# CPAM application just accepted: next steps?



## GraceS

I just received my "numero d'identifiant d'attente" from CPAM. Though the number has 15 digits, it starts with a "2" then my birth year and month, so I think the first 13 digits are actually my permanent number. The letter says that INSEE just needs to certify my "état civil," then I can receive my Carte Vitale and can create my Ameli account.

My question is: am I now officially in the French health system to the point where I can cancel the health insurance required for my visa, and apply for cover from a mutuelle? Or do I need to wait until I'm further along in this CPAM process?


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## Bevdeforges

That sure sounds like an official Sécu number - the last two digits are a "check sum" to the first 13 digits.

I would give them the information on your état civil before I cancelled anything. You're going to want to have access to your Attestation de droits - which you can get from your Ameli account to just print out as you need it. But it should only be a matter of a couple weeks now. (Chances are you'll need the Attestation de droits in order to sign up for a mutuelle anyhow.)


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## GraceS

Thanks, Bev!

As for the "etat civil" I assumed that the letter was explaining the rest of the immediate process--not requesting additional support documents. But maybe I misunderstood? Here is the exact wording of the letter:

_Madame,

Nous avons le plaisir de vous informer que vous dépendez de la CPAM de Paris. Votre numéro d'identifiant d'attente est le suivant: XXXXXXXXXXXXX

Vos frais de santé seront remboursés sur ce numéro.
Pensez à l'indiquer quelle que soit la nature de vos demandes auprès de notre organisme.

Lorsque les services d'INSEE auront certifie votre état civil:_

_Vous recevrais la formulaire "Ma Carte Vitale"_
_Vous pourrez ouvrir votre compte Améli sur le site www.ameli.fr_

_Avec tout mon attention,_


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## BackinFrance

As I understand it, you are indeed attached to the French health system, but you still need to complete the information requested before your claims will be processed. Keep your feuilles de soins as of now and claim back on them once you have your attestation des droits.


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## GraceS

So, Bev and BiF, you both consider this a request for documents that prove my "etat civil." 

Thanks for this! I hadn't read it that way. To date, I've been through all the usual administrative processes (visa application, OFII, bank account, long term apartment, etc.) and only once have been asked for added documents. That request was for my original CPAM application, where I had to re-send one of my documents. The request was very direct, and included a mailing address for the reply docs. This letter is quite different!

So, would you recommend I send follow up documents to the CPAM address and representative from this letter? Or am I meant to contact INSEE and figure out who to send to there?


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## BackinFrance

GraceS said:


> So, Bev and BiF, you both consider this a request for documents that prove my "etat civil."
> 
> Thanks for this! I hadn't read it that way. To date, I've been through all the usual administrative processes (visa application, OFII, bank account, long term apartment, etc.) and only once have been asked for added documents. That request was for my original CPAM application, where I had to re-send one of my documents. The request was very direct, and included a mailing address for the reply docs. This letter is quite different!
> 
> So, would you recommend I send follow up documents to the CPAM address and representative from this letter? Or am I meant to contact INSEE and figure out who to send to there?


Perhaps if you informed CPAM of your était civil they are simply waiting for confirmation from INSEE. If you didn't then I suggest you contact CPAM advising of your status and asking just in case if they require anything else. I have never heard of a letter like this. But, as I said, you are covered.

Of course if your local office is open, it would be simpler to go in and ask them.


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## Bevdeforges

From reading the text of the letter, I don't get the feeling they are asking you for any further documents - just advising you that INSEE is verifying your status and to hang in there a little bit longer. But the best way to check this is to wait a few days and just try setting up your Ameli account. We've had a number of folks through here who have tried as soon as they get the letter from CPAM, only to find that it takes "a few days" after receipt of your permanent sécu number before the system can handle your request.

Once you can open up an online account, you should be able to get your Attestation and that's the "magic key" to all the health care stuff. At that point, you can cancel your private health cover - or set up the mutuelle - or both.


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## mohsel

I don't think you need to do anything, they already have your documents, they tell you it is out of their hands now as you have your definitive number.. 
the next steps will come from INSEE reviewing your 'etat civil' then you will gt the application to create your carte vitale....
in any case, wait for 2 weeks (may be 3) .. then just ask them...
for the time being as you have your definitive number, you can cancel your other insurance and start getting your fees reimbursed (through the manual document system, feuille de soins) ... 
also for mutuelle, you can start shopping for one using your number, the carte vitale is just a way to simplify your life, but you have all the rights open for now.


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## BackinFrance

I think maybe the delay is just because INSEE is now responsible for ensuring that all the phantom cards that have not been returned when people have died, left the country permanently or have a name change because of marriage, divorce (particularly in the case of foreigners who often don't retain their maiden name) etc. Hopefully it won't take too long and you don't now need to do anything other than wait patiently for your attestation des droits and the letter for getting your carte vitale. The good thing is that you have your permanent social security number.


