A - Salaried workers and their families

a)  Introduction

Any person who has the status of a "salaried worker" in France, independent of nationality,  is automatically affiliated with the French Social Security system, provided he or she works at least a set minimum number of hours and contributes a defined minimum amount to the system.  This means that when a researcher signs a contract with a laboratory, a research institution, a university, or another public or private employer, he or she automatically acquires the statute of a "salaried worker" (salarié) and is entitled to all the benefits of the French social security system. This also means that his/her health expenses are covered, as well as work-related injuries, death, disability, old age and more. Contributions to the French social security are made by direct deductions from the salary (they appear undre the heading Charges salariales on the payslip). This applies both to the private and public sectors. The URSSAF (Union de Recouvrement des cotisations de Sécurité Sociale et des Allocations Familiales) is the office responsible for collecting the sums paid by salaried employees of the private or public (workers under government contract) sectors and the contribution paid by their employers.

The "salaried" status will extend the health insurance coverage to the researcher's spouse and children under a dependency clause. The "dependent" status covers spouses (through marriage) as well as partners (common-law spouses) and partners who are joined by a civil solidarity pact (PACS). All children under the responsibility of the person insured are considered dependents :

- until the age of 16 years ;
- or up to 20 years if they are students, or if they cannot work due to disability or a chronic illness ;
- or until the end of the academic year in which they turn 21 if they had to interrupt their studies due to illness.

Finally, ascendants, descendants and other relatives can also acquire the status of dependent if :
- they live under the same roof as the person insured ;
- and they help with house cleaning and the upbringing of at least 2 children under 14 years who are dependents of the person insured.

b)  Administrative formalities

The employer is legally required to declare the hiring of a salaried scientist with the URSSAF before he/she starts working. The URSSAF automatically transmits the dossier to the Social Security. This declaration of intent is generally made 8 days before the starting date of the contract (registered letter, fax or other means of communication). 

The researcher is required to visit the local national health office (Caisse Primaire d’Assurance Maladie - CPAM) of his/her place of residence one month after the starting date of the contract in order to establish a "right to Social Security " for himself/herself as well as  the members of his/her family.

European nationals or foreigners who have been affiliated somewhere else in Europe and their families must present :

- Form 1104 properly completed (available at the local CPAM or through the FnAK upon request) or your European Health Insurance Card
- an old Carte Vitale (if you had one)
- a bank identification form (Relevé d'Identité Bancaire – RIB)
- the photocopy of your ID card or passport
- a birth certificate and/or a fiche individuelle d’état civil (record of civil status, or birth and marriage certificates)
- a proof of employment certifying that the researcher :
- has worked at least 60 hours in the previous month (employer certificate, work contract, pay slip,....) or :
- has paid contributions on the basis of a salary that is at least equal to 60 times the hourly SMIC (the index-linked minimum growth wage), over a period of 1 month, or :
- has worked at least 120 hours, or :
- has paid contributions on the basis of a salary that is at least equal to 120 times the hourly SMIC, over a period of 3 months, or :
- has worked at least 1 200 hours, or :
- has paid contributions on the basis of a salary that is at least equal to 2030 times the hourly SMIC, over 1 year.

Nationals of non-EU countries and their families must present :

- the same documents and proofs (except for form 1104)
- the récipissé de demande de carte de séjour (receipt for a residency permit application) or the visa consulaire de séjour temporaire (consular visa for a temporary stay).

c)  Reimboursement of  medical expenses: benefits in kind

These are reimbursements of visits to general family doctors, dentists, specialists, tests, medication as well hospitalization. Even if all the conditions for your affiliation have not been fulfilled at the start, do not worry. As a salaried worker, a researcher is covered retroactively from the first day of employment. Carefully keep all the feuilles de soin (care forms) supplied by the doctors, dentists and other medical staff.   

These forms can either be turned in to the CPAM when registering to activate your "right to social security" (droit à la sécurité sociale), or they can be sent later. Reimbursement is retroactive. When registering with the local CPAM, the researcher will be given a social security number.

d)  Sick leave and other cash benefits

For cash benefits (i.e. payments, not reimbursements of expenses), the conditions are essentially the same : in order to receive daily compensation during the first six months of sick leave, the researcher must justify :

- having worked at least 200 hours over the three months preceding the sick leave ;
- or having paid contributions on the basis of a salary that is at least 1015 times the hourly SMIC during the 6 months preceding sick leave.
The insured person must also justify having been registered for 12 months at the start of sick leave.

