"Social Security"

France has one of the most efficient systems of social protection in the world. Every salaried worker, of French nationality or a foreigner, has the right to benefit from Social Security in order to cover health costs incurred due to accidents or illnesses. The financing of these benefits is guaranteed mainly by a contribution deducted from the employer and employee's salary. If you are a salaried worker, you pay these contributions automatically, and when you are affiliated, you will given a number as well as a "carte d'assuré social" (Social Security card) [7] which will allow you to be reimbursed for any health costs incurred by you and your beneficiaries [5] (providing they do not contribute themselves, which is the case for example, if you are a trainee at the CIES). Your beneficiaries are your spouse or your partner and your children in your charge who are less than 16 years old (or less than 20 years old if they are studying).

You must pay attention to the fact that only salaried workers are affiliated to the Social Security. If you are a grant holder or even if you benefit from allowances, you are not considered as a salaried worker in France and you need to draw up a "assurance personnelle" (personal insurance) [1] policy or be insured from your country of origin.

Benefits from the "Caisse Primaire d'Assurance Maladie (CPAM)"

The French Social Security reimburses the affiliates as well as their beneficiaries at different rates, both variable and fixed by the law, for medical and dental costs incurred (consultations and visits to GP's and specialists, tests, radiology,...) medication prescribed by the doctor as well hospitalisation fees (surgery, maternity,...) providing that you have worked at least 60 hours during the last month or 120 hours over the last 3 months ("délai de carence", waiting period). If you come from a EU or EEA country and have an E 104 form, you are covered immediately. The reimbursement of daily contributions (50% of the gross daily salary) only starts from the moment when you have worked at least 200 hours during 3 months preceding stopping work. First of all you must pay the fees incurred before being partly reimbursed by the Caisse Primaire d'Assurance Maladie (CPAM) in your area. All that remains to be paid by you are what is called the "ticket moderateur" (deterrent fee) [20] and the possible "dépassement d'honoraires" (exceeding fees) [13] which can be paid by your "complémentaire santé" (complementary health insurance) [2].

Complemetary Health Insurance (Mutual Health Insurance)

The Social Security does not generally entirely reimburse health costs incurred. It may be that the remaining fees are high. In the case of hospitalisation, 80% of the fees are reimbursed and the 20% which remains could still be a considerable sum if you do not pay assurance santé complémentaire (complementary health insurance contributions). There are numerous possible policies which propose different packages guaranteeing an almost complete reimbursement of remaining fees (ticket modérateur and dépassements d'honoraires) (deterrent fee and exceeding fees) as well as certain cases which are either badly reimbursed or not at all by the Social Security (vaccination, spectacles, dentures etc.) Your host will advise you on this point.

Furthermore it is interesting to note that many complementary health insurance policies offer the services of "centres mutualistes" (Care Centres for the mutual insurance company) [8] as well as Tiers Payant (third party insurance) [21].

The centres mutualistes group together all the practitioners of all specialities who apply "tarifs de convention de la Securité Sociale" [19] and practice the Tiers Payant (Third Party) policy. Thus, in general you will not have to pay anything and the possible dépassements d'honoraires (exceeding fees) will be quite visibly reduced.
The Tiers Payant (Third Party) is a system which helps you avoid paying fees in advance (consultations, medication,...) which should be reimbursed by the Social Security. You can benefit thanks to certain complémentaires santé (complementary health cover policies) in establishments and with practitioners which have signed an agreement with a health insurance organisation. It is important to point out that this system is used in the case of a professional illness.

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