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## GraceS

Thanks Bev, Bif, Mohsel. 

Now, onto mutuelle research!


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## Bevdeforges

GraceS said:


> Now, onto mutuelle research!


If you have an insurance agent, you may want to start there. Main thing is to decide what mutuelle services you need and want - are most medical services in your area Schedule 1 (i.e. they stick to the official list of charges) or are there many on Schedule 2 or otherwise "non-agréé" pricing schedules? Consider your needs for things like eyeglasses, hearing aids, "alternative" health services (osteopathy, homeopathy, etc.), dental work, etc. Check, too, the availability (and desirability) of local hospitals - in case you need some sort of surgery or major treatment, would you be likely to be going to a private hospital?

But overall, you can change mutuelle fairly easily - perhaps only as the annual contract renewal date approaches, but you're not shackled to the first one you choose.


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## 1790260

Bevdeforges said:


> From reading the text of the letter, I don't get the feeling they are asking you for any further documents - just advising you that INSEE is verifying your status and to hang in there a little bit longer.


That's my take on it too.

With regard to a mutuelle, that can be a onerous task. There are a number of comparateur sites (quellemutuelle, plus the usual others) but note that no such site will reference all offers. A number of mutuelles won't appear.. They give a good idea of prices though. Then you you have to decide what you want covering and at what level, and that obviously impacts on price and 'all signing all dancing' covers are expensive, so you have to cut your cloth.

Arguably, and I am venturing into personal opinion/bias here, but some cover is not of not particularly good value for money (if that is a criteria). Dental particularly, but optics too to an extent. The tarifs on some dental work is very low, (no dentist could live on those! Kinda like the UK in that respect - but another story) and some work has no tariff, so you pick up the entire tab. So you can have 300% dental but still end up with a bill. Clearly, this all throws the emphasis on you determining exactly what you're likely to need - not necessarily an easy task. I wouldn't go so far too say it's a minefield but it does take dedication and research, unless of course you're flush - and then you take something that looks comprehensive from a major player (AXA, Swisslife, etc) Like all insurance it's a balancing act; what you can afford balanced with your own prioritised needs, all with the hope you never really need it.

Added to that, different policies are not always 'like-for-like' in areas so direct comparison is not easy. It's like comparing 2 different shopping baskets of goods; do you prefer the jam in one, or the tea biscuits in the other.

Amongst those providing a complémentaire, some are businesses and some are true mutuelles. That may also be a factor for you and may also impact on the price, service, etc.

Suffice it to say that some people don't bother at all. Or have only hospitalisation cover of around 200 - 300% as that keeps things affordable for the low waged (but over CSS level)

In our first years here (around the first 10) we paid our mutuelle maybe around €10k over that time, and only ever went to the docs twice a year and had a couple of fillings. On a strict cost/benefit analysis, it didn't stack up. We could have stuck that in a savings account as 'just in case' funds... but that's not how one should have to view it imho.

Edit: I'm reminded, re glasses and the like, I know a number of folk that got themselves sorted in the UK; appointments easier to get (or were!) and glasses more affordable. They didn't bother with cover in France for that. Times have changed though, and I'm aware you can get glasses 'on line' here in France now, and specs shops have affordable ranges now.

Point is, there are a number of factors for consideration and many/most are your own personal circumstances and needs. Hence the need for having a think about it, and perhaps even a bit of an awareness as to how the system operates. I know some people grasp it quickly and intuitively, and others struggle and it never really makes sense to them.... I'm somewhere between the 2!


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## GraceS

Bevdeforges said:


> Main thing is to decide what mutuelle services you need and want - are most medical services in your area Schedule 1 (i.e. they stick to the official list of charges) or are there many on Schedule 2 or otherwise "non-agréé" pricing schedules?


I'm in Paris, so I've also come across a kind of Schedule 3 pricing: "eye watering"! 
Kidding. Still cheaper than the US.



Bevdeforges said:


> Check, too, the availability (and desirability) of local hospitals - in case you need some sort of surgery or major treatment, would you be likely to be going to a private hospital?


Your suggestion led me to this helpful review of Paris Hospitals: French Medical System : An overview of Parisian Hospitals (parisattitude.com)


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## GraceS

Thank you, Bev and Appunti for these detailed suggestions. I'm finding that, just as you say, decisions about "best" are very individual--and the devil is in the details.

For example, I occasionally need a specialized dental procedure. It's a bit pricey, but not too bad. I originally thought I'd select a mutuelle policy with a high level of dental coverage, so it could be covered. But when I researched further, this procedure isn't covered by CPAM, and also doesn't seem to be covered by the "high dental coverage" plans I've looked at so far. 

