2. Health Insurance Cover in France

1. Introduction
2. Health Cover for Self-Employed
3. Health Cover for Cross Border Workers
4. Health Cover for Retired Persons
5. Health Cover for Early Retirees
6. European Health Insurance Card (EHIC)/Global Health Insurance Card (GHIC)
7. Travelling Abroad from France

2.4. S1 Health Cover for Retired Persons

2.4.1 EEA Retired Nationals

For the purposes of this section we define a 'retired person' as someone of the age of retirement of their country of origin, who exercises no professional activity, and who is in receipt of a State Pension from their home EEA country.

If you are an EEA national and in receipt of a State pension, or you suffer from long term incapacity, then in order to register with the French health system you will need to apply for a Form S1 certificate of entitlement from the social security authority in your country.

We also include in this category people under the age of retirement, but in receipt of long-term incapacity benefit.

UK nationals who relocated to France before January 2021 are entitled to an S1 when they reach State retirement age.

For UK nationals who relocate to France after 2020, their rights to healthcare and possible right to an S1 certificate are set out in the Trade and Cooperation Agreement signed by the UK and EU, which we covered in our Newsletter article at Brexit - Health Cover in France for Pensioners. This agreement retains S1 health cover for those of State retirement age.

Subsequent guidance issued by the consulate in London states:

'Following new instructions on the issuance of Long Stay Visitor Visas, valid S1 Form is now accepted as evidence of medical coverage. Please provide a copy of your S1 Form. If you don’t hold a S1 Form, you will need to provide a private Health insurance, which must cover full requested long stay visa, up to 1 year.'

Those who hold an S1 certificate of exemption will only nominally be affiliated to the French health system (PUMA) for the purposes of administration, as European regulations grant them and their family members an entitlement to health cover via the certificate, paid for by their home country.

As a retired person, if you have an S1 you will continue to benefit indefinitely from health insurance cover in France on the same terms as French nationals.

Holders of an S1 certificate do not pay the PUMA health insurance charge, although the charge is now only paid by very few people due to the resources test that is used.

As well as exemption from the health charge, the use of the S1 also exempts you from the payment of social charges on your pension income. In effect, your health cover is being paid for through reciprocal arrangements in place within Europe; only those actually affiliated to the French health system pay these charges on their pension.

However, the use of the S1 does not mean you will get free health care in France. It simply means that you will not need to pay into the French social security system or to take out private health insurance in order to obtain health cover.

As the French health system only covers a percentage of basic health charges, ranging from 35% at the bottom end to 100% for major illnesses, if you wish to ensure all your costs are met you will need to take out voluntary ('top up') health insurance.

Even then, you will be responsible for paying some residual costs that are not picked up by either the social security or most voluntary health insurance systems.

So do not assume an S1 picks up all your health costs; it does not.

To obtain an S1 those from the UK should contact the NHS Business Services Authority at:

Overseas Healthcare Services, Bridge House, 152 Pilgrim Street, Newcastle Upon Tyne, NE1 6SN

Telephone: 0191 218 1999 Telephone from outside UK: +44 191 218 1999

The NHS have stated that the S1 application should be submitted 90 days before departure from France, and it will be sent to the UK address.

For UK nationals, as it is then possible that you will not receive your S1 prior to your visa application being submitted, it is not always possible to use it for the visa process. You need to make enquiries to the OHS about the processing period.

In addition, however, until the S1 has been approved by the local French health authority, it is not valid in France. So although you may have an S1 for the visa application, it could be months in France before the S1 is validated and you have health cover.

Accordingly, you may be best advised to take out a private health insurance policy to cover the application and validation processes, but which you can terminate when you are in the French system. These policies are available from our partner on the link below.

You need to present it to your local French health authority, the Caisse Primaire d’Assurance Maladie. There is no need to complete any kind of application form, although you should include an accompanying letter. Ensure you send it recorded delivery with confirmation of receipt - lettre recommandée, avec accusé de réception. We are aware of many, many cases where the health authority will deny ever receiving the application.

You should ensure keep a good quality copy, as the UK authorities are reluctant to issue a duplicate.

