By SUSAN CALLAHAN, Associate Editor and Featured Columnist
My friend Sophie is French, born and raised in Paris. For the last 10 years, she has lived in New York with her American husband. She recently learned that she has cancer and, afraid to take her chances, she has decided to go back home to the French health care system she grew up in to get her care. This turn of events made me wonder, is a returning French expat who returns home to France entitled as a right to be treated by the French health system?
The answer is more complicated than you would think.
The French Are Entitled to Health Care Under Their Universal Health Care Law
Entitlement to health care coverage is a basic pillar of the relationship between each French citizen and the French state. That idea, that everyone deserves health care, began in the Third Republic in the late 1800's and was formalized in 1945. Under the French system, citizens and foreigners who are durably established in France, meaning they live there, receive emergency care at no cost. Other care is covered for 70% of the cost. The remaining 30% is paid by the patient or his or her complementary private insurance plan.
To keep your rights under the French health system, you must reside there. The minimum number of months is open to interpretation. To initially join the system, you must be resident for at least 3 months. But to re-join the system after leaving the country and establishing residency in a foreign country, it is possible you may need to establish residency in France again.
That means you would have to establish that France is now your home. Usually, that requires having a proof of residency (called a "justificatif de domicile") such as a utility bill in your name.
So, even if you are a French system, technically you would need to re-open your rights, or as the French say "ouvrir des droits", to the health care system.
How to Re-start Sophie's Rights to French Health Care
When Sophie returns to France, if she is having an emergency, she needs to simply go to the hospital and she will be cared for, as a matter of right.
But she will need to follow steps to re-open her rights to reimbursement for non-emergency services.
She will need to contact her local union "caisse" or health office (CPAM) and deliver the documents they need to satisfy themselves that she is a French resident. They will then enroll her in the system.
All this paperwork is needed because, contrary to popular opinion, the French health care system is not free. It is paid for by the contributions of employers and employees as well as, in the case of non-workers, by a healthy slice (8%) of their passive income above a threshold.
What does all this mean for Sophie, since she has cancer, and no job in France? Her care is probably going to be taken care of by the French State. Cancer is a long-term illness or a serious illness or perhaps viewed as a emergency, any of which cases would entitle her to 100% coverage.