When a new system was effective from 1 July 2005 it was required that every person of 16 years and over, living in France and benefiting from social security must nominate a medical doctor to be their attending medical practitioner (médecin traitant).

The attending practitioner or primary care physician, chosen by you, will be responsible for your direct care and for all referrals to other medical practitioners and specialists. They are the individual you first visit regarding any medical issue, and are responsible for maintaining your medical file of visits, examinations and diagnoses.

While it is not obligatory to have a médecin traitant, all medical consultations and treatments you receive that have not been referred by your médecin traitant will be reimbursed by social security at a very much reduced rate.

They will refer you to other care if necessary and collect and keep the information and results of consultations, and may be required to coordinate medical follow-up.

While it is generally advisable to choose a general practitioner (généraliste) as your médecine traitant, they can be a general practitioner or specialist, in private practice or a hospital or clinic and need not be geographically close to you. The only stipulation is that you name one person, not an entire group practice (cabinet de groupe).

Once your doctor has agreed you will need to jointly fill in the Cerfa form No 12485*01 Déclaration de Choix du médecin traitant (S3704) which they will have to sign and stamp. You must then submit this form to your Caisse Primaire d'Assurance Maladie (CPAM) office.

You may change your médecin traitant with no penalty and no questions asked. Simply complete a new Déclaration de Choix du médecin traitant form with the new doctor and submit it to your CPAM office. The new declaration will cancel your preceding choice.

For further information:

Download the Déclaration de Choix du médecin traitant : (PDF)
http://www.ameli.fr/fileadmin/user_upload/formulaires/S3704.pdf

A person who is eligible to the refund of permitted medical expenses on the same basis as the insured, Subject to where CPAM agrees that the legal definition of ‘Dependant’ is satisfied under French Law.  However, this could include spouse, unmarried partner, a child or any other dependent person who has been living with the insured for at least one year.

The Carte Vitale (Green Card or French Medical Card) is the French National Insurance Card which gives evidence of membership and rights to health insurance under the French Health system.

It contains all the administrative information necessary for any permitted refund:

□    The contact information of the payment centre
□    Name, first name, date of birth of the insured and their beneficiaries
□    The deadline of opening of the rights for benefits
□    It can also contain information about top up (“Mutuelle”) insurance

This is the Universal Health coverage that is designed to help those in financial difficulty to have access to medical treatment.

Basic CMU is affiliation to the French Health Service providing basic health expenses cover for anyone living regularly or permanently in France.

Complementary CMU also includes the possibility of top up insurance, where anyone living in France permanently on a low income can, under certain conditions, benefit from top up insurance.

Firstly, this should not be confused with a Mutuelle or ‘top up’ provided by an insurance company.

If you are on a low income, you can obtain a CMU Complimentaire which pays the balance of the healthcare portion, the ticket modérateur, up to 100% of the Tarif de Convention.  You should contact your local organisation (e.g. CPAM, RAM etc) to ascertain whether you are entitled to one.

The income thresholds can be found here:
http://vosdroits.service-public.fr/particuliers/F13375.xhtml

An explanation can be found here:
http://www.ameli.fr/assures/soins-et-remboursements/c.m.u.-et-complementaires-sante/la-c.m.u.-complementaire/choisir-votre-organisme-complementaire.php

The application can be found here:
http://www.ameli.fr/fileadmin/user_upload/formulaires/S3711.pdf

This organisation, the ‘Caisse Primaire d’Assurance Maladie’ (CPAM), administers the French Health system.  They have offices locally and these can be found in the French telephone directory.  It is this organisation that one should approach in order to integrate into the French Health system.

These are fees that ‘overstep’ the Tarif de Convention.

Those doctors and institutions who abide by this government regulated Agreement are deemed Conventionée.

Those doctors and institutions who do not abide by this Agreement are deemed Non-conventionée.  In this case, they may fix their fees outside the Agreement, but CPAM will only refund the patient in line with the government set tariff (Tarif de Convention).