The conditions for the commencement of statutory sick pay are determined based on the date work was interrupted.

B - Non-salaried workers and their families

The "Salaried" status entitles persons to numerous rights from the viewpoint of the French Social Security. However, many researchers do not have a "salaried" status. The following points describe alternative means to obtain health cover :

a)  The Universal Health Cover (CMU)

The Universal Health Cover, or CMU, was created by the law 99-641 of 27 July 1999. This law adds a new criteria that entitles registration with the national health system for persons who do not have health insurance because they do not have a salaried status. Affiliation to the basic CMU is granted upon request by the researcher. The researcher must prove regular residence in France. Affiliation to the CMU universal health cover is free if the annual household income is less than 7 083 euros.

Article L 380-1 of the Social Security Code stipulates that a lawful stable resident who is entitled to registration with the general Social Security scheme cannot receive payments "in kind" from any other health and maternity insurance. In other words, in order to be covered by the CMU, a resident must not be covered by another social security system, for example from his/her country of origin. This is also true for his/her beneficiaries (spouse or partner, children).

In practice, all foreigners and their families who have been legally in France for at least 3 months are entitled to the CMU. They must present their carte de séjour (residency permit) or récépissé de demande de carte de séjour (receipt for a residency permit application), unless the researcher holds a visa long séjour temporaire (Temporary long-stay visa) mentioning "Dispense temporaire de carte de séjour" (Temporary visa exemption) or if he/she is exempted from such a document (for instance, European nationals only need to show proof of residence (such as a telephone, gas or electricity bill, or a rent receipt).  

If the household income is above 7 083 euros, the CMU is not free and the researcher must pay a contribution. The contribution usually represents 8% of the household income of the previous fiscal year minus a fixed sum (7 083 euros). It is advisable to compare this rate with that of private insurances, because the latter have flat monthly premiums : the higher the household income during the previous year, the more expensive the CMU contribution will be.

The "basic" CMU reimburses up to 70% of all medical expenses. Affiliation to the basic CMU is effective from the day of request. The CPAM issues a provisional certificate of rights to the CMU (Attestation provisoire de ses droits à la CMU) to the beneficiary of the basic CMU. After verifying that the person is not already covered by a compulsory health insurance in any other capacity, the CPAM will forward by mail a definitive certificate of rights to the Basic CMU (Attestation définitive de droits à la CMU de base) together with the Carte Vitale, or asks the affiliate to update an old Carte Vitale if he/she had one previously. 

 
The CPAM also offers a Supplementary CMU (CMU complémentaire) to help pay the balance of medical expenses. You may qualify for supplementary CMU only if your household income is no higher than :

Numbers of persons living in the house	Amount of  family net income/ month
1 person	598,23 €
2 persons	897,35 €
3 persons	1 076,82 €
4 persons	1 256,29 €
beyond 4 persons, amount for each supplementary person	+ 239,29 €

b)  Private insurances

Many private companies offer medical insurance to persons who are not obliged to contribute to the national health scheme. Some even offer contracts specifically designed for guest researchers and foreign trainees on scholarships. If you choose this type of protection, we advise you to review the contracts carefully since the coverage and rates are very different from one company to another.  It is however possible to find contracts at very advantageous rates that are immediately active (without délai de carence) and that do not require you to subscribe to a supplementary health insurance because they cover 100%.

For example, the Kastler Foundation has negotiated with its partner "AXA assurances" a health insurance that is specifically adapted to researchers who are not covered by the general social security system (non-salaried professionals and professionals who would pay high CMU contributions). The contract can be subscribed to for a duration from one month up to a year, and is renewable. It offers an excellent reimbursement of health expenses (medical, pharmacy, hospital, etc.).

c)  European nationals and non-EU nationals with health cover from an EU country

An EU national or a citizen of a third country with a health cover from another EU country
who comes to France to do research as a non-salaried worker are reimbursed for all health expenses incurred while in France if their stay is short (that is, if he/she does not establish residence in France). The European Health Insurance Card is valid only for short stays as a non-salaried worker.  

Before leaving for France, you should request the European Health Insurance Card. It will entitle you to reimbursements for medical expenses incurred during your stay.

