![]() Patients may see a doctor other than the primary care physician under certain circumstances: in the event of a medical emergency, the absence of the primary care physician or his locum, or if the patient is far from home. However, if the patient has not registered with a primary care physician or consults a specialist doctor directly, they will be refunded at a lower rate and pay more out-of-pocket than if they had stayed within the coordinated care pathway. Medical procedures are reimbursed at the standard rate when carried out or recommended by the primary care physician, given that the patient is following the coordinated care pathway. Patients can change their primary care physician by notifying their local health insurance fund. The primary care physician can be either a general practitioner or a specialist. The primary care physician's role is to keep the patient's personal medical record up to date, prescribe further medical investigations, or refer the patient to hospital services or other health-care professionals (physiotherapists, nurses, etc.). Scope of coverage Physician and outpatient careįrom the age of 16, all patients must choose a primary care physician ( médecin traitant) who will provide referrals as part of the “coordinated care pathway” system. However, minors over the age of 16 can apply to be insured in their own right. Only minors continue to be considered beneficiaries up to September 30th of the year in which they reach the age of 18, whether or not they are enrolled in certain educational programs, and provided that they are not employed. Under the Universal Healthcare Coverage system ( Protection Universelle Maladie/ PUMA), which was rolled out on January 1st, 2016, adults can no longer be considered beneficiaries, even if they are not employed. Insured persons are entitled to such health benefits both for themselves and for beneficiaries not covered by any social security scheme in their own right. ![]() Healthcare expenses cover medical and paramedical expenses as well as medications, orthopedic appliances, and hospital costs. Parents can apply for a separate carte Vitale for children ages 12 and up. Depending on personal circumstances, it also contains the information needed to use the third-party payment system (meaning that the patient does not pay amounts upfront that will later be reimbursed either by the health insurance system or by his/her supplementary insurance, which kicks in once the patient has been reimbursed by the national system. It is issued to all persons aged 16 and over and contains all of the administrative information the patient's health insurance fund needs in order to reimburse their healthcare expenses. The carte Vitale is a card with an embedded microchip that certifies entitlement to health insurance. The French health insurance system covers health expenses (reimbursement of healthcare costs) for insured persons and their minor dependents, and cash benefits (daily medical leave benefits for temporary incapacity for work) for insured persons. The calculation basis for this contribution is capped at 8 times France's annual social security ceiling, Which is €351,936 in 2023. AND whose investment or property income (real estate and other property income, investment income, etc.) amounts to more than 50% of the annual social security ceiling (i.e. €21,996 in 2023).those with no employment income or whose income from employment in France amounts to less than 25% of the annual Social Security ceiling (i.e.have been residing in France (including Guadeloupe, French Guiana, Martinique, Reunion Island, Saint Barthelemy and Saint Martin) on a stable and ongoing basis for at least 3 months.Ĭertain members are liable to a 6.5% alternative health care contribution ( cotisation subsidiaire maladie/ CSM), on an earned-income and asset-tested basis:.and by the General Social Security Funds ( Caisses générales de sécurité sociale/ CGSS) in France's Overseas Departments.įrance's universal healthcare system (PUMa) guarantees coverage of healthcare expenses for all individuals who:.the local Health Insurance Funds ( Caisses primaires d'assurance maladie/ CPAM) in metropolitan France.Health, maternity and paternity insurance benefits are provided by:
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