This is an association, usually an insurance company, which provides for top up or complimentary health insurance.  This top up insurance allows for better reimbursement of health expenses by complimenting the percentage reimbursed by the French Social security.

How it works:

Suppose you visit a doctor who works within the Tarif de Convention.  The charge is € 20. The French Health System (CPAM) pays 70% which is € 14. A 100% plan would pay up to 100% of this 'Tarif de Convention' or up to € 20, and, as such, would pay the difference less a statutory €1 charge.
 
This is fine until one encounters a situation where the service costs 150% or 250% of the 'Tarif de Convention'. If the doctor, in the above example, had charged € 40, and you only had a 100% 'top up' policy (100% of the 'Tarif de Convention'), then you would be liable for the difference, in this case € 19 after the statutory charge.  This is where the 150% and 300% plans come in, as they would have paid 150% and 300% of the 'Tarif de Convention' respectively. As to which plan you choose, a lot depends upon where in France you wish to reside; obviously, Paris and Nice are going to be far more expensive than other, more rural areas.  Realistically, we tend to find that many people opt for the Argent 150. But obviously, the decision would rest with you.

The establishments and practitioners in France are comprehensively classified by the state. The two principal classifications are Conventionée and Non-conventionée. Conventionée means that the doctor, consultant, hospital or clinic etc. has agreed to observe the price levels negotiated by their associations or in the case of hospitals by themselves with reference to their annual budgets. This price level is known as the Tarif de Convention and upon it the whole system of charging and re-imbursement is based. Both the state service and the French insurance companies use percentages of the Tarif de Convention to define the payments they will make.

Certain establishments and practitioners, especially consultants, are free to charge more than the Tarif but this is limited as it was established in the courts that the extra charged must be "tactful and reasonable." These extra charges are called Depassement d’honoraires and are on the increase. One should be careful; it is best to ask first before treatment commences.

Establishments that are non-conventionée are unusual and appear to be frowned upon by the system. For example, where CPAM, the organisation that administers the system, pays 80% to 100% of the Tarif in the case of establishments that are conventionée, the Tarif is reduced by 90% for the purpose of making the calculation where the establishment is non-conventionée.

Both public and private establishments may be conventionée and both are excellent. Your doctor will be able to advise you on this matter.

How do I find out if a doctor, health professional, pharmacist, hospital etc., works within the Tarif?

1. Click Here: http://www.ameli.fr/assures/annuaires/professionnels-de-sante.php
2. Simply enter the name, select the profession, complete the postcode and click on 'rechercher' to begin searching...

This occurs where the top up, or Mutuelle, insurance automatically pays all or part of the cost of healthcare.  It applies generally to payment for prescription medicines prescribed by the doctor.  The insured merely presents their ‘top up’ card (usually white) and their Carte Vitale (Green) to the pharmacist and makes no cash payment.  This can also apply to other costs, in particular, hospitalisation costs, where the insurance company has agreed in advance.

ACOSS  (L'Agence centrale des organismes de Sécurité sociale) is the central Social Security Office.

ASSEDIC (Association pour l'Emploi Dans l'Industrie et le Commerce) is the office that manages unemployment benefits.

ANPE (Agence Nationale pour l'Emploi). This is the organisation to contact for general advice on employment matters.

CAF (Caisse d'Allocations Familiales) is the office which pays out family income support and the RMI (revenue minimum d’insertion), a benefit paid out to people with very limited financial resources. These are the regional offices of CNAF (Caisse nationale des allocations familiales).

CANAM (Caisse Nationale d'Assurance Maladie des professions indépendantes) is the office for the self-employed.

CANMTS (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés) is the office for salaried workers.

CNAM (Caisse National d’Assurance Maladie) is the State Health Insurance Office for salaried employees.

CNAV (Caisse Nationale d’Assurance Vieillesse) is the State Pension Scheme Office.

CPAM (Caisse Primaire d'Assurance Maladie) is office which reimburses medical costs.

