GUIDE health insurance

Transcription

1 CAMPUS FRANCE

2 This guide is intended for persons covered by an Campus France social protection plan: "Mainland France 80%" or "Mainland France 100%" "Guests". You will find that it contains information and practical advice in addition to the general and special terms and conditions of which you were notified when taking out Campus France insurance cover. You are covered by one of the Campus France social protection plans. This is a private health plan and consequently you do not come under the general French social security and healthcare system. You are not concerned by the coordinated healthcare plan no by the requirement to consult a specific medical practitioner. This information is important and should be communicated when you consult healthcare providers. Campus France will not issue you with a Carte Vitale and will not give you a French social security number. IF YOU FALL ILL You may consult the medical practitioner of your choice. Various types of medical practitioners existin France: Accredited practitioners (charging Standard Fees): Sector 1 Practitioners in Sector 1 have undertaken to charge standard fees fixed by agreements entered into with the French National Healthcare Authorities. They may only charge supplementary fees in exceptional circumstances, e.g. when complying with a specific request made by a patient, such as a home visit when the patient is quite able to go to the practitioner's surgery, or when the patient wishes to see the practitioner outside the latter's normal consulting hours. Supplementary fees are not reimbursed by Campus France. They are borne by the patient or by a Mutual Health Fund if the patient has taken out extra insurance cover with such a body. For information purposes, the official standard fee as of 1st January 2011 charged by a general practitioner stands from EUR 23 to EUR 28 for a consultation with a specialist. Accredited practitioners (charging own fees): Sector 2 It is best to verify the fees charged before consulting a practitioner in Sector 2, since practitioners in this sector are free to fix their own fees, which are higher than officially fixed standard fees. NB: Campus France will not reimburse the difference between the fee actually paid and the official standard fee. This is borne by the patient of by a Mutual Health fund if the patient has taken out extra insurance cover with such a body. Practitioners operating in this sector are required to post their fees in their waiting room. You may also ask what their fees are when you phone to make an appointment. Non accredited practitioners (no-fee agreements with the authorities) A practitioner who does not belong to either of the above categories is completely free to fix his own fees. NB: Campus France will not reimburse fees paid to consult a practitioner in this category who has not entered into any fee agreement with the French National Healthcare Authorities. PATIENT 'S CONTRIBUTION TO PAYMENT OF EXPENDITURE Under the French tiers payant system, patients do not need to advance payment to doctors or chemist s themselves, since payment is made automatically by the insurer (social security office, insurance company or top-up scheme). Campus France has set up a tiers payant system with certain practitioners, healthcare centres and pharmacists, whose names and addresses are to be found in the list appended to this notice. You should show your card when having recourse to these practitioners, healthcare centres and pharmacists. Health Insurance 11/2011-2

3 Persons covered by the "Mainland France" social protection plan will only be required to pay the 20% patient's contribution, known as the "ticket modérateur". NB: the 'patient s contribution' corresponds to that part of medical expenses to be borne by the patient. For persons covered by other social protection plans, no payment is required, unless certain healthcare expenses are excluded from cover under special conditions. If you see a doctor or use the services of a pharmacist or healthcare centre not included on Campus France tiers payant scheme, you will have to pay first then apply to us for reimbursement. For major healthcare expenses (such as hospital care and re-education), you should submit a request for prior approval (entente préalable), after agreement of the medical adviser upon which we will pay the bills directly. TERMS OF REIMBURSEMENT Reimbursement rate Persons covered by the "Mainland France 80%" social protection plan will be reimbursed at 80% of the French Social Security standard rate. Persons covered by the "Mainland France 100% and Guests" social protection plan will be reimbursed at 100% of the French Social Security standard rate. What do I have to do to be reimbursed? Send us the following: The healthcare form showing proof of payment, duly filled in by the practitioner or healthcare centre and showing the name and forename of the patient. This healthcare form is handed to the patient by the practitioner or the healthcare centre after consultation, The medical prescription issued by the practitioner or healthcare centre justifying expenditure on X rays, laboratory analyses and other treatment, Pharmacist invoices completed by the accompanying labe (these labels are to be found on the boxes containing medication and must be stuck on the healthcare form in the place specified). NB: Campus France will not be able to reimburse you unless you comply with these requirements. How do I fill in the healthcare form? The following details must be entered on the healthcare form: number of the file name and forename personal address in France signature. Where should I send my mail? Applications for reimbursement, applications for prior approval, and mail addressed to the Campus France consultant physician, should be addressed to: Campus France 28, rue de la Grange aux Belles Paris NB: No application for reimbursement will be accepted 2 years after the date of the healthcare involved. Health Insurance 11/2011-3

4 EXEMPTION FROM PAYMENT OF THE PATIENT'S CONTRIBUTION Persons suffering from long-term illnesses may be exempted from payment of the patient's contribution. This means that your medical expenses will be covered 100%, on the basis and within the limits of standard social security fees. An application for such exemption should be sent to the Campus France consultant physician, whose opinion will determine whether Campus France accepts or refuses the application. If the application is granted, exemption from payment of the patient's contribution: Will be granted for the period determined by Campus France after consultation with the Consultant Physician of Campus France Will be limited to care and treatment directly connected with the long term condition justifying the exemption Medical care and treatment not connected with the long term condition justifying the exemption will be reimbursed in normal conditions. IF YOU NEED TO STAY IN HOSPITAL Campus France will only cover expenditure incurred by a stay in accredited hospitals and clinics charging standard fees. Any stay in hospital must first obtain prior approval, no later than 10 days prior to admission, accompanied by the medical diagnosis sent in a sealed envelope to the Campus France consultant physician. In cases of emergency, the application for cover must be sent within 48 hours of admission to hospital, accompanied by the medical diagnosis sent in a sealed envelope to the Campus France consultant physician. Campus France may refuse cover due to exclusions listed in paragraph VI Article 17 of the General Terms and Conditions or if requisite procedures have not been complied with. It is therefore in your interest to apply for prior approval before any stay in hospital. If Campus France agrees to such cover, it will, upon presentation of the relevant invoice, settle all hospital fees directly, together with the daily occupancy fee at 100% of the social security standard rate. Any additional costs, telephone, private room, fees over the standard rate shall be borne by the insured person. For any medical advice, insurance cover and prior approval, please contact the Consultant Physician of Campus France: Docteur Paul Walecki pwegide@gmail.com DRIVING A MOTOR VEHICLE Any consequences arising from the driving of a motor vehicle and any and all trailers or containers towed by or coupled thereto or piloting airplanes without prior authorisation by Campus France are excluded from insurance cover, in accordance with Article 17 of the General terms and Conditions. If you intend to drive a motor vehicle, we therefore strongly suggest that you check: That your motor vehicle has the requisite insurance cover That your driving licence is valid on French territory and we request that you send Campus France an application for permission to drive a motor vehicle together with a copy of your driving licence, your insurance certificate and the vehicle registration book. Health Insurance 11/2011-4

5 Campus France accredited Practitioners and Healthcare Centres in Paris Alain BALDO - Philippe GUIGARD 65, boulevard Kellermann Paris Métro : Cité Universitaire edited Medical Centres Stéphane MEDIONI 36, boulevard Saint-Michel Paris Métro : Saint-Michel / Odéon Bernard JOMIER 31, rue d'hautpoul Paris Métro : Ourcq / Botzaris Centre de Santé de la Mutualité 24, rue Saint-Victor Paris Métro : Maubert Mutualité/Cardinal Lemoine Centre de Santé René Laborie 29, rue de Turbigo Paris Métro : Les Halles MGEN 178, rue de Vaugirard Paris Métro : Pasteur / Saint-Jacques / Glacière Institut Alfred Fournier 25, boulevard Saint-Jacques Paris RER : Denfert Rochereau Accredited Dental care centres Centre Dentaire Saint-Lazare 46, rue de Londres Paris Métro : Europe / Saint-Lazare Campus France accredited Practitioners and Healthcare Centres outside Paris AIX-EN-PROVENCE Armand ARROUAS 4, rue Peyresc Aix-en-Provence AMIENS Isabelle LUCIANI 73, mail Albert 1 er Amiens BESANCON Myriam FORNOT Véronique DUPUIS 1, rue de l Épitaphe Besançon Alexandre TROUSSEAU 6, place de l Europe Besