# Assurance Maladie Travel Cover?



## jweihl

We've gotten our social security numbers and are now in the process of converting the health insurance policy we bought to qualify for our visa into a mutuelle. It seems pretty straight forward, but one aspect is unclear to me. 

The policy guide says that “benefits can be claimed during temporary stays of up to 90 consecutive days in the event of unforeseen illness anywhere in the world, as well as your country of nationality if your costs are covered by your statutory scheme.” 

I am having a hard time figuring out if this means that we would have any coverage for when we make short trips back to the US. I posed that question to our agent and got less than clear information (call someone at Assurance Maladie). I'm assuming that the "statutory scheme" refers to Assurance Maladie obtained via PUMA. If that's right, does Assurance Maladie cover costs while traveling outside France/EU? 

Anyone have any insights? I've never heard of "statutory scheme" before. Honestly, it sounds like a minor sex crime.


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## Bevdeforges

"Statutory scheme" just refers to the state mandated medical program. And actually, the CPAM (also known as Assurance Maladie) does provide some cover for "necessary" medical expenses while you are visiting overseas. Just know that it is at CPAM standard rates and limited to the percentages reimbursed normally by the French system. Obviously, French "standard" fees are a fraction of what you'll wind up being charged in the US. 

But if you're over here as retirees, you're better served by the "free" part of your US Medicare cover. At least that will cover you for hospital stays in the US. Or, do like everyone else does, get "trip coverage" for overseas (i.e. non-EU) travel. Air France used to offer it for quite reasonable rates when you book your flights online. 

Mutuelles don't normally cover travel outside of France. For travel within the EU, there is the EHIC card - again for "necessary" medical treatment while outside France.


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## BackinFrance

The EHIC card in France is called CEAM, EHIC is the English term.


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## Nunthewiser

Slightly OT, but I have noticed that many of the premium cartes bancaires available from French banks offer decent (about 155k euro) medical coverage included. Some of these can be had for around 10 euros/mo, if memory serves.


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## Bevdeforges

American Express has offered a travel insurance to cardholders as long as I can remember - however be sure to check the terms and conditions before you sign up. Many of those credit card insurances have fairly tight limitations and may or may not include cover for US travel, or else they limit it to a fairly short period of time - either per trip or in total across the year.


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## Crabtree

You need to apply for CEAM either via the Ameli website or one of the machines in a CPAM office It gives cover for the EEA area If travelling outside Europe you really need a travel insurance policy


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## Nunthewiser

Bevdeforges said:


> American Express has offered a travel insurance to cardholders as long as I can remember - however be sure to check the terms and conditions before you sign up. Many of those credit card insurances have fairly tight limitations and may or may not include cover for US travel, or else they limit it to a fairly short period of time - either per trip or in total across the year.


The French ones I have seen seem perfectly suitable for at least a 2 month trip back to, yes, even the US, if you are comfortable with 155k upper limit. Beats a sharp stick in the eye, but may not be enough to pay for that kind of damage at US rates.


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## rynd2it

BackinFrance said:


> The EHIC card in France is called CEAM, EHIC is the English term.


Not exactly - EHIC, or now GHIC, is provided by the UK government and is valid in France. The CEAM is the card issued by the French government to Carte Vitale holders BUT is not available to UK retirees on an S1.


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## Bevdeforges

Nunthewiser said:


> if you are comfortable with 155k upper limit. Beats a sharp stick in the eye, but may not be enough to pay for that kind of damage at US rates.


For an American retiree who also has their Part 1 Medicare it actually might do. Just be sure to check the limitations on how long you can out of the country on the bank card insurance. Does that include medical evacuation? (Only asked because the usual types of "travel insurance" you get over here usually do.)


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## Nunthewiser

Bevdeforges said:


> For an American retiree who also has their Part 1 Medicare it actually might do. Just be sure to check the limitations on how long you can out of the country on the bank card insurance. Does that include medical evacuation? (Only asked because the usual types of "travel insurance" you get over here usually do.)


"Reimbursement of up to €155,000 per beneficiary, per event and per year with an excess of €75; up to €155 for dental expenses without deductible and per event (after deduction of compensation paid by the health insurance body)" and "
No mileage allowance. Return of the beneficiary to his residence or transport to an appropriate hospital service close to his residence."

This one happens to be the Gold Mastercard at Fortuneo, which, if I am translating correctly is 9e/mo or free if you keep/flow some money into the account.


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## BackinFrance

rynd2it said:


> Not exactly - EHIC, or now GHIC, is provided by the UK government and is valid in France. The CEAM is the card issued by the French government to Carte Vitale holders BUT is not available to UK retirees on an S1.


Yes, but it was a US expatriate who was asking and he isn't a UK citizen.


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## Bevdeforges

Nunthewiser said:


> This one happens to be the Gold Mastercard at Fortuneo, which, if I am translating correctly is 9e/mo or free if you keep/flow some money into the account.


