Health Insurance

Statutory health insurance coverage

Subscription to a health insurance scheme is compulsory. Social protection in the area of health is essentially the role of the Assurance maladie, the health insurance branch of the social security system (which also includes a family benefits branch and an old-age pensions branch), operated by the “social partners” under the supervision of the state. The entire population thus has health insurance coverage, generally on a work-related basis (as a beneficiary) or as a dependant of a beneficiary.

In France, health insurance is administered by several different schemes. The principal scheme is the general social security scheme (Régime général) which provides coverage for salaried workers in commerce and industry, and their dependants (about 80% of the population in all).

The scheme operates through three different tiers:

1. the National Health Insurance Fund for Salaried Workers (CNAMTS),
2. 16 regional health insurance funds (CRAM),

3. 128 local health insurance funds (CPAM) in mainland France and 4

   general social security funds (CGSS) in the overseas departments.

The agricultural scheme (MSA) covers farmers and agricultural employees and their dependants (about 9% of the population).
The social security scheme for the self-employed (RSI) comprises the different funds managing health insurance coverage for non-agricultural self-employed people: entrepreneurs, artisans, tradespeople, self-employed professionals, etc. (about 6% of the population).

Other smaller schemes, also operating on a work-related basis, cater for certain specific categories of the population (miners, railway workers, seamen, etc.).

Health insurance is funded by contributions based on professional earnings and a tax levied on all income (including investment income) known as the CSG (contribution sociale généralisée).
For the payroll contributions component, the burden is shared by employees and employers.

To qualify for cover an individual must generally have worked at least 120 hours during the previous month, or 600 hours in the previous six-month period. Different rules apply for self-employed people.

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Complementary health insurance coverage

Some cases such as serious illness, maternity or industrial injury qualify for total (or quasi-total) coverage of health care costs. The rest of the time, the health insurance system reimburses only part of the cost (which will vary depending on the type of service provided), leaving the remainder, or ticket modérateur, to be borne by the patient.

Over time, to cover the portion of cost borne by the patient, various complementary health insurance systems began to emerge.
Today, there are three types of complementary health insurance:

1. the mutual benefit funds (mutuelles), which began to develop at the end of the nineteen century and today cover about 40 million people,
2. the private insurance companies, which are increasingly targeting the health market,
3. the provident institutions, which are co-managed by representatives of employers and employees and have a smaller share of the insurance market than the above two types of organisation.

In most cases, complementary insurance is provided through the workplace, in which case contributions are shared by employers and employees.

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The Universal Medical Coverage programme

The Universal Medical Coverage programme (CMU, couverture maladie universelle) extends eligibility for social security health insurance to low income people on the basis of legal residence in France. In practice, CMU beneficiaries are of two kinds:

In practice, CMU beneficiaries are of two kinds:

1. people who are not eligible for, or who have exhausted their rights to benefit (an increasingly rare situation, which still occurs however),
2. people on low incomes who have health insurance coverage, but cannot afford complementary coverage. The mechanism that applies in this case is the Complementary Universal Medical Coverage programme (CMU complémentaire).

For beneficiaries of the minimum guaranteed income (RMI, revenu minimum d'insertion) entitlement to the CMU is automatic. Overall, there are about 4.3 million CMU beneficiaries, mostly under the CMUC programme.

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