Social Security - Sickness Insurance

Under certain conditions, ascendants, descendants (in-laws and direct relations) and dependents living with the policy-holder may also be eligible as beneficiaries. Insured persons receive a ‘Vitale’ card from their local CPAM (Primary health insurance body), which must be shown when they visit the doctor in order to be refunded quickly for care received and, if necessary, for a third of the cost due.

The insured person must choose a GP whom they must consult in order to have their medical costs reimbursed. Only the GP can refer the insured person to a specialist where necessary. Treatment received from a GP other than the one with whom the person is registered or from a specialist consulted without a referral from the chosen GP will be refunded at a reduced rate, except in exceptional circumstances (e.g.: emergency care) and visits to certain specialists, i.e. gynaecologists, ophthalmologists, dental surgeons or psychiatrists (for 16 to 25 year-olds).

In addition, employees are eligible for cash benefits (payment of daily allowances) in the event of work-related sickness and accident (or occupational disease), subject to certain conditions. They must provide evidence of having worked a minimum number of hours as wage-earners or a having paid a certain amount in contributions, the exact figures for which depend on the length of time they are out of work.

Persons who are not eligible for the general scheme may benefit from CMU (Universal Sickness Coverage) if they have lived in France on a regular basis for at least three months. Depending on their financial situation, they may qualify for the basic CMU allowance and possibly also the supplementary CMU.

Text last edited on: 03/2007

Source: European Union
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