HEALTH COVERAGE IN FRANCE

HEALTH COVERAGE IN FRANCE Guide intended for foreign students in France for their studies international arrivées - terminal 1 15:09 NOM ORIGINE DESTINATION HEURE STATUT UI SM 25227 22341 BERLIN LONDRES PARIS-CDG MARSEILLE 16:15 15:10 CA PH 56824 85512 TOKYO NEW-YORK PARIS-CDG 18:15 19:20 ES 96654 ATHENE TOULOUSE 20:30 OS 22574 MADRID 21:30 CA GD 46335 45678 ROME ABIDJAN PARIS MARSEILLE CDG 22:10 22:45 PO KL 14545 54561 MEXICO AMSTERDAM PARIS CDG 23:50 23:10 BIENVENUE Issue 2008-2009 www.lmde.com

Editorial Damien Berthilier President of LMDE 26 years old, student of Public Law, Lyon 2 Contents You have decided to study in France and we would like to take this opportunity to welcome you. Completing all or part of one's university curriculum abroad is a particularly meaningful experience. The French healthcare system is reputed to be the only one that incorporates a specific type of coverage just for students. The fact is that for the past 60 years, students have been managing their own healthcare programme through representatives elected from among members of the LMDE student association. Nonetheless, understanding how the French healthcare system works and mastering all the steps that need to be taken can prove to be rather complicated. This is why we have attempted to gather all the information in this guide that could be useful to you. LMDE has also developed several specific services: telephone representatives who speak English and Spanish, documents translated into several languages, access to joint surety to facilitate finding housing. But above all, LMDE, as guided by its mission statement, addresses proposals to local public authorities aimed at simplifying the arrival and integration of foreign students into the system and improving the quality of their stay in France. Therefore, we hope that this guide will help you toward successful studies in France. Good reading and once again, welcome! Social security in France P 2 1) What is the Sécurité sociale - the sécu? P 2 2) What is the Sécurité sociale student insurance? P 3 3) What is a supplemental health insurance policy? P 5 The healthcare system in practice P 6 1) The attending GP P 6 2) The course of care P 8 3) How to access healthcare at your university/college? P 8 4) How to access preventive action? P 10 Student autonomy and solidarity P 10 Helpful contacts P 11 1

Nearly 250,000 foreign students enrol each year in one of France's institutions of higher learning (university or college). Regardless of their country of origin, these students have considerable needs, and a wellprepared transition to France helps ensure a safe stay, especially as regards health-related expenses. * Source: French department of Foreign Affairs Social security in France 1) WHAT IS THE FRENCH SÉCURITÉ SOCIALE - THE SÉCU? The French "Sécurité sociale" system constitutes the mandatory component of France's national Health Insurance scheme. The French Sécurité sociale in particular guarantees the handling of medical expenses. The individual receiving care is generally reimbursed between 35% and 70% of a rate established by the Social Security administration. It is therefore advisable to separate reimbursements made by the Sécurité sociale from expenses that remain your responsibility. EXAMPLE: For an expense of 10 for medication: 6.50 are reimbursed by the Sécu and 3.50 are not reimbursed. For a 22 consultation with a sector 1 government regulated GP (meaning he or she does not practice extra billing): 14.40 are refunded by the Sécu 15.40-1 of fixed contribution), and 6.60 are not reimbursed. SÉCURITÉ SOCIALE REIMBURSEMENTS * Hospitalisation Medical or surgical hospitalisation 80% to 100% Elective abortion 80% Daily hospital fee 0% Transportation 65 or 100% Outpatient care Surgery without hospitalisation 70% Pharmacy 35% to 65% General practitioner 70% Laboratory (medical tests) 60% Dental and Optical Dental care 70% Dental prosthesis 70% Optical 65% Specialists and Paramedical Radiology 70% Specialist 70% Orthopaedics/Prosthesis 65 to 100% Medical assistant (physical therapist, nurses, etc.) 60% Other 18 lump sum 0% * Applicable rates subject to respect of the course of coordinated care. 2

