THE healthcare system in France is widely regarded as one of the best in the world, indeed many Brits are or have moved to France to take advantage of this system, writes Tristan Freer.
Why then should expats be worried about medical insurance?
The number of British people living and working abroad has, in recent years increased exponentially.
In a recent BBC programme the number was estimated at around 5.5 million Brits living permanently abroad with far more living abroad for a significant portion of time in a year including those working abroad who are still UK domiciled or resident.
Whether you are taking an expatriate posting, intending to stay abroad for a significant period or intending to move overseas permanently, you need to consider effective international private medical insurance (PMI). This will be able to respond should you have a medical emergency whilst you are abroad.
In most Westernised countries, such as France, there is a high quality and effective health service, but unlike the UK where NHS treatment is free at the point of use, this is not the case in France or many other European countries.
To bypass this, a form called an EHIC (European Health Insurance Card), which used to be known as an E111, is issued where an individual continues working and paying National Insurance contributions in the United Kingdom.
The EHIC entitles you to state-provided medical treatment at reduced cost or sometimes free, if you become ill or have an accident during your stay.
The EHIC covers:
* access to the same state-provided healthcare as a resident of the country you are visiting
* treatment for long-term and existing illnesses, such as dialysis for kidney disease, and
* routine maternity care.
Each country’s healthcare system is slightly different so your EHIC may not cover everything that would be free on the NHS. Many countries expect patients to pay towards their treatment. You may be able to claim the money back in the other country or when you return to the UK.
Private treatment is not covered by the EHIC. Neither are privately run services, for example, some state-run hospitals in other countries have private ambulance services.
The EHIC does not cover going abroad for planned medical treatment or to give birth to your baby.
If you no longer pay tax and National Insurance Contributions within the UK but do pay tax in France this will not apply and you will be required like any normal French resident to pay upfront for any treatment that you receive and then recover this from the French government.
This is all potentially problematic should you have some kind of medical problem which now requires immediate treatment in France.
This would be covered by the NHS within the UK but under the French system you may be liable to pay a (potentially large) sum of money out of your own pocket which you will then need to claim back from the French government.
Some questions you may have:
I am French resident and pay income tax in France, surely this means I would be covered?
You may be entitled to receive this refund of your health care expenses in France if you are French resident and pay income tax in France.
However, there are thresholds under which not all of the costs will be able to be claimed back.
What about my EHIC (E111) or E109? Won’t I be covered by this?
Not necessarily, this is dependent upon many things; one factor that may be taken into account is where you are staying whilst in the foreign country.
If you are staying in a property which is owned by you this almost certainly will not apply. You will not be covered by your EHIC or E109 if you are moving abroad to live or in most circumstances if you are working abroad.
In regards to living in France, in practical terms, what this means for UK tax payers is that you will not be issued with a Carte Vitale, a card used by French citizens to ensure that they are refunded for medical expenses.
Despite this, as you are still covered under the French health system, it will mean they have the longer drawn out process of having to make any necessary payment, at say the pharmacy, or their médecin traitant (general practitioner), initially, and then submitting the necessary paperwork to CPAM (the French equivalent of the NHS) to hopefully be refunded.
I have annual Holiday Insurance cover why would I need a private healthcare policy?
PMI works upon almost the same principle and reasons why you would take out holiday insurance.
In effect, you don’t want to be faced with a large bill should you fall ill whilst you are abroad and you like the security of knowing that should there be an issue, you would be flown back to the UK where you can be with your nearest and dearest.
It should be noted here that if you are staying in your own home abroad you would not be covered by your annual or single trip Holiday Insurance cover.
I already have PMI in place privately or through my employer. Does this mean I am covered?
If your company is a UK company and does not require you to work abroad then the chances are that you would not be covered by your employer’s group PMI policy.
If you have a private policy it is also worth checking that it provides international cover, if it is not clearly stated the chances are that it doesn’t. However a quick phone call to the provider would tell you for certain.
Isn’t Private Medical Insurance expensive?
Whilst international PMI is not a low-cost product, costs can be controlled through voluntary excesses and no-claims bonuses similar to the workings of car insurance.
Costs can also be kept lower if you only include European countries and not use a worldwide policy. However, the main point to note is that the premium is mainly dependent upon your age and any pre-existing medical conditions you might have.
Basically, the younger you are and the less pre-existing conditions you have the cheaper the cover. The price for an average 50 year-old couple with no pre-existing conditions would be around £100.00 per month.
What should I look for in a PMI policy?
It is important that the type of cover is suitable for you. For example some schemes will cover basic illnesses but will exclude chronic conditions which could leave you vulnerable to a large bill if you were to develop a long term illness whilst living abroad.
In the event of hospitalisation, a request for a bon de prise en charge (form to receive free treatment) should be made to the insurer.
In this case, the insurer will then issue a guarantee to settle their share of the policyholder’s proportion of the invoice direct with the hospital concerned.
Some policies will also provide the potential for emergency evacuation in the instance of civil unrest or a natural disaster this is especially useful if you are considering travelling to or living in a less stable country or one where they are affected by natural disasters.
There are a range of these types of policies available and picking the correct one can obviously be very difficult.
It is always wise to speak to a specialist before contracting on one of these policies.
However, there are some important questions that you should ask yourself:
* Is the type of cover suitable for me? It is important to ensure that the type of cover that you buy matches your circumstances and covers the factors you would consider to be important, such as evacuation cover or a basic level of cover which pays out only on the basic illnesses.
* Is the level of cover suitable for me? Consider the level of policy excess that you are willing to accept, a higher excess may be cheaper now but in the future it could prove costly.
Decide what amount you would be willing and/or able to pay should the worst case scenario arise.
* Does the policy cover the countries I will be travelling/moving to? It is important that the policy covers medical expenses in the country you are intending to travel to or live in. There is nothing worse than paying for something upon which you are never able to claim!
* Is this the best price for this cover? The best way to ensure this is to seek professional and independent advice, but there are of course cost comparison websites on the internet that can give you a reasonable idea.
Remember, PMI is a solution to provide peace of mind to you and your family whilst you are living abroad; the peace of mind to know that, should the worst happen, you would be covered and not be expected to pay large medical bills.
Tristan Freer is a partner at Bank House Investment Management Limited. Tristan can be contacted by e-mail or by telephone on 01242 520074.