Health Insurance for Expats

Written by Phil Heinlein

From Reporter Issue 100

RECENT CHANGES EARLY IN 2008 HAVE MADE THIS ARTICLE OBSOLETE. PLEASE SEE MORE RECENT ARTICLES IN "Expat Issues"

OF ILLS AND BILLS…

Phil Heinlein takes another look at private health insurance…

As Larry Fulton of Exclusive Healthcare — a man with an encyclopaedic knowledge of medical insurance matters — likes to point out, there is a lot of ignorance and misunderstanding among resident foreigners here about how the French social security system works. “Many of them only get to understand properly when they’ve been ill and discovered that what they believed to be the case just isn’t so. To start with, it’s not true — as some Brits think — that if you come from an EU country then you get access to medical care without payment. Of course, that’s nonsense — it’s not true for the French themselves, let alone foreigners. The first lesson you have to learn when you get involved with health care in France — and paying for it — is that the system is very complicated. It’s also comforting to know that the care provided is of extremely high quality.”

“Being sick could cost you money”

La Sécu, then, doesn’t offer “free” care. Those covered by the system receive a percentage of what the treatment costs and have to make up the balance from private insurance. For example, visits to doctors’ offices are reimbursed up to 70 per cent and pharmacy costs may only qualify in some cases for cover of 35 per cent. A patient may have to pay as much as 20 per cent of hospital costs although total cover is accorded in some cases. An additional complication is that doctors and hospitals and clinics fall into two broad categories: those who accept a tariff laid down by the government (known as conventionné) and those who have opted to charge fees above the official levels (non-conventionné). In the latter instance reimbursement is strictly limited.

As we have often noted in our news columns, the social security system is in chronic deficit and the government is continually looking for ways of saving money. This means that charges to patients are likely to increase (see “Cash Point”). What’s clear is that being sick could cost you money. Some expats from within the EU — including a lot of Brits — think they can avoid problems by producing form E111 which is issued in a holder’s own country and gives entitlement to health care when visiting another country in the Union. But there’s a snag: E111 applies only to emergency treatment and the French are fed up with abuse of the system by residents. It will likely disappear next year.

Until January 2000 full cover under French social security was usually only available to those foreigners who were registered as legal employees or, with form E121, had transferred their status as pensioners from another EU state. With the first day of the new millennium, that changed. Under a new law all residents of France were required to register with the Sécu for what is called couverture médicale universelle (CMU) and so acquired a full right to treatment. Larry Fulton again: “It’s a remarkable piece of legislation, unique in Europe. As a private medical insurer I have to say it has changed our market.” How does it work? Put simply, an individual with a taxable income of up to 6677 euros a year or a couple with 9604 euros get treatment completely free and those on the lowest incomes get a free top-up. Incidentally, the government says it’s going to make those strict cut-off points more flexible. Above the income limits, those affiliated via the CMU — basically, those not in work or on pension — have to pay 8 per cent of their taxable income as their contribution.

So what does this mean for private health insurance? “To start with,” says Lone Guiran of International Health Insurance Denmark, “people need a top-up product to cover the difference between what the Sécu pays out and the real cost involved. But there are still some who need full private cover. For example, those who have second homes here and come and go and don’t qualify for legal residence and then people who travel a lot should make certain they are adequately insured. It’s no use telling a doctor in Dallas or Dubai that you’ve got the French CMU. They’ll want cash down or a guarantee from a reputable insurer. And don’t forget those travel policies sold at airports often only cover emergencies, not any on-going problems you may have.” Larry Fulton agrees with all this: “We make it clear to new arrivals that for most of them it’s the top-up product they’ll need. As for travel insurance, you need to look closely at what you’re buying. We have a policy that’s valid up to age 69, some others stop at 65.”

“Read the conditions with care”

But how to choose your company? Lone Guiran’s phrase about “a reputable insurer” is crucial. For example, those who advertise in our pages are certainly within that category — BUPA, Exclusive Healthcare, Good Health, International Health Insurance Denmark, William Gerard, Peter Johnson, Westerzee, Eric Blair. But there are some other companies with more dubious reputations. One major health insurer is notorious for fighting claims.

This article can’t be a consumer report — there’s simply not space, for one thing — and anyone looking for health insurance, either full cover or a top-up product, should talk to the companies. Before doing so, it’s useful to define your own situation clearly and, if relevant, that of your family. Try to foresee how your medical circumstances are likely to change — with age, ills (and bills) increase in number. And when choosing a product make sure you will be able to keep up the payments. On the other hand, don’t automatically go for the cheapest product — it’s unlikely to be the best. Above all, it’s essential to read the conditions of any proposed insurance with care. That way you will pick up on advantages. For example, Exclusive’s Gateway product — offering immediate cover to new arrivals — allows for monthly payment while IHI Denmark provides free cover to children under the age of 10 on their parents’ policy. But careful reading will also alert you to restrictions that could cause you trouble later. As Antibes insurance man William Gerard likes to say, “The large print giveth, the small print taketh away.” So… read with care. n

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