
• 2.About 20% of doctors are non-conventionné. Their fees are reimbursed much less by the Securité sociale and mutuelles. Practitioners who are conventionné à honoraires libres charge variable prices. The Securité sociale will reimburse at their conventionné fixed rate, and the mutuelle normally covers the rest of the cost. For instance, if your non-conventionné doctor à honoraires libres charges you €35 for a consultation, the Sécu will reimburse 70% of €20, not 70% of €35.
• 3.Make sure that all practitioners who do not accept the carte vitale complete a feuille de soin and return this to you after each consultation. Also make sure that pharmacists similarly complete their part of the feuille, and attach the vignettes from the medicine boxes.