France Health Insurance (CNAM/Ameli): Everything You Need To Know .. 2023

In this article, we have compiled everything you wonder about France health insurance for you.

Ameli health insurance (National Health Insurance Fund) is in charge of the health system in France. Would you like to know more about its missions, special plans and the coverage offered by this service? Continue to read this guide.

France Health Insurance (CNAM/Ameli)

France Health Insurence’s main mission is to protect the health of insured persons in their personal and professional lives. It guarantees access to health care for all and implements prevention measures to limit the risk of disease and fight against the effects of population ageing.

Also read: Health Insurance in Germany

What is the National Health Insurance Fund?

The National Health Insurance Fund is the branch of Social Security that deals with sickness, as well as industrial accidents and occupational diseases.

What is Your Health Insurance Fund?

The health insurance fund to which you are attached depends on your professional status. General, agricultural or special schemes, we will come back later on to the different schemes to which you can be affiliated according to your activity.

What are the Health Insurance Coverage and Compensation?

Health Insurance offers you a reimbursement of your health costs. But that’s not all. It also allows employees to benefit from daily allowances in the event of a work stoppage. Also, it provides financial protection for workers who are no longer temporarily able to work, and thus provides for their needs.

How Does Health Insurance Reimburse Health Costs?

Health Insurance reimburses care according to an agreement rate determined by the Social Security. It reimburses a percentage of your expense, the co-payment being covered by the mutual health insurance.

A mutual health insurance is required insofar as certain health expenses are never reimbursed by the Social Security, such as fee overruns, alternative medicine, private rooms in the context of hospitalization, etc.

What are the Different Health Insurance Schemes?

 The disease branch has three regimes:

• The general scheme, to which employees, the self-employed have been affiliated since 2018, pensioners, job seekers, etc.
• The agricultural scheme, which concerns both agricultural employees and farmers
• There are 27 special regimes. Among them are the SNCF, RATP, the Senate, sailors, mines, worship, etc.

Everything You Need to Know About the Vital Card

The Vitale card is a card issued to any person affiliated with Health Insurance. It is essential since it allows remote transmission during a medical expense. Clearly, instead of resorting to a care sheet (issued and filled in by the health professional that you then have to send to Social Security), with the Vitale card, the health professional transmits to Social Security, in real time, the information about your expense so that you can get a refund more quickly.

Then, the Health Insurance sends the information to your mutual health so that it completes the coverage.

With third-party payers, sometimes you don’t even need to advance fees anymore. By presenting your Vitale card, your health expenditure is automatically covered.

All you Need to Know About the Ameli Insurance Certificate

The health insurance certificate is a document linked to your vital card. It allows you to attest to your affiliation to a social security scheme. Issued at the same time as the Vitale card, the health insurance certificate must be presented at the time of your employment, when subscribing to a mutual health insurance, etc.

You usually receive this document by mail, but if you have misplaced it, you can still download it from your Ameli France account.

How Do I Call Social Security?

If you want to contact the Health Insurance about a reimbursement of health expenses, a work stoppage and your daily allowances or an occupational disease, the Health Insurance number is national. It’s 36 46. This number is free.

Another way to contact Health Insurance: its France Amelie website. By going to your account, you can make an appointment at the Primary Health Insurance Fund nearest you. This personal space also allows you to send an email to an advisor.

Of course, you can go directly to your Primary Health Insurance Fund. You don’t know his address? It’s very simple. Are you looking for a health insurance fund in Paris? Go to the Ameli.fr website and indicate, in the addresses and contacts section, your postal code. The site then displays the main health insurance fund of Paris, then the other reception points of the department. And this obviously works for all French departments.

Discover the Ameli Health Insurance website

By visiting the site www.ameli.fr, you have access to all your information concerning your health coverage. This site allows you to do the following:

• Consult your refunds in real time
• Search for a health expenditure over the last 27 months
• Download your certificate of rights
• Make an appointment at your Primary Health Insurance Fund
• List current appointments
• Download your monthly repayment statements
• Download a tax statement
• Declare a change of situation (address, birth, bank details, change of usual name)
• Order a new Vitale card
• Order your European Health Insurance Card (EHIC)
• Declare the loss or theft of your Vitale card
• Apply for affiliation to a Solidarity Health Supplementary (CSS)
• Request a refund for a personal transport
• Track work stoppages

How Do I Get A Certificate of Entitlement to Health Insurance?

