Along with their basic rights under France’s state healthcare system, which comes with French social security affiliation, most people choose to pay for supplementary insurance to pay for costs not covered by the state.
This is called a mutual either complementary health and is provided by a non-profit organization or insurance company.
However, France has a ‘free top up’ system to help those with modest means.
The current scheme complementaire santé solidaire (CSS) has been around since late 2019 and replaced two previous programs.
These were the Couverture maladie universelle complementaire (CMU-C) and the Aide pour une complementaire santé (ACS). Both CMU-C and ACS assisted with those medical expenses above the basic state reimbursement threshold that would normally be recovered with a carte Vitale.
The CSS program is intended to be an improvement over the two older assistance regimes by expanding the existing assistance system to a greater number of low-income people.
Where is CSS applied?
As with previous programs, CSS applies to doctor appointments, prescription drug pharmacies, blood work labs, etc. and also stays in hospitals.
CSS beneficiaries are exempt from paying fees to doctors, dentists and health assistants (nurses, physiotherapists, etc.) and are not required to pay the hospitalier daily rate in hospitals.
Drugs and medicines at pharmacies, as well as medical devices (canes, wheelchairs, bandages, prostheses, etc.) are also covered, and beneficiaries now also have free access to most eyeglasses, dentures, and hearing aids.
How does the CSS system work?
Under the new CSS system, eligible beneficiaries must still register with a government-approved certificate. complementary healthand the government will pay for the company to cover its costs.
You will not be required to make any advance payment and the doctors may not charge you any dépassement. The latter refers to a part of the fees charged by certain doctors that exceeds the rate set by the State.
Please note that not all health insurance providers are approved to administer your CSS benefits; To find a list of government-approved insurers in your area that can accept your application, check the searchable database. available here.
Who is eligible for CSS?
Eligibility for the CSS is determined on the basis of your income level and membership in the French health system.
Unfortunately, last year the French suspended CSS eligibility for people (mostly retirees) whose healthcare is paid for by another EU state, or Britain, under the S1 health certificate scheme. It has been speculated that scrutiny of the post-Brexit rules may have influenced this to apply at this time, whereas it did not in the past.
An association that helps foreigners in France suggested that it could be argued that the change is discriminatory and suggested that interested people apply and be refused. i should try to challenge this. However, so far we have not heard of any change in policy.
Otherwise, for those eligible and with lower income, the CSS is free, for others whose income is not considered low enough, an economic contribution will be required but less than the total cost of hiring an ordinary mutual.
The calculation of this contribution takes into account the applicant’s income level and age.
People who have the RSA income support benefit will now automatically be credited with the complementaire santé solidaire (CSS) as very few people were found to be taking it.
Access to pensioners of the Aspa pension supplement will also be ‘facilitated’, to whom the documentation that allows them to register will be automatically sent.
Beneficiaries of the government’s CSS program must pay a modest contribution if their income reaches a certain level. If so, contributions are calculated based on income and age levels.
It is guaranteed that the CSS contribution does not exceed a maximum amount of €1 per day and per person.
CSS may not cover additional costs if you choose to see your doctor outside of regular business hours, if your doctor pays for a home visit, or if your doctor determines that your visit is not warranted.
What are the income limits to benefit?
A single-person household with an annual income of €9,571 or less will receive CSS coverage at no charge, while a single-person household with an income of up to €12,921 can receive CSS coverage at a cost.
For its part, a household of two people with an income of up to €14,357 can receive CSS coverage at no cost and couples with an income of up to €19,381 can take advantage of coverage at cost. The ceilings are raised accordingly for larger families.
These numbers refer to your household members, including spouses, common-law partners, long-term unofficial partners, and dependents.
Entitlement is based on actual amounts of money received in the 12 months prior to application, but does not include some forms of income, such as certain welfare benefits (see form link below for more information at regard).
How can I request CSS?
You can apply for the CSS online through your Ameli account at Marches month or in person at your local Cpam.
To apply for CSS, you must complete the Cerfa Form No. 12504*08 that describes your household and your family’s income.