So, although I have higher than normal dental care needs, an average level of dental coverage will probably be best for me.


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## BackinFrance

The document is dated 2018 Grace and it is my understanding that the situation has changed significantly since then with various of the better known hospitals in Paris having gone downhill in terms of facilities, condition of buildings or parts thereof, and services available.


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## Bevdeforges

GraceS said:


> Still cheaper than the US.


That is the big thing that impresses those of us from US origins. It can also be really difficult to assess the "odd services" - i.e. those not covered (or not much) by CPAM that are covered (to some extent) by the mutuelle. I know with the dental "appliances" (i.e. crowns, bridges, that sort of stuff), our mutuelle has various categories and then gives a maximum amount in euros that they will reimburse for each. The various categories of reimbursement can be difficult to decipher at first - and I don't think any two mutuelles use the same schedule of reimbursements. 

There is now the policy that every optician has to have a dozen or more frames available that will allow you to get a pair of glasses for €0 - but I have a pretty complicated prescription that also kind of limits the frames I can consider. So I go for a plan that has a fixed maximum from the mutuelle and work around that. And don't forget that some mutuelles offer services that aren't covered by CPAM at all - but you may or may not be interested in those things.

And, if you're in Paris, you have access to both the American Hospital in Paris (though it's actually in Neuilly) and the British Hospital in Levallois-Perret. Both of which are private hospitals and so you need 200 or 300% cover - but you can pretty much be assured of doctors and staff who speak English. (I admit to having gone to the American Hospital a couple of times in my earlier years here. Sometimes you really don't want to have to deal with the language difficulties.)


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## 1790260

GraceS said:


> when I researched further, this procedure isn't covered by CPAM


Yep, a 'top-up' will only top up what the state doesn't pay, and if the state don't pay for the procedure at all then you're on your own. Maybe there are policies that would but you're maybe heading into the private health care area.


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## Bevdeforges

appunti said:


> Maybe there are policies that would but you're maybe heading into the private health care area.


That hasn't been my experience, though I admit we have a private insurance company "mutuelle." (Admittedly through the company we use for several other types of insurance.) Still, if they offer even partial reimbursement for something you need or want, it could be worth the asking price for the policy.


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## BackinFrance

appunti said:


> Yep, a 'top-up' will only top up what the state doesn't pay, and if the state don't pay for the procedure at all then you're on your own. Maybe there are policies that would but you're maybe heading into the private health care area.


That is not correct. There are mutuelles (indeed many though the the options may vary greatly) hat have plans that reimburse even when CPAM pays nothing.


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## 1790260

BackinFrance said:


> That is not correct. There are mutuelles (indeed many though the the options may vary greatly) hat have plans that reimburse even when CPAM pays nothing.


You live and learn (though in my defence I did acknowledge the possibility!)

I didn't think it was common practice and mutuelles based there percentages on the_ tarif conventionné_ and if there isn't one, well.... but of course it's always worth asking, as @Bevdeforges says. I know I asked my mutuelle about a dental procedure (coincidentally) and they said 'computer says no, not covered by CPAM'

I must admit, I think it a complex system for the average person in the street to get their heads around (though obviously easier if you're brought up with it and used to it) Makes me appreciate the good old NHS even more!


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## BackinFrance

I agree it is complicated, even for those raised here. I would say it has become ever more complicated over the past couple of decades, and that is essentially because of the insurance industry and the way insurers operate.


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## Bevdeforges

appunti said:


> I must admit, I think it a complex system for the average person in the street to get their heads around (though obviously easier if you're brought up with it and used to it) Makes me appreciate the good old NHS even more!


To some extent, I think this may be a function of where you are from ("where you're coming from" in the most literal sense). I never did figure out how the NHS system worked - though I only lived in the UK for a year. Fortunately, I was young and healthy at the time, so I never really needed to figure it out.

Coming from the US, believe me, the French system is amazingly simple once you understand that there are no "deductibles" "co-pays" or rejection of legitimate claims. And, the notion of having a list of what is and isn't covered and at what cost is mind blowing for newly arrived Americans.


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## jweihl

If I recall correctly, I received two different letters after my application was processed. The first letter just acknowledged that they were creating my "dossier" and informing me of my number. A couple of days later I received the actual "Attestation de Droits à l'Assurance Maladie" which I understand to be the official acceptance into the system. I've been told that the date of the Assurance is the effective date of insurance and that claims can be made for treatment only back to that date. I would wait until I got my hands on that attestation before canceling anything.

If you're able to create your AMELI account you should be able to download a copy of your Attestation ... of course without an attestation having been issued, you can't have an AMELI account.


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