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Dental insurance in France

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France is known for its famous healthcare system and the benefits it provides to its users. It is considered one of the best public healthcare systems out of all the others, and it led France to be part of the countries with best healthcare system in the world. One of the selling points of this system is its insurance policy. In this article, we will learn what makes this health insurance system so appealing.          

All legal residents in Frances are obliged by law to have health insurance. Expats (people from another country) are now eligible to apply for the French health insurance (l’assurance maladie) in order to access France’s world-renowned healthcare system, now that the French government has instated a new universal healthcare insurance system known as the Protection Maladie Universelle (PUMA) in January 2016. In truth, this system existed before, but it was very underdeveloped to function properly. Individuals who are not covered by PUMA or might want to increase their health coverage must apply for a private health insurance while living in France. Bupa Global, an international health insurance provider, explains who is eligible for public medical insurance in France and whether they need to avail to private French health insurance for foreigners.

The old health insurance scheme Couverture Maladie Universelle (CMU) was replaced by the Protection Maladie Universelle (PUMA) on January 1st, 2016. Since then, it has been granting all residents in France, including foreigners, easier access to health services inside the country. Under PUMA, legal permanent residents in France are entitled to state health insurance if they have lived in the country for three or more consecutive months on a stable and regular basis. This healthcare reform has simplified the requirements for workers and residents in France to qualify, thus unlimited healthcare access will now be an automatic and continuous right of all residents regardless of age, prior medical history and record of paying French social security contributions (cotisations sociales)

The prior health insurance system for foreigners was only offered if a number of living or employment conditions were met. If this situation changed, foreigners were urged to apply for state health coverage under a different and more suitable category. As a consequence they could leave you uncovered by any health insurance during extended periods of time. The new PUMA scheme guarantees that any legal resident in France will be able to stay with their French health insurance plan despite changes in their personal circumstances of loss of employment or business. This also means that people who have already received insurance from the old system, the CMU, they will no longer have to apply yearly to renew their coverage, hence effectively reducing the administrative burden on state insurance workers. PUMA also equalises the rights of European Union citizens and Non-EU citizens to apply for their carte vitale (health insurance card) and receive French Health insurance after three months of residency in France, Non-EU citizens already enjoyed this right prior to 2016, while EU citizens had to wait five years before they could apply for health insurance, a law that was tremendously criticized for undermining this last group free movement within the European Union.

The CMU-complémentaire (CMU-C), which is a program that provides free health insurance in France for low income or unemployed people, also continued to be used as a complement of PUMA, though the requirements vary. Whether you are one or the other, you are eligible for a free complementary state-funded healthcare. Expats will need to first activate PUMA in order to qualify for CMU-C. Once you have been deemed eligible, all medical and dental costs will be fully covered and you will not be asked for upfront payments after healthcare services have been rendered.

The healthcare reform mostly affected residents who were, previous to 2016, not covered by employment or business-based health insurance, current people who have had changes in their personal or employment circumstance and residents in France. It has no practical implications to those who were employed, self-employed or retired EU expats with a valid S1 form.

Thanks to this PUMA system, expats living in France can apply to receive a state health insurance under its program if they have lived in France for less than Five years, do not have paid employment, are under the national age of 65, and do not receive a pension from any European country. Non-European students who are older than 28 years with no salaries and British early retirees are also eligible.

One can apply for health insurance in France as long as three months of consecutive residency have passed. If it gets approved, the government will assess whether you need to pay contributions towards the Unions de Recouvrement des Cotisations de Sécurité Sociale er d’Allocations Familiales (URSSAF). One will have to find private health insurance, should the application fail.

As a general rule, all individuals, including foreigners, who plan long-term lives in France, must have French health insurance. This is stated by law. All legal residents in France and salaried employees who pay into the French social security system will be eligible for state medical insurance in France, although there are some exceptions depending on one’s situation. Here are the requirements for each category.

For residents in France, according to PUMA, those who have proof of stable and regular residency in France for at least three consecutive months and you will keep doing so for at least three more months yearly, are entitled to health insurance. By Stable and regular it is implied that your family or main home is in France.

Employees who work in France are entitled to French healthcare insurance as well, through the cotisation sociales (social contributions) they pay to the French social security system.

Citizens from the European Union, European Economic Area and Switzerland, and their families who are staying temporarily and not working in France more often than not already have access to their European Union Health Insurance Card (EHIC). Providing the family or the person decides to become a resident or stay long-term in France, they can apply for the French Health Insurance.