You may need to present your S1 to the tax authority for exemption of social charges on your pension income, although it is normally enough to simply declare the fact that you hold an S1 on your tax notice and make it clear you seek exemption from social charges on your pension income on this basis.

If you propose to run a business in France, then you will not be eligible for an S1, even though of retirement age, as you will be insured through your business. An S1 is only available if you are inactive and State retired. In addition, you will have no entitlement to an S1 when you retire. You can read more at S1 or French Pension?.

One other benefit of an S1 is that you retain your rights to healthcare in the UK, as if you were ordinarily resident in the UK.

2.4.2 Permanent Incapacity

The rules governing entitlement to UK long-term incapacity benefit have changed in recent years, with the abolition of Incapacity Benefit and it's replacement by 'Employment and Support Allowance (ESA)'.

The benefit is exportable to France, although claimants are required to demonstrate a satisfactory national insurance record, and all claimants in France will be required to have a periodic 'Work Capability Assessment' by a French doctor.

However, the entitlement to cover from the UK via an S1 only applies to those who relocated prior to 2021.

A person on incapacity benefit is likely to be entitled to receive full reimbursement of all the medical costs relating to their condition, provided it is classified as a Affection de Longue Durée – (ALD) by the medical authorities.

Similarly, anyone who suffers from a long-term or major illness is likely to find that 100% of costs in relation to the treatment of this illness are covered by the French social security system, provided it is also on the list of affections de longue durée – (ALD).

2.4.3 'Dependant' Spouses

A 'dependant' spouse of someone reaching State retirement age is also granted cover under an S1.

The definition of just what is regarded as being 'dependant' includes all those in a married relationship or in a civil partnership. Thus, even though your spouse may have an independent source of income, they would be admitted as a dependent.

Only in the case of those not married, or in a civil partnership, would it normally be necessary to prove financial dependency.

The decision as to who is dependent is not made by the French authorities, but by your country of origin. Some local health authorities in France have been known to contest dependency status, but the cases have been rare, and generally not upheld.

In the event that the holder of an S1 dies before their 'dependant' younger spouse reaches retirement age, then the surviving partner will continue to retain health cover through the S1 for 12 months.

However, use of this arrangement may not be necessary, as you would normally be granted automatic and permanent access into the French health system through 'accident of life' provisions. You can read more about this rule at Health Cover for Early Retirees.

You may be liable for the PUMA health charge, although few households now pay it due to the resources test that applies.

On this basis a dependent younger spouse of a retired person should always be able to obtain State health cover in France.

If one of partners in a household works or is in business in France, while the other is retired and in receipt of a State Pension, then three possible scenarios open up, with the rules a little unclear and application of the rules varied.

The first is and most likely approach is for the retired partner to obtain cover through an S1, while the other partner continues to be affiliated to the health system through their business or employment.

The second is that the local health authority accept both being insured through the S1. We consider this scenario unlikely (but not inconceivable) as the S1 is for use by retired persons living abroad in Europe. It is incompatible with a professional activity.

The third is where the local health authority in France insists that both be insured through the employment or business. However, it is questionable whether the French authorities could insist on this approach. Indeed it would not be financially advantageous for them to do so, as with separate insurance for each partner they receive two insurance premiums, one paid by the social security agency of the S1 recipient and the other directly by the business owner.

2.4.4. Non-EEA Retired Persons

If you live outside the EEA and you relocate permanently to France as a retired person, you will need to check with the relevant authority in your home country whether there are any reciprocal agreements with France. As stated above, this does not apply to UK residents, who are covered via the Brexit agreement.

You will almost certainly be required to take out private medical insurance, as you will need to justify you have the resources not to be a burden on the French social security system and to have health insurance cover. This cover will need to be taken out before you will be granted your long-term residence permit.

Ultimately, however, if you establish a right of residence in France of whatever duration, you will be able to make application for State health insurance cover. Indeed, there are increasing signs that the French authorities are insisting that once you become legally resident in France you opt in to the State system; even if you do not, you may still be liable for the health insurance charge.

Accordingly, all we can advise is that if you arrive in France with a residence permit and suitable health cover, once you have established at least three months residence you should consider making application for admission to the health system. If you are successful, the cover should last at least for the duration of your residence permit, which may then be renewed.

You can read more in our Guides to Moving to France.

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