Looks quite reasonable for the US, especially if combined with Medicare Part ! cover for the retirees. And depending on how often you travel (and for how long).


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## gprit

Well....I have a Credit Agricole Premier Gold card.....taken out 3 years ago because of it's health and cancellation cover.
However....I last week had to cancel a trip to the French Alps because we all had Covid. My claim has been refused becaus they now say Pandemics are excluded. I am continuing to argue that this exclusion is not in my contract...CA say it's now on their website....but I have NEVER been informed of any variation of contract......and hey...this exclusion is now buried on their website under BANKING/MAKING PAYMENTS FROM YOUR ACCOUNT !!!


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## BackinFrance

gprit said:


> Well....I have a Credit Agricole Premier Gold card.....taken out 3 years ago because of it's health and cancellation cover.
> However....I last week had to cancel a trip to the French Alps because we all had Covid. My claim has been refused becaus they now say Pandemics are excluded. I am continuing to argue that this exclusion is not in my contract...CA say it's now on their website....but I have NEVER been informed of any variation of contract......and hey...this exclusion is now buried on their website under BANKING/MAKING PAYMENTS FROM YOUR ACCOUNT !!!


Lots of insurances are doing that now when you cannot travel because you are Covid positive, I think though that if you book through a French travel agent you may not have the same issues. It is definitely not the best time to book travel, though this particular issue has been known for weeks and possibly several months.


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## Peasant

Nunthewiser said:


> The French ones I have seen seem perfectly suitable for at least a 2 month trip back to, yes, even the US, if you are comfortable with 155k upper limit.


$155K might get you three days in an ICU in the US.


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## Mandipants

Bevdeforges said:


> "Statutory scheme" just refers to the state mandated medical program. And actually, the CPAM (also known as Assurance Maladie) does provide some cover for "necessary" medical expenses while you are visiting overseas. Just know that it is at CPAM standard rates and limited to the percentages reimbursed normally by the French system. Obviously, French "standard" fees are a fraction of what you'll wind up being charged in the US.
> 
> But if you're over here as retirees, you're better served by the "free" part of your US Medicare cover. At least that will cover you for hospital stays in the US. Or, do like everyone else does, get "trip coverage" for overseas (i.e. non-EU) travel. Air France used to offer it for quite reasonable rates when you book your flights online.
> 
> Mutuelles don't normally cover travel outside of France. For travel within the EU, there is the EHIC card - again for "necessary" medical treatment while outside France.





jweihl said:


> We've gotten our social security numbers and are now in the process of converting the health insurance policy we bought to qualify for our visa into a mutuelle. It seems pretty straight forward, but one aspect is unclear to me.
> 
> The policy guide says that “benefits can be claimed during temporary stays of up to 90 consecutive days in the event of unforeseen illness anywhere in the world, as well as your country of nationality if your costs are covered by your statutory scheme.”
> 
> I am having a hard time figuring out if this means that we would have any coverage for when we make short trips back to the US. I posed that question to our agent and got less than clear information (call someone at Assurance Maladie). I'm assuming that the "statutory scheme" refers to Assurance Maladie obtained via PUMA. If that's right, does Assurance Maladie cover costs while traveling outside France/EU?
> 
> Anyone have any insights? I've never heard of "statutory scheme" before. Honestly, it sounds like a minor sex crime.


Instead of a "mutuelle," I am using supplementary coverage from MSH International through AARO (the Association of Americans Resident Overseas). You don't carry a card but are automatically reimbursed for any out-of-pocket expenses. I'm not sure how it compares in price to a mutuelle since I carried this over from the original full coverage I had with MSH. When I was traveling back to the States, I checked to see if I would be covered by the supplemental policy and was told that it would cover emergencies. Otherwise, if you still carry Medicare, Part B, Parts A and B should cover many things.


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## jweihl

Follow up question to Americans: Has anyone any experience in getting any sort of reimbursement from Assurance Maladie or your mutuelle for emergency health care received in the US? Specifically, were you successful in your claim? And how much of the bill did they cover? We still have two and a half years to wait for Medicare so trying to sort out options until then for probably 2-4 weeks per year in the US.


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## Bevdeforges

jweihl said:


> Has anyone any experience in getting any sort of reimbursement from Assurance Maladie or your mutuelle for emergency health care received in the US?


Not "emergency" care as such - but I did have eyeglasses made up while in the US - after breaking the pair I was wearing. There is a form for it and you need to include prescriptions and bills and the whole bit. I got a payment from CPAM for the usual contribution toward eyeglasses (at French rates). Not much - something less than 100€ on glasses that wound up costing me $500 or so - but this was several years ago and the standard reimbursement toward eyeglasses wasn't much anyhow at the time. 

You're far better off getting a travel policy for short trips back to the States. It has been a while since I've been back, but at the time I could usually get a 2 or 3 week cover for something between 35 and 50€ for the trip. Though the premium does depend on your age, so it may be much higher for me now. Some travel policies won't cover you past age 65, while others cut off at age 80 or so.


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