CRAM (Caisse Régionale d’Assurance Maladie) is the office which pays out pensions.

DDTE (Direction Départmentale du Travail et de l'Emploi). This is the department with sub-offices in most major towns, dealing with issues such as unfair treatment in the workplace, and giving more detailed advice on employment matters

URSAFF (Union de recouvrement des cotisations de sécurité sociale et d'allocations familiales) is the organisation in charge of the collection of Social Security contributions.

This is the familiar French term for social security system (La Securite Sociale).

It is divided into four different categories, which are referred to as régimes.

(1) The régime général is for salaried employees working in trade and industry
(2) The régime autonome is for the self-employed
(3) The régime agricole is for agricultural workers
(4) The régimes spéciaux are for special categories of workers, like civil servants or railway workers

The régime général, which covers some 80 percent of French citizens, divides up into four sectors:

•  Health insurance and accidents at work
•  Retirement
•  Family income support
•  The collection of contributions

The system then further subdivides into the following agencies:

ACOSS
AGESSA
CAF
CFP
CNAVPL
CMU
CRDS
CSG
CNAMM
CNAMTS
CPAM
URSSAF

For an overview any of these, please visit:

http://www.securite-sociale.fr/institutions/organigr/organigramme.htm

For specific information on them, please visit:

http://www.securite-sociale.fr/liens/oss/tele_services.htm

Or the Securite Sociale website:

http://www.securite-sociale.fr/

This is the element of the medical expenses not covered by fixed payments made by CPAM. 
This leaves the individual liable for payment of this portion of the medical expenses and is usually cover by their complementary insurance policy.

The Carte Blanche is often referred to as the ‘Mutuelle Card’.  It functions similar to the Carte Vital and can be ‘swiped’ at any pharmacy or hospital.  It enables immediate electronic payment of the ‘top up’ element payable by your Mutuelle.

In the context of medical insurance, this is confirmation by the insurer that they agree to settle their share of the policyholder’s proportion of a hospital invoice direct with the hospital concerned.  It can be issued at the request of the policyholder, though is normally automatic when a claim is notified. Put simply, it is confirmation of ‘guaranteed payment’ by the insurer to the hospital.

Any resident in France is subject to French restrictions governing the parcours de soins (“care pathway system”) where patients are required to appoint a médecin traitant (“acting doctor”) from whom they must obtain a referral before seeing a specialist.

Failure to follow the parcours des soins will result in a reduced reimbursement from CPAM.

This is explicitly stated on the Ameli website:

Depuis le 31 janvier 2009, si vous ne respectez pas le parcours de soins coordonnés, le montant de vos remboursements est diminué de 40 %. Vous êtes considéré comme en dehors du parcours de soins si vous n'avez pas déclaré de médecin traitant ou si vous consultez un médecin sans être orienté par votre médecin traitant. Pour avoir l'assurance d'un suivi médical et bénéficier d'un meilleur remboursement, pensez à choisir et à déclarer votre médecin traitant.

Click Here to see the original document... www.ameli.fr

This is a statement issued by CPAM showing payments made by them in respect of medical treatment you have received.

This is vitally important if you are looking to claim a refund from your ‘top up’ insurer - they should also be sent to the insurer if you are hoping to claim under your “EHIC Holiday Top Up” plan.

In very simple terms, an "Avis d'imposition" is a document that you receive from the French taxation office, that shows you how much tax you have to pay.

An “Avis d'imposition sur les revenus” specifically relates to the taxation on your income.

The document specifies how much tax you have to pay on your annual income for the previous year. That document also contains the information on how much income you had declared for that year.

It should be mentioned that sight of these may well be a future means, along with proof of medical insurance, employed by the French authorities in determining the applicability of the “Five Year Residency ” rule, as to proving whether an individual was ‘legally resident’ in France and thereby allowing entry into the French health service.

Click Here for further information regarding the Five Year Residency Rule