To obtain your certificate of entitlement to health insurance, you can:

• Go to Ameli and download your certificate of rights directly. It’s instant, you can save it or print it out.
• Go to a health insurance fund and ask for a certificate at the counter, or even use a kiosk at the reception.
• Contact Health Insurance at 36 46 and ask to receive your certificate of rights by mail.

Health Insurance: A Component of Social Security

Social security is often confused with health insurance. However, Social Security includes all benefits related to family, retirement, recovery and illness. Health Insurance, as the name suggests, only takes care of illness (as well as work stoppages and occupational diseases). Health insurance is only a specific branch of Social Security.

Health Insurance Certificate

The certificate of rights is an important document that you must keep in the same way as your Vitale card. You don’t have it anymore? There are various ways to get a new health insurance certificate.

The Health Insurance Certificate is a document that certifies that you are indeed affiliated to a social security scheme. It contains the information contained in the Vitale card.

The certificate of health insurance paris rights may be requested by your employer when you are hired, but also by your health insurance when you subscribe to your contract. This will also be the case for your request for CSS (complementary health solidarity) or the registration of your children in the nursery or school.

Clearly, the health insurance certificate is essential.

This certificate should not be confused with the certificate of accommodation of the Health Insurance or with the certificate on the honor of Health Insurance.

If you are going abroad, you can apply for a European Health Insurance Card. While waiting to receive it, you can apply, not for a European Health Insurance Card certificate, but for a temporary replacement certificate.

How Do I Get A Certificate of Rights From the Health Insurance?

There are various ways to apply for a health insurance certificate.

Upload Your Certificate of Social Security Rights on Ameli.fr

If you have created an online account on Ameli.fr, this is the easiest and fastest solution. All you have to do is go to your account and go to “my procedures” then “download certificates of rights”. This allows you to get your certificate immediately and print it out.

Get Your Social Security Certificate of Entitlement by Going to A Health Insurance Fund

To obtain a certificate of entitlement to Health Insurance, if you do not have Internet, you can go directly to the cash desk nearest you and apply at the counter. You will also find multiservice kiosks that allow you to obtain your certificate.

Request Your Certificate of Entitlement to Social Security by Phone

You can reach Social Security at 36 46, from Monday to Friday. Be careful, this call is chargeable. Ask a counsellor to send you your health insurance certificate by e-mail or by post.

Request A Certificate of Rights by Mail

You can perfectly make a request by mail by sending a letter to the Primary Health Insurance Fund (CPAM) nearest you.

Please remember to indicate your full identity, your Social Security number and the address at which you would like to receive your certificate.

What Information is Mentioned in the Certificate of Entitlement to Social Security?

On your certificate of Primary Health Insurance Fund you will find the following information:

• Your identity
• Your postal address
• Your Social Security number
• Your AMC code (code of your health insurance)
• Your organization
• The names of your beneficiaries

What are the Deadlines For Receiving Your Certificate of Rights?

The time it takes to receive your Vitale Card certificate will vary depending on how you request it. On Ameli.fr, the reception is immediate. The same applies if you go to a kiosk in your health insurance fund. By phone or by mail, allow a few days for the delivery of your certificate.

How Do I Request A Certificate of SSI Rights (Ex RSI)?

Since the disappearance of the RSI in 2018, the self-employed have been affiliated to the general regime. As a result, they too can create an Ameli account and request their certificate of rights online. They can also use the other biases mentioned above.

Health Insurance Plans

In France, there are different health insurance schemes depending on your status. In 1945, at the time of its birth, Social Security was to constitute a single system. However, some professions have preferred to maintain an independent social protection system.

The General Regime

This is the health insurance plan to which most French people are affiliated. It covers about 88% of the French population according to the Social Security itself (the general health insurance scheme covers jobseekers, most employees, the self-employed, pensioners, etc.).

It is composed of 5 branches, namely:

• The family branch
• The disease branch
• The occupational accidents branch
• The retirement branch
• The recovery branch

The general scheme is a mandatory health insurance scheme that covers major risks and manages the collection of contributions.

It is composed of 4 large boxes, namely:

• ACOSS (central agency of social security organizations)
• The CNAF (National Family Allowance Fund)
• CNAM (National Health Insurance Fund)
• The CNAV (National Old-Age Insurance Fund)
• These funds are themselves divided into local funds.

The Social Regime For the Self-Employed (RSI)

The social regime of the self-employed was a regime that addressed entrepreneurs, from the sole proprietorship to the multinational. It was a specific fund to which the self-employed contributed.

However, long criticized, the RSI disappeared on January 1, 2018. The health insurance scheme of a self-employed entrepreneur or a business manager is today the general scheme, the assets previously on the RSI had to change their health insurance plan.

Agricultural Social Mutuality (MSA)

The agricultural social system is made up of a one-stop shop. No specific branches, health insurance, occupational accidents, occupational diseases, retirement and family are centrally managed. The MSA manages the collection of its contributions. Employees and self-employed workers in the agricultural sector are members of the MSA.

Special Regime

In France there are so-called special regimes that concern a small part of the population.

Local Health Insurance Plan Alsace Moselle

The Alsace-Moselle regime is quite specific. It concerns policyholders in Bas-Rhin, Haut-Rhin and Moselle.

Since 1884, the Alsace-Moselle Social Security has been managed autonomously and offers higher reimbursements than in the rest of France.

For example, when the general scheme reimburses 70%, the Alsace-Moselle scheme reimburses 90%. In return, insured persons contribute more.

The Student Health Insurance Scheme

Like the RSI, Student Social Security has disappeared.

Since the start of the 2019-2020 academic year, students no longer benefit from a special regime, they are affiliated to the general scheme or to the MSA.

Also, no affiliation is necessary, they are always covered by their own social security or that of their parents.

Other Special Regimes

In France, there are various special regimes for specific professions.

When we talk about special regimes, we immediately think of civil servants, SNCF, RATP, EDF-GDF, etc.

Notary employees and clerks, mining and religious workers, sailors, employees of the National Assembly and the Senate are also governed by a special regime.

Today, in France, there are 27 special schemes covering about 7% of the population.

Health Insurance Reimbursement

The health insurance branch of the Social Security provides health coverage to insured persons. It also covers daily allowances, as well as disability pensions and even offers a solidarity health supplement for the most modest households.

Health Insurance Coverage

Health insurance coverage is quite extensive. This branch of Social Security is dedicated to the reimbursement of health care, occupational accidents and occupational diseases.

The Treatments

When you make a health expense, it is the Health Insurance that reimburses you part of it. It covers the following expenses:

• Medical consultations with general practitioners and specialists
• Various examinations (blood test, radiology, MRI, CT…)
• Prescription drugs
• Hospitalization
• Optics, Dental and Hearing Aids

However, it does not cover all medical care. Also, it does not reimburse alternative medicine such as osteopathy, for example. Likewise, the private room in case of hospitalization, self-medication, or adult orthodontics are not reimbursed by the Health Insurance.

Daily Allowances

When you are an employee and you are no longer able to work, the Health Insurance comes in once again. In the event of a work stoppage, she offers to compensate you. Daily allowances are calculated according to your salary.

These daily allowances are paid following an absence from work due to illness, an accident at work, a leave following a birth or adoption of a child, etc.

Daily allowances can also be paid to tradesmen and self-employed professionals under certain conditions.

Pensions, Allowances and Annuities

Health Insurance coverage is also available to people who are permanently disabled or incapacitated as a result of an accident at work who receive a pension or pension.

It also supports widows and widowers with a dedicated allowance and offers a death benefit to relatives under certain conditions.

The Complementary Solidarity Health (CSS)

People with modest incomes can apply for CSS. The complementary solidarity health offers two solutions:

• A free health insurance for the most modest
• A health insurance company whose contribution is capped according to age for people with slightly higher incomes

Health Insurance Coverage Abroad

When you go to stay in a country of the European Union, ask for your European Health Insurance Card which allows you to benefit from coverage in case of health expenses in the country in which you went on vacation.

In other countries of the world, if you are forced to consult a health professional, you can, on your return, fill out the form “care received abroad” to obtain coverage. However, this is based on reimbursement rates in France and not on expenses actually incurred abroad.

