Health problems can very often lead to significant expenses. In order to allow the population to reduce their health costs, the French government has taken a number of measures, through the social security health insurance. Many organizations linked 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 the CPAM.
What is the primary health insurance fund or CPAM?
The Caisse Primaire d’Assurance Maladie, much better known by the acronym CPAM, is an organization linked to health and which exercises public service missions in France. Some people tend to confusing the CPAM with social security although they are two different entities. Indeed, social security is a set of institutions. It is made up of several branches, including health insurance, the role of which is to reimburse health expenses. However, the CPAM is itself a branch of the health insurance scheme and is therefore a sub-branch of social security.
As explained to us by CPAM of Nantesthe role of CPAM within social security is to make a link at the departmental level between Health Insurance and the insured. More specifically, it facilitates access to care. The CPAM also manages two branches of social security, namely the sickness branch and the accident at work and occupational diseases branch. There are 102 CPAMs in France and there is at least one in each department of the country. You must go to the CPAM on which you depend in order to benefit from the services of this organization.
To fully fulfill its role, the CPAM must accomplish many missions. There CPAM’s first mission is linked to reimbursement and compensation. To this end, it is responsible for processing claims for compensation from policyholders, reimbursing policyholders’ health expenses, compensating people in a state of disability, paying the death benefit, etc. The second mission of the CPAM is responsible for managing and monitoring subscriptions (registration of policyholders in the general scheme, answers to questions from policyholders, etc.). The CPAM is also responsible for monitoring the rights of insured persons and implementing health and social action.
How to be affiliated with the CPAM?
Do you live and work in France and wish to be affiliated with the CPAM? There is nothing more simple. Indeed, thanks to the universal health protection (PUMA), you can make a request for affiliation to the CPAM as long as you work or live in a stable and regular manner on French territory. If you want to register with the CPAM, you must first complete the health insurance eligibility application form. You must then send your entire file duly completed with all the necessary supporting documents to the CPAM on which you depend. The documents to be provided include:
- a copy of your ID or passport,
- a copy of your employment contract or simply your last payslip,
- proof of residence (more than three months old, if you are not employed),
- your bank account statement.
In certain situations, you may be required to provide additional supporting documents. If you are a non-EU national, for example, you will be required to provide a photocopy of your residence permit and your birth certificate. Once your file will be processed by the CPAM, you will be assigned a temporary social security number. You will only receive a permanent number after verification of your civil status documents by the national institute of statistics and economic studies (INSEE). Once you have this number, you can then order your vital card.
Reimbursement of your medical expenses by the CPAM
The CPAM is the organization responsible for reimbursing your care. This reimbursement is made according to the rate of reimbursement of health insurance. This rate is quite variable. It is 70% for medical acts, 60% for paramedical acts, transport costs and small equipment and 80% for hospitalization up to 30 days and 100% beyond 30 days. To be reimbursed by the CPAM, you must send a care sheet to the person on whom you depend.
The care sheet is a sheet given to you by the healthcare professional after any medical act. Once you have this care sheet in hand, you must complete it correctly by filling in all the information requested. Then you have to do it reach the CPAM by post postage paid or by depositing it directly at one of the reception points in your department. The healthcare professional can also use the vital card.
This card allows him to send your care sheet electronically to Health Insurance. As for the refund time, it may vary depending on your CPAM and the method used (vital card or care sheet). It is on average 30 days. Regarding the deadline for reimbursement, once the care sheet is in your hands, you normally have a maximum period of 2 years to send the document and get reimbursed. If the reimbursement concerns 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
Although theHealth insurance through the CPAM reimburses part of your medical care, this reimbursement is not always sufficient and very often the remainder payable by you can be extremely high. In addition, some services are not very well reimbursed by health insurance, or even not reimbursed at all. Your bill can therefore very quickly become high. This is why you must take out complementary health insurance (also known as mutual health insurance) in order to supplement your health insurance.
Mutual health insurance is a contract taken out 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 the reimbursement of health insurance. Complementary health insurance is thus an insurance contract that allows you to benefit from much more comprehensive health coverage.
For really take advantage of your health insurance, you must first choose your contract carefully. To this end, 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 retain only the best of all.