Retirees from the UK and the EEA (European Economic Area) who are receiving pensions from their home countries and have their principal residence in France can apply to the French health insurance if they have a valid S1 form, formerly known as E121 and E106). This form is issued by their respective national health departments and confirms the holder’s long-term commitment to living in France.

Any children who is 16 years old or below is eligible for healthcare insurance in France regardless of their situation, nationality and condition.

Foreign students are not typically recognised as ‘French residents’, meaning most students must acquire the required Students’ Social Security (Sécurité Sociale Etudiante), which covers health expenses while in France. The exception to this rule is if the student falls under one of these categories.

  • EU or EEA citizens with valid EHIC
  • A resident of Quebec with social security coverage
  • A student with a French government scholarship.
  • A student with plans to study in France for less than three months
  • Non-EEA citizens who are older than 28 years and have no salaried employment, in which case they can apply for health insurance in France under the PUMA scheme.

Students who live in France for less than six months per year will not, in general, be eligible for public healthcare. Those who are not eligible will have to find a private solution. Fortunately there is a wide range variety of affordable options in regards to private health insurance, though this is more a matter of perspective whether it is cheap or not.

Most dentists ( geo allo garde dentiste ) in France work within the framework of the French health insurance system. This means that someone inside PUMA will be able to get basic dental care at a reasonable price without compromising its high quality. A reimbursement is generally of 70% by the social security system.

However once the treatments go beyond the basics, things become a little different. Let’s use someone as an example. Eileen Collins, from Languedoc wrote ‘Thankfully, we had decent ‘top-up’ health cover through a ‘mutuelle’. This was written in reference to a bill she received that was over €2000 from her dentist. Eileen needed a bridge over three teeth, a treatment for which she received only €400 from the health system. Her voluntary health insurer paid a further €900, leaving €700 to be paid directly from her own pocket. A voluntary health insurer is an insurance cover that will pay most, but not all of the residual costs of medicinal care, so one will still be left with a small amount to pay oneself. The amount will vary depending on the terms of ones policies, circumstances and the nature of the treatment.

Eileen’s experience is no different from the rest, as the French authorities have effectively disengaged from reimbursement of specialist treatment, allowing dentists to impose their own charges on such work. The main reason behind this arrangement is to ensure that everyone is able to have access to basic dental treatment at a reasonable cost.

Dentists spend around 70% of their time on basic dental care, but it only accounts to a 30% of their income. That is only a third of their earnings. The remaining two-thirds of their income come from treatment for which they set their own prices. And on that matter, while they are completely entitled to set their own prices for specialist treatment, they are also required to do so with modesty, meaning that their prices cannot go over the roof. However, this norm is not defined enough, as there are no clear numbers in the regulation, so charges may vary widely.

If anyone wants or is in need of using dental treatment in France, there are really only three possible ways to reduce the cost of these treatments.

The first thing one should immediately do after hearing an outraging price, is to consider getting alternative quotations from different dentist. It can happen that it is no the treatment what is expensive, but the dentists. However, this can be easier said than done, especially in rural areas, as there might not be that many dentists there. Keep in mind that a dentist who offers the same treatment for less money is not necessarily of lower quality or a scammer. That is just what he thinks is reasonable for the treatment to cost.

A second way to go around things is to take a look at the voluntary ‘top-up’ health insurance policy, to see whether it grants sufficient cover for dental treatment. Most basic policies only offer to reimburse the 30% of what the social security system does not cover, and only at the basic rate. Accordingly, one might have to opt for a more expensive ‘top-up’ health policy in order to get a larger reimburse. There are those that even reimburse a 100% of the excess dental charges.

However, a more practical, and cheaper, solution is to obtain a dental treatment from a dentist who is on a list of recommended dentist from your voluntary health insurer. These dentists will offer lower prices to those who hold a policy with the relevant insurer. It might be even possible to find a dentist that will settle part of the charges directly with the insurer, leaving one to only pay directly that part of the charge not met either by the social security system or the insurer.

To give closure to this article, here are some personal opinions about the French insurance system. I believe it is a very well thought-out system that is really trying its best to benefit everyone, and regarding dentistry, it is possible, even if it is with a bit of planning, to make dental services accessible for everyone, including the ones that are more specialized. This system, as well as other aspects of the French healthcare system, clearly represents France’s policies on its citizens health, and why it is one of the best, around the globe.