The French government have merged two schemes that provide financial assistance towards health costs for those on a low income.

Since his election in May 2017 President Macron has introduced significant changes to the system of health and social security in France, mainly through the development of a more uniform, central model in the organisation and provision of care.

Chief amongst the measures have been:

• The introduction of a more streamlined system of universal health care through PUMa - Protection Universelle Maladie;
• The abolition of the separate social insurance fund for the self-employed, the RSI, and its merger with the general fund, with similar action also taken in relation to the social insurance funds for artists and authors and for students;
• Improved access to dental, optical and auditive care through the 'reste a charge zero' measure.

There is more information about all of these changes on the links below.

More recently, the trend towards greater centralisation of the system went a step further, with the merger of two separate funds that provide financial assistance towards health care and insurance costs.

The two schemes are called CMU Protection Complémentaire (CMU–C) and the Aide au paiement d'une Complémentaire Santé (ACS)

The first of these schemes provides free health care to low-income households, whilst the second provides financial assistance towards a complementary health insurance policy.

In both cases the receipt of either of these aides means that for the patient there is:

• No consultant surcharges, known as dépassement d’honoraires;
• No payment to the doctor/hospital for treatment, due to the use of tiers payant;
• Exemption from the €1 obligatory patient charge, called the participation forfaitaire.
  

The main difference, therefore, between the two schemes is the income threshold that is used to determine eligibility for assistance, with the threshold for access to the ACS around 35% higher than that for eligibility to the CMU-C, as follows.

In practice, the assessment and application process is a little less generous and more complex than the bare figures would suggest, but there is no indication that a reduction in the level of complexity is being planned.

Nevertheless, although the two schemes will retain their individual identities, there will be a single application form used for both of them, something which is already in place.

Where the income of the applicant exceeds the level that would grant them eligibility to the CMU-C, but they are within the resource level for the ACS, they will be offered the CMU-C for a maximum of €30 a month, depending on income.

This means that for some households affiliation to the CMU-C will be free, whilst for other households it will be contributory. The government estimates that several million households will be eligible for the new contributory CMU-C.

Effectively, the merger of the scheme provides a household with a 'mutuelle' for €30 a month, provided by through the State.

Not surprisingly, complementary health insurers have reacted with horror to the scheme, for if it is possible for a household to apply for ACS and obtain 100% health cover through the CMU-C there will be no need for them to take out a separate complementary health policy.

Philippe Mixe, president of the Fédération nationale indépendante des mutuelles (FNIM), calls the change a «serpent de mer de la nationalisation rampante.»

Nevertheless, the complementary insurers will still play a role as delegated bodies of the CMU-C/ACS, with responsibility as administrators, as applicants will still be able to choose their 'organisme gestionnaire'.

The merger of the two schemes will be operative from November 2019.

The application procedures for both the CMU-C and ACS are given in our guide below.