The European Health Insurance Card is personal and bears your name. It is issued free of charge with a validity of one year and is renewable.

The European Health Insurance Card certifies that you are entitled to health insurance.  It will extend your coverage for necessary medical care during a temporary stay in France,  whatever the purpose of your trip (professional, training, study, vacation, tourism) provided that you respect the formalities required by your country of residence.
The European Health Insurance Card has been available in France since June 2004. It replaces the E111 form and other forms  (E 110, E 119, E 128) that have been in use for temporary stays in Europe.

What information is contained in the European Health Insurance Card?
The European Health Insurance Card contains the following information :
- name, first-name, date of birth and social security number of the card holder ;

- the number and date of expiration of the card ;
- the code of the country issuing the card ;
- the number identifying the health insurance with which the holder is affiliated.

How to obtain a European Health Insurance Card ?
The European Health Insurance Card is not issued automatically : it must be requested from the relevant authorities of the country you depend on for health insurance. The card should be requested at least 2 weeks prior to departure, to allow for its preparation and delivery.

Usually, the card is sent by mail, but this depends on the country.

 Important :

- the European Health Insurance Card is personal. You should request a card for each member of your family, including children under 16 years of age ;
- you do not need to provide any particular document with your request. Your national health agency already has all the data necessary to issue the card ;

- if your European Health Insurance Card cannot be issued before your departure, your national health agency will give you a temporary certificate of insurance, valid for 3 months that you can use instead of the European Health Insurance Card.

In what countries can you use the European Health Insurance Card ?
Starting June 2004, you can use the European Health Insurance Card (or the temporary certificate) in most countries of the European Union (including the 10 new member states that joined on 1 May 2004) :
Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, The Netherlands, United Kingdom ;
You can also use the European Health Insurance Card in Iceland, Liechtenstein, Norway and Switzerland.
 
How to use your European Health Insurance Card ?
The European Health Insurance Card (or the temporary certificate) certifies that you are entitled to health cover while in another European country for a temporary stay.
If you need medical care while in France, the card guarantees reimbursement of health care expenses locally or shortly after your return home, according to French formalities and social protection laws.

Remember  : the European Health Insurance Card is not a means of payment.

What to do if you have forgotten your European Health Insurance Card ?
If you need medical care during your stay and have forgotten your card, you must pay all expenses incurred. Keep all bills and justifying documents and present them to your own health insurance agency when you have returned to your country.

d)  Countries that signed bilateral agreements of social protection

France has signed numerous bilateral agreements with other countries in matters of social protection. Some of these agreements cover healthcare and work injuries, and in particular these agreements define which laws apply. In most cases, the law in force is that of the country in which the insured person pursues his/her professional activity.

The benefits vary according to the specific bilateral agreement. It is difficult to summarize all the provisions they include.

If a researcher does not qualify for affiliation with the French Social Security system and before subscribing to a private insurance, it is advisable to check whether France has signed a social protection agreement with the researcher's home country. The content of these agreements is often thin regarding health protection. For instance, often these documents just state that for short stays in France (less than 3 months), a non-French citizen will continue to be affiliated with the social protection system of his/her home country.

Before a researcher leaves for France, he/she should check with his/her local social protection agency whether the bilateral agreement between his/her country and France includes health insurance and work-related injuries. If that is the case, the researcher will be able to claim reimbursement for health expenses in France by presenting the documents justifying the health care received as well as a certificate of affiliation with the health insurance system of his/her home country at the desk for international affairs (Service des relations internationales de la Caisse Primaire d'Assurance Maladie) of his place of residence in France (the local CPAM office).

France has signed agreements with the following states :
Algeria, Andorra, Benin, Bosnia Herzegovina, Burkina Faso, Cameroon, Canada, Cape Verde, Congo, Croatia, Gabon, Israel, Ivory Coast, Jersey, Macedonia, Madagascar, Mali, Morocco, Mauritania, Monaco, Niger, Poland, Philippines, Québec, Czech Republic, Romania, San Marino, Senegal, Switzerland, Slovakia, Slovenia, Togo, Tunisia, Turkey and  Federal Republic of Yugoslavia, United States.
The text of all these agreements can be consulted at the following site :
http://www.cleiss.fr/docs/textes/index.html

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