4 Voluntary 'Top Up' Health Insurance in France

1. Limits of State Health System
2. How Much do you Pay?
3. Does a Top-Up Policy Make Sense?
4. Obtaining Voluntary Health Insurance
5. Terminating Your Top-Up Policy

4.3. Does Top-Up Insurance Make Sense?

In considering this question, remember that whether you are retired, or you run your own business in France, the French social security system reimburses only a proportion of your health charges - around 70% for routine treatment and 80% for hospital treatment.

Only in the case of major or long term illness or if you are on a low income are you entitled to 100% cover.

On this basis if you were only using the health service for occasional minor ailments it is unlikely that it would be worthwhile to take out voluntary insurance.

However, like all insurance policies, whatever your circumstances, you never know when you might need to call on it.

Moreover, not all major illnesses are covered at the rate of 100%. The list of such illnesses is strictly defined in law and there are many costly medical treatments not on this list.

There is also a need to consider your age and medical circumstances. Most expats who relocate to France are aged 50+, with medical needs that are likely to reflect this level of seniority. You may also find it more difficult to get voluntary insurance the older you become.

Aside from the cost, you also need to consider the psychological benefits of having full cover, giving you the peace of mind you may need to enjoy your life in France.

Some factors to consider are:

First, if you have a prescribed serious medical illness, the health system will cover all of your basic costs at the rate of 100%, provided the charges are at the official rate. So there is a certain level of peace of mind about your costs if you do become seriously ill. You will still need to pay extra, or have insurance, for a private room in a hospital, or possibly a television in your room, as well as certain other minor non-reimbursable charges. Neither, as we stated above, will the basic insurance cover consultant charges over and above the official rate, which have now become very common. So although having a major illness means you obtain 100% reimbursement does not necessarily mean you will not have to meet some costs.

Second, unless you have a decent policy, those charges (mainly consultant charges) in excess of the official rate will not be reimbursed by your complementary cover. This is because the complementary health policies vary in the extent of their cover. At the bottom end a basic policy will cover your charges not met by the statutory system, provided these are at the official rate; at the top end there are policies that will cover all extra charges and additional services and facilities you may require.

Third, if you are on a low income you can obtain entitlement to 100% reimbursement of your costs through Complémentaire Santé Solidaire - CSS. Consultants treating CSS patients are required to charge only the basic rate, although there is no right, for instance, to a private hospital room funded by the CSS.

So, in summary:

• In the event that you become seriously ill, in general the statutory system will cover your basic costs;
• Even should you take out a complementary insurance policy it does not necessarily mean that all your costs are covered;
• Those on a low income are fully protected through the CSS.

Accordingly, if you are prepared to pick up routine medical treatment yourself, you might find it more economic to take out a ‘hospitalisation only' plan. Such policies are up to 80% cheaper than a general policy.

What they amount to is that you take personal responsibility for meeting your routine health costs (as well as optical and dentistry) not reimbursed by the social security system, but that in the event of hospitalisation the insurer will meet most or all of your non-reimbursable statutory costs.

Nevertheless, as with the standard policies these 'hospitalisation only' policies vary in the level of their cover, so you would need to read the policy carefully, particularly with respect to dépassements d'honoraires and other 'comfort' items you may seek if admitted to hospital, eg a single private room.

Perhaps most importantly, hospital out-patient treatment is not normally included in such policies.

We provide an analysis of all the charges to which patients are liable in our France Insider article at Patient Health Charges.

Next: How to Find a Policy

Back: Limits of State System