Health – Practical Life

In general, choose a doctor who applies a government mandated, sector 1 rate (“conventionné de secteur 1”), which will ensure a better reimbursement rate.

The fees established by the doctor and the baseline reimbursement rate with the Assurance Maladie health care offices may vary based on the type of doctor (generalist or specialist) and the sector of their practice (sector 1 or 2):

• A doctor in sector 1 applies a rate that is fixed in agreement with the Assurance Maladie.
• Doctors who apply a sector 2 rate set their own prices: they are authorized (with tact and moderation) to charge higher prices than those set out by social security. Charges that go beyond the standard price limit are not reimbursed by the Assurance Maladie.
• Government approved doctors that apply a controlled rate (“option de pratique tarifaire maîtrisée” or “Optam”) apply prices that are slightly higher than those outlined by social security. In this case, social security applies a higher reimbursement rate than that outlined in sector 1, thus lowering the excess fees.

 

If you visit a doctor in the context of the streamlined healthcare system, 70% of the price will be reimbursed by social security. The remaining 30% may be covered by your supplementary health insurance. For additional medical expenses (medicine, laboratory tests…), consult the reimbursement chart on the Assurance Maladie website. You may also contact us for further precisions.

To find out how to be reimbursed, consult the section entitled “The Carte Vitale”.

Once you have registered with the Assurance Maladie offices, you will receive a health insurance certificate (“attestation de droits à l’assurance maladie”) which will include your personal information. Once you have received your official security number, you can request your Carte vitale . Put your insurance certificate in a safe place and keep your Vitale card with you at all times.

Requesting your Carte vitale (health insurance card)

The carte vitale is the card given to those insured by Assurance Maladie. It attests to your registry with Assurance Maladie abd serves as proof of your social benefits. The card is free, strictly confidential and contains all the information required for the reimbursement of your health-care-related fees. By showing it to your doctor, you can rest assured that you will be automatically reimbursed in one week without needing to send a treatment form (feuille de soins).

When you have received your official social security number, you can request your carte vitale on your ameli account under the tab “Mes démarches” (“The Steps in My Process”) or on the ameli application for smartphones or tablets by completing the carte vitale request form and by providing the requested supporting documentation (a recent identification photo and ID card).

If you have already received your Vitale card

During each visit, you must show your Vitale card to your doctor. You must also show it each time you buy prescription medicine at a pharmacy. This information is then sent to social security electronically, which makes the reimbursement faster and easier (it takes 5 days to receive social security reimbursements in your bank account).

If you have supplementary health care insurance and you chose remote transmission, social security will automatically be informed and the reimbursement for your supplementary insurance will also be automatic.

 

If you have not yet received your Vitale card…

You can still receive medical care if you have not received your Vitale card or if you forget to bring it with you. The Vitale card makes it easier for you to be reimbursed, but it isn’t required.

Without a Vitale card, the healthcare professional that you consult (nurse, physical therapist, dentist, etc.) will give you a healthcare paper (“feuille de soin“) that you must fill out, sign, and send to social security in order to be reimbursed.

 

• You don’t have a carte Vitale but you are registered with social security

Do you have a valid certificate of rights (“attestation de droits”) to social security with a social security number (even if it is temporary)?

You can send your healthcare papers to your CPAM center right away in order to be reimbursed by indicating the social security number that was assigned to you. Save copies of these papers until you receive your reimbursement.

 

• You don’t have a Vitale card and you have not yet received the confirmation of your registration with social security

Save your healthcare papers in a safe place. As soon as you receive your certificate of rights to health insurance (“attestation de droits à l’assurance maladie”) with a social security number (even if it is temporary), send them to your CPAM center by mail in order to be reimbursed. Save all copies until you receive your reimbursement.

 

Please note: the Vitale card is not a payment card. You must pay up front when you present your Vitale card. Your reimbursement will then be sent directly to your French bank account.

For more information, you can go to the Ameli website. 

In general, when consulting a healthcare professional, you pay for your visit up front and are reimbursed later. However in certain cases, you may benefit from payments made directly by your insurance or “tiers payant”; you are thus exempt from paying the healthcare professional up front.

• The partial “tiers payant”: you only pay the portion of the expenses not covered by the Assurance Maladie (meaning just the co-payment).
• The total “tiers payant”: you have nothing to pay. The healthcare professional is paid directly by your Assurance Maladie coverage and your additional health insurance.

 

Please note: For certain expenses, a “tiers payant” is required (hospitalization, maternity hospital…) but for others, it is optional and depends on an agreement with social security (pharmacies…).

Once you have received your social security number, you can create your “Ameli” account online, here.

This account allows you to:

• request your Vitale card (la carte vitale) online if it hasn’t already been requested
• track your reimbursements
• do your online processes
• download your documents
• make a request for your European Health Insurance card
• contact your health insurance by email

 

Please don’t hesitate to contact with us if you have difficulties with this.