2) WHAT IS THE FRENCH SÉCURITÉ SOCIALE STUDENT INSURANCE? For all students (both French and foreign) the Sécu is managed within the framework of the Sécurité sociale student insurance. Developed in 1946, the Charte de Grenoble, founding text of French student trade unionism, defined the student as a young intellectual worker, who as such is entitled to particular social welfare. In 1948, based on this text, a law was established to create the Sécurité sociale student insurance and to decide to entrust its management to the students. The creation of this specific insurance from the general health insurance plan established student autonomy, student who is acknowledged as doubly major: major with regard to health management and major to manage one's own Sécurité sociale insurance. The reasons that propelled the enactment of this law dating September 23, 1948 still apply: specific health problems faced by students, their aspiration toward autonomy, increased precarious situations on campus and the place students must legitimately occupy in our country's democratic life. LMDE was given the authority, by ministerial order, to manage the Sécurité sociale student insurance. LMDE today manages the Sécurité sociale of nearly 800,000 students. Student Sécurité sociale reimbursement rates are identical to those of the general health insurance plan. 2.1) The general rule: You are under the age of 28 on October 1 and you are not on a European exchange programme: You must register with the Sécurité sociale student health insurance plan and select a student mutual insurance company. You could choose La Mutuelle des Étudiants (LMDE) as the organisation to manage your health insurance. LMDE-centre 601 of the Sécurité sociale, with 153 offices in France (in addition to its website and telephone platform), is the only student national Sécurité sociale centre. Registration with the student health insurance system must be completed during enrolment in your institution. The registration cost for school year 2007-2008 is 192. To help students with their application, LMDE-centre 601 has documents in foreign languages available (English, German, Spanish, Arabic, Chinese and Italian), which present all of the Sécurité sociale student health insurance plan's particularities. LMDE has also been selected by the CNOUS (Ministry of Education's Student Affairs Office) as the sole organisation responsible for coordinating services for both French and foreign scholarship recipients. 3

Furthermore, its telephone platform (3260 and say LMDE ( 0.15/mn, taxes included)) allows you to contact representatives speaking English and Spanish, and to obtain information in both these languages. Following your registration you will receive a card attesting to your membership with the student health insurance plan: the Carte Vitale. Personal and non-transferable, your Carte Vitale must be presented to healthcare professionals. It will allow you to be reimbursed simply and without delay. LMDE (centre 601) provides all new enrolled students with a guide that explains clearly and in simple terms the Carte Vitale's particularities and how the healthcare system works. 2.2) Two exceptions: You are more than 28 years old on October 1: You are not entitled to the student health insurance plan. As for French students, your interlocutor is the Caisse Primaire d'assurance Maladie (CPAM) closest to your residence. You will find your CPAM address on the Caisse Nationale de la Sécurité sociale website: www.ameli.fr You are on a European student exchange programme: In this case, most formalities will have been completed when you enrolled in higher education in your country of origin. If this is the case, you became affiliated to the National Health Insurance system in your country. Your receiving institution in France is in contact with your institution at home. With your European Health Insurance Card (EHIC), that you will have requested in your home country, you can benefit from the Sécurité sociale in France. IMPORTANT We recommend that you register your EHIC with the Caisse Primaire d'assurance Maladie (CPAM) near your place of residence in France. To find the address of your CPAM, log on to the Sécurité sociale website at www.ameli.fr or contact LMDE at 3260 and say "LMDE" ( 0.15/mn, taxes included). 4

3) WHAT IS A SUPPLEMENTAL HEALTH INSURANCE POLICY? Similar to French students, it is essential to complete your Sécurité sociale reimbursements with those of a private mutual insurance company. EXAMPLE: 50 at the pharmacy for medication (blue sticker - vignette bleue): You receive a 16.50 reimbursement from the Sécurité sociale; (i.e. 17.50-0.50 x 2 as the medical deductible) You are therefore responsible for paying 33.50 ( 33.50-1 deductible) To obtain a reimbursement for the remaining 32.50, it is in your interest to subscribe to a supplemental health insurance policy. To enjoy better coverage of your healthcare expenses, you could subscribe to a private LMDE health insurance policy. LMDE offers a complete range adapted to students' situations. Since it is managed by students, LMDE wants to meet your needs. It recommends private health insurance policies that are developed together with healthcare experts and students such as you. To optimally cover all eventual healthcare needs, you may elect to subscribe to a private health insurance policy sponsored by LMDE: Tous Soins (or all-inclusive healthcare), Soins Courants (for routine healthcare), or Forfaits (a package product), whose reimbursement amounts depend on the level of coverage chosen and the policy premiums paid. LMDE = SÉCU + PRIVATE HEALTH INSURANCE POLICY = OPTIMAL COVERAGE OF YOUR HEALTHCARE EXPENSES For further details, please visit your closest LMDE agency (addresses available on www.lmde.com) or call 32 60 and say LMDE ( 0.15/mn, taxes included)). 5

