This chapter tells you what you need to know in order to claim for health care in France.

If you have worked and paid social security contributions in another country of the European Union, your period of work and the contributions that you have made may be taken into account when your benefits are calculated in France.

In what situation can I claim?

Sickness benefits guarantee the payment of benefits in kind (repayment of healthcare) for beneficiaries and their right-holders.

Benefits in kind cover medical and paramedical fees, along with pharmaceutical costs, fees for the use of medical equipment and hospitalisation.

The following may benefit from these allowances:

• the beneficiary himself;
• his or her minor right-holders.

What conditions do I need to meet?

The right to these allowances is subject:

• either to practising a professional activity;
• or to having a stable and lawful residence in France.

What am I entitled to and how can I claim?

Healthcare without hospitalisation

Each patient aged over 16 years old needs to choose a general practitioner, who will guide him in his course of healthcare and who will coordinate the person's personal medical file.

All the medical acts realised or recommended by the general practitioner will be reimbursed at the normal rate, as the patient is in the circuit of coordinated care.

In principle, a certain proportion of the cost is to be paid by the beneficiary: this is the co-payment rate. This will be higher if the patient is outside the health circuit. Moreover, a flat rate contribution of €1, which is not repaid, is requested for any consultation or act carried out by a doctor, radiological examinations and laboratory analyses.

In the case of a general practitioner, the repayment of consultations is as follows:

* According to the doctor's area of activity, repayment may be different:

• doctors in sector 1 fully adhere to the agreement and respect the negotiated rates with health insurance;
• registered doctors, complying with the Controlled Pricing Practices Option (Option de pratique tarifaire maîtrisée, Optam), apply moderate excesses: by signing this agreement, they have promised to moderate and stabilise his/her fees in order to facilitate his/her patients' access to healthcare;
• doctors in sector 2 set their fees freely.

For more information on the sums repaid, consult the dedicated page of the sickness benefits website.

Drugs

Drugs are delivered on medical prescription. In order to be reimbursed, they must feature on the social security beneficiaries' list of reimbursable drugs.

The repayment rate for drugs varies according to their use:

• 100% for drugs recognised as irreplaceable and costly;
• 65% for drugs that have a major or significant medical service;
• 30% for drugs with moderate medical benefit;
• 15% for drugs with a low medical benefit.

Healthcare with hospitalisation

Social security contributes to the costs entailed by the hospitalisation of the beneficiary or his beneficiaries. This repayment includes all the services provided by the hospital:

• medical and surgical fees corresponding to the acts carried out during the hospital stay;
• drugs;
• examinations;
• operations.

In case of hospitalisation in a public establishment or an accredited private clinic, 80% of hospitalisation fees are reimbursed. In certain cases, the reimbursement is equal to 100% (from the start for certain insured persons and from the 31st day of hospitalisation for everyone).

Unless exempted, the beneficiary must pay a flat daily hospital fee amounting to €20 per day of hospitalisation (€15 in the psychiatric department).

For treatments costing €120 or more, the patient is charged a flat fee of €24.

Certain establishments can practise excesses of fees that will not be reimbursed by health insurance. Any additional fees for personal comfort (e.g. a private room) are no longer reimbursed.

More information on hospitalisation is available on the health insurance website.

A flat co-rate payment of €19.61 for admission to an emergency service not followed by a hospitalization (Forfait Patient Urgences, FPU) is applicable (reduced to €8.49 or cancelled in some cases).

Jargon busters

• Circuit of coordinated care: The beneficiary chooses a general practitioner (generalist or specialist). This general practitioner will be consulted for all health issues and can, if necessary, refer the beneficiary to a specialist or order hospitalisation. Any beneficiary who does not name a general practitioner or does not go to this doctor first is outside their coordinated course of healthcare and so will have fewer costs reimbursed. Children under 16 do not have to name a general practitioner.
• Co-payment rate: Amount of statutory consultation rate that the beneficiary has to pay.

Know your rights

The following links provide further information about your rights. These sites are not the responsibility of the European Commission and therefore do not represent its viewpoints:

• In order to make inquiries on the rates and repayments practised by health and hospital professionals, consult the sickness benefits directory.
• More information on reimbursement rates is available on the health insurance website.
• Centre of European and international social security matters (Cleiss) page on health insurance in France.

Commission publication and websites:

• Social security allowances: your rights as a European citizen abroad

Who do you need to contact?

Contact health insurance online or find the nearest primary health insurance fund to where you live on the dedicated page of the sickness benefits website.