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everything you need to know about the health insurance system

Health problems can very often lead to significant expenses. In order to give the population the opportunity to reduce their health costs, the French government has taken a number of measures through the social health insurance. Many organizations related to health insurance were then created. One of these organizations is the Primary Health Insurance Fund (CPAM). Find out everything you need to know about CPAM.

What is the primary health insurance fund or CPAM?

Caisse Primaire d’Assurance Maladie, much better known by the acronym CPAM, is an organization linked to health and exercising public service tasks in France. Some people tend to confusing CPAM with Social Security even though they are two different entities. In fact, social security is a set of institutions. It consists of several branches, including health insurance, whose role is to reimburse health expenses. However, CPAM is itself a branch of the health insurance scheme and is therefore a sub-branch of social security.

As the CPAM in Nantes explains to us, the role of the CPAM in social security is to create a link at departmental level between Sygesikring and the insured. More specifically, it facilitates access to care. CPAM also administers two branches of social security, namely the sickness branch and the occupational accident and occupational diseases branch. There are 102 CPAMs in France and there is at least one in every department of the country. You must go to the CPAM on which you depend to avail the services of this organization.

To fully fulfill its role, CPAM must perform many missions. That CPAM’s first mission is linked to reimbursement and compensation. For this purpose, it is responsible for processing claims of policyholders, reimbursing policyholders’ health expenses, compensating persons in a state of invalidity, paying the death benefit, etc. CPAM’s other mission is responsible for managing and monitoring subscriptions (registration of policyholders in the general scheme, response on questions from policyholders, etc.). CPAM is also responsible for monitoring the rights of the insured and implementing health and social measures.

How do you become affiliated with CPAM?

Do you live and work in France and want to be associated with CPAM? There is nothing more simple. In fact, thanks to the universal health protection (PUMA), you can make one request for connection to CPAM as long as you work or live in a stable and regular manner on French territory. If you wish to register with CPAM, you must first complete the application form for health insurance eligibility. You must then send your entire file duly completed with all necessary supporting documents to the CPAM on which you depend. The documents to be submitted include:

  • a copy of your ID or passport,
  • a copy of your employment contract or just your last pay slip,
  • proof of residence (more than three months old if you are not employed)
  • your bank statement.

In certain situations, you may be asked to provide additional documentation. For example, if you are outside the EU, you must provide a photocopy of your residence permit and your birth certificate. When your the file will be processed by CPAM, you will be assigned a temporary social security number. You will only receive a permanent number after confirmation of your civil status documents by the National Institute for Statistics and Economic Studies (INSEE). Once you have this number, you can order your vital card.

Reimbursement of your medical expenses from CPAM

CPAM is the organization responsible for reimbursing your care. This refund is made at the rate of reimbursement of health insurance. This rate is quite variable. It is 70% for medical procedures, 60% for paramedical procedures, transport costs and minor equipment and 80% for hospitalization up to 30 days and 100% beyond 30 days. To get reimbursement from CPAM, you must send a care sheet to the person you depend on.

The care sheet is a sheet you get from the healthcare staff after any medical procedure. Once you have this care sheet in hand, fill it out correctly by filling in all the requested information. Then you should do it reach CPAM by mail postage paid or by depositing it directly at one of the receiving points in your department. The healthcare staff can also use the vital card.

This card allows him to send your care record electronically to the Swedish Health Insurance. As for the payback period, it may vary depending on yours CPAM and the method used (vital card or care sheet). It is an average of 30 days. Regarding the deadline for reimbursement, once the care note is in your hands, you usually have a maximum of 2 years to send the document and get reimbursement. If the reimbursement relates to an illness, this period begins on the date of treatment and expires at the end of the same calendar quarter.

Mutual insurance to complete your health insurance

ThoughHealth insurance through CPAM reimburses part of your medical treatment, this reimbursement is not always sufficient and very often the balance you have to pay can be extremely high. In addition, some services are not reimbursed very well by the health insurance, or even not reimbursed at all. Your bill can therefore very quickly become high. Therefore, you must take out supplementary health insurance (also known as mutual health insurance) to supplement your health insurance.

Mutual health insurance is a contract entered into with an insurance company that covers part or all of the medical procedures not covered by social security, or the rest at your expense after reimbursement of health insurance. Supplementary health insurance is thus an insurance agreement that gives you the opportunity to benefit from far more comprehensive health cover.

Too real benefit from your health insurance, you must first choose your contract carefully. For this purpose, we advise you to take into account many criteria such as your needs, your insured profile (senior, student, etc.), the guarantees offered, the deductible, the price of the insurance, etc. To make the right choice, do not hesitate to compare several offers. This will allow you to keep only the best of it all.

* Presse Santé strives to convey health knowledge in a language that is accessible to everyone. IN NO CASE can the information given replace the opinion of a healthcare professional.
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