The healthcare system in practice 1) THE ATTENDING GENERAL PRACTITIONER (GP) The healthcare system in France relies on a course of coordinated care: each contributor to the health insurance must choose an attending practitioner upon registering with the Sécurité sociale. The attending GP's role is to ensure coordination of your healthcare programme. He or she will refer you to corresponding physicians, in the event of particular needs. The choice of general practitioner is left entirely up to you and is not permanently binding inasmuch as you have the right to change at any time (e.g. following a move). Warning: you may choose not to enter the course of coordinated care, but in this case, you will receive less of a reimbursement from the Sécurité sociale and you will end up burdening yourself with greater expenses. The attending GP you choose must be officially declared to LMDE. You will find the declaration form at LMDE agencies or by downloading on the LMDE website: www.lmde.com. LEXICON Affiliation: This refers to the association with a particular Sécurité sociale centre. (for example centre 601). Registration: This is the administrative procedure that allows for the awarding of a Sécurité sociale number. Set patient's contribution (ticket modérateur): It is the difference between the cost of treatment established by the Sécu and the mandatory reimbursement portion, whatever the rate applied by the healthcare professional you are consulting. Government-regulated GP (Médecin conventionné): This is the GP who has signed an agreement with the Sécurité sociale. They are listed according to two sectors: The sector 1 doctor in the system applies the conventional rate. Exceeding the fee is only authorised in case of a special request on your part (e.g. for a visit outside of your physician's regular consulting hours). These excess fees are not reimbursed by the health insurance system. The sector 2 doctor in the system is not bound to a particular fee schedule and is authorised to apply excess fees, whose amounts are not reimbursed by the health insurance system. Fixed 1-euro participation: This is a sum automatically deducted from the amount the Sécurité sociale reimburses you. This fixed participation (which was set at 1 euro on April 7, 2008) applies to all medical procedures undertaken by a physician as well as to any medical exams you may be asked to take. As a general rule, this 1-euro fixed participation is not reimbursed by any of the supplemental health insurers. Medical deductibles: This is the sum stipulated in the policy automatically deducted from the amount the Sécurité social reimburses you. This deductible pertains to pharmacy products ( 0.50 / box of medicine), transportation ( 2 / trip), any procedures administered by paramedical personnel (nurses, physiotherapists, etc.) and medical treatment ( 0.50 per treatment visit). As a general rule, the medical deductible is not reimbursed by the supplemental health insurers. 6

2) WHAT IS THE COURSE OF CARE? The diagram below explains the steps to follow to obtain optimal healthcare fee reimbursement within the framework of the course of care. Do not forget to present your Carte Vitale Do not forget to present your Carte Vitale. YOU ARE ILL You consult your ATTENDING GP who provides you with standard care. If necessary, he refers you to a CORRESPONDING PHYSICIAN (specialist) for specific advice or regular treatment. With a prescription from your doctor: you purchase your medication from your pharmacist. you undergo a biological or radiological examination. LMDE will reimburse you and provide a benefits statement to you, summarising the reimbursements from which you benefit. If LMDE manages your Sécu and supplemental health insurance policy, you are reimbursed the mandatory and supplementary portions of your healthcare expenses in one payment. If LMDE manages only your Sécu, do not forget to transfer your benefit amount to your mutual insurance company if you have one. It will reimburse the supplementary portion of your healthcare expenses. Steps to take: During a first registration with LMDE, complete the form to select an attending GP. Send your banking details from an account in your name and set up in France in order to benefit from a simpler and quicker reimbursement process. Respect the course of care to be better reimbursed. Present your Carte Vitale card to both your doctor and pharmacist, and always have it up to date should your situation change. Enclose the documents required for reimbursement. 7

2.1) What happens in case of hospitalisation? If your condition requires hospitalisation, you can contact any hospital. In case of hospitalisation, 80% of expenses are covered by health insurance. It will remain your responsibility to pay the set patient's contribution (ticket modérateur), a set per diem hospital fee for your hospital stay and a 18 lump sum: these expenses could be reimbursed by your supplemental health insurance policy. 2.2) How do I obtain medicine? Medicine is dispensed only upon prescription from your attending practitioner. Medicines are not delivered free of charge. Depending on the particular circumstances, medicine is reimbursed at a proportion of 35%, 65% or 100%. In conclusion, you will always have to make a financial contribution for each item of medicine, which could be reimbursed by your supplemental health insurance policy. As a general rule, supplemental health insurers do not reimburse the 0.50 deductible per box of medicine. 2.3) How to decrease your advances of healthcare expenses if you subscribe to LMDE supplemental health insurance policy? You are given access to our service Passerelle santé (gateway to health). Dial 3260 and say "LMDE" ( 0.15/min, taxes included), you will come in contact with an advisor who will help you find a government-regulated physician near your location or place of study. Therefore, you will be able to receive treatment without paying excess fees. You benefit from the third-party payer system. LMDE has signed numerous agreements with healthcare professionals across the country (including French overseas department). These agreements are structured to make LMDE members exempt from having to advance money for treatment, depending on their specific level of social security coverage. LMDE provides to its members a healthcare access guide presenting the full range of LMDE agreements. Be sure to request a copy either at the reception desk or by phone: 3260 say LMDE ( 0.15/min, taxes included). 3) HOW TO ACCESS TREATMENT ON CAMPUS? On most university campuses, you will find Médecines Préventives Universitaires (MPU) (University preventive medicine Unit) or Services Universitaires de Médecine Préventive et de Promotion de la Santé (SUMPPS) (University services for preventive medicine and promotion of health). Depending on the campus, at MPU, you could benefit from preventive consultations conducted by physicians and nurses, have access to certain specialists, and in all cases, find someone who will listen or provide advice regarding any health-related questions or problems you may have, your sexuality, your psychological condition, etc. In several university towns, so-called Bureaux d'aide Psychologique Universitaire (BAPU) (Academic Psychological Assistance Offices) are available to refer students to psychologists near their place of study should consultation be required. 8

MPU and BAPU provide students with medical consultations at a low cost, close to campus, by professionals who are aware of the particular needs of students. Do not hesitate to resort to these places for advice, someone who will listen, and in some cases, treatment. For information on organisations near your campus, contact your University's administration or your LMDE agency (list of addresses on the www.lmde.com website). You could also request information from the CROUS. They will guide you and also have social assistants who could meet with you regarding a difficult social situation. 4) HOW TO ACCESS PREVENTIVE ACTION? At the various LMDE offices, you will find documents and other information resources on numerous subjects affecting student health (alcohol, marijuana, sleep disorders, hearing problems, stress, smoking, sexually transmitted infections (or diseases), etc.). Some documents on prevention can also be downloaded from www.lmde.com. If you subscribe to a supplemental LMDE health insurance policy, certain preventive treatments could be reimbursed, such as: smoking cessation, vaccinations, contraceptive pills and condoms. Autonomy and student solidarity Whether French or foreign, students can experience real difficulties to come up with a security deposit required to rent an apartment or to be approved for a student loan. LMDE thus laid out a way to increase student financial autonomy by reinforcing the level of solidarity among all students. Should you be affiliated with LMDE as your Sécurité sociale centre and/or have subscribed to an LMDE supplemental health insurance policy, you would be able to gain access to the FGSE Student Solidarity Guarantee Fund. This source of financing, which was introduced specially by LMDE and its bank partner, allows the Banque Populaire to directly stand surety for a student, particularly when seeking to qualify for housing or a loan, without requiring a security deposit from parents or a third party. For further details, please refer to the www.labanquedesetudiants.com website or contact your LMDE agency. 9

Useful contacts CNOUS: Centre National des Oeuvres Universitaires et Scolaires: www.cnous.fr Egide: Centre Français pour l'accueil les échanges internationaux: www.egide.asso.fr LDH: The Human Rights League: www.ldh-france.org GISTI: Immigrant Information and Support Group: www.gisti.org ANAEM (ex OMI): www.anaem.social.fr UNEF: Union Nationale des Étudiants de France: www.unef.fr UEVF: Union nationale des Étudiants Vietnamiens de France: www.uevf.fr UEAF: Union des Etudiants Algériens de France: mail:ueaf_asso@yahoo.fr RUSF: Réseau Université Sans Frontières: www.rusf.org Health insurance: www.ameli.fr CIDJ: Centre d'information et de documentation jeunesse: www.cidj.asso.fr CAF: Caisse d'allocation Familiale (housing allowance): www.caf.fr To know your rights and procedures: www.service-public.fr If you are a student from Belgium, request the guide produced together by LMDE and La Mutualité Socialiste Belge (Belgian socialist mutual association): I'm going to France / I'm going to Belgium. Choose LMDE, the only national centre for student Sécurité sociale Centre- 601 Choose LMDE, the only national student mutual insurance company

Why choose LMDE? LMDE is France's only Sécurité sociale centre dedicated to students! 153 offices and welcome centres spread throughout France (metropolitan France and overseas territories) Local welcome centres ready to meet with you where you study A vote of confidence from nearly 800,000 students The only nationwide mutual insurer for students Managed for students by LMDE member students elected for three-year terms A social economy company acting on behalf of universities, institutions of higher learning, regional authorities, university and school medical services and a myriad of associations. LMDE: an actor in the field of health and prevention for young people! An Expertise and Prevention Observatory (EPSE) conducts student health surveys on a regular basis. Each year, several hundreds of health prevention and promotion actions are carried out on campuses, high schools and within university housing centres across France (metropolitan and overseas territories). Nearly 15 prevention and good citizen topics are dealt with: road safety, alcohol, tobacco, marijuana, risks to hearing, sexuality, anti-homophobia, awareness of distress or depression symptoms, disabilities within a university setting www.lmde.com La Mutuelle des Étudiants - LMDE: mutual association n 431 791 672, subject to the provisions of book II of the Mutual insurance system code. This document has no contractual value - LMDE Studio - 08068