If you are an expatriate, you will be attached to the country of expatriation.

Health Insurance Compensation

Health Insurance reimbursement is provided on a reimbursement basis. It takes a percentage of that base.

The reimbursement rate of the Health Insurance changes according to the type of care (for example, 70% for the consultation of a general practitioner). In some cases, the coverage is 100% (for certain examinations of pregnant women, for long-term conditions, etc.).

After the reimbursement of the Health Insurance, the co-payment remains at your expense. It is covered by the complementary health service. This is the difference between the reimbursement basis of the Health Insurance and its coverage.

If the expense is greater than the reimbursement base, only the mutual health can intervene according to the level of the guarantees subscribed.

How Does Teleconsultation Ameli Work?

Ameli teleconsultation is gaining ground! Medical consultation on the Internet (or telemedicine) can help fight medical deserts, the impossibility of travel and the spread of epidemics. Since September 15, 2018, teleconsultations have been reimbursed by Social Security. Explanations.

Teleconsultation, Telemedicine: Definition

Unlike a traditional consultation, teleconsultation is carried out remotely by a doctor, via the Internet. He can be a general practitioner or a medical specialist.

When you do a teleconsultation, you do not have to be alone in front of your screen: you can be accompanied, if you wish, by a health professional, such as another doctor, a nurse or a pharmacist.

Even if it cannot be practiced for all types of consultations, telemedicine has many advantages! Among them:

• Medical advice accessible everywhere: it allows people residing in medical deserts or staying abroad to see their doctor anyway despite the distance.
• Faster care and follow-up: in the face of excessively long consultation periods that can reach six months of waiting for some specialists, teleconsultation presents itself as a solution.
• Avoid spreading a virus in the event of an epidemic: with the Covid-19 coronavirus, the rise of teleconsultation has allowed many patients to consult a doctor from home, without risk of contamination either for themselves or for others.

Teleconsultation: How Much Does It Cost?

Teleconsultation of a doctor costs as much as a traditional consultation: 25 euros for a general practitioner with a sector 1 agreement.

Reimbursement of teleconsultation costs is subject to the same rules as a traditional consultation:

• 70% by Social Security
• Your health insurance can reimburse the rest

Like a traditional consultation, the third-party payment is applied in the following cases:

• Patients with long-term conditions (diabetes, cardiovascular diseases, hypertension)
• Pregnant women,
• Patients receiving complementary universal health coverage (CMU-C) or assistance in acquiring complementary health (ACS).

The Rules For the Reimbursement of Teleconsultation

To benefit from teleconsultation, it must be carried out under the following conditions:

• The doctor must know the patient

To ensure the quality of the teleconsultation, the doctor must have physically consulted the patient at least once in the last 12 months preceding the remote consultation. The doctor has knowledge of the patient’s medical history or medical data.

• Respect for the care pathway

Still, to ensure the quality of care, teleconsultation must be part of a coordinated care pathway. It is the attending physician who will have to refer his patient to a specialist to carry out the consultation remotely.

Is Reimbursement For Teleconsultation Provided by Lesferrets’ Mutual Health Partners?

Many health supplements present in our mutual comparison list reimburse medical teleconsultations. Among them, we can mention Miltis, Thélem, April or even Cocoon.

Some offer telemedicine for only some of their contracts, while others include telemedicine in all their plans, like Cocoon, for example. To find out more, do not hesitate to read the details of the guarantees available for each offer.

Teleconsultation Platforms

There are many teleconsultation platforms: Doctolib, MyDoctors, Qare, DoctorDirect… It is often your doctor who offers to contact him by sending you a link to the telemedicine platform of which he is a partner.

These platforms have been designed specifically for medicine:

• They are secure and guarantee medical confidentiality
• They allow documents such as orders or work stoppages to be sent to each other
• They provide the doctor and the patient with an online means of payment.

Teleexpertise Accompanies Teleconsultation

Teleexpertise allows the doctor to consult another doctor for his expertise directly or via secure messaging with the consent of the patient. Since February 2019, doctors have been able to resort to this practice. Initially, teleexpertise was applied in the following cases before becoming widespread:

• Long-lasting affection
• Patients with rare diseases
• Residing in areas where doctors have little presence

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