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 or e mail [email protected]

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 of 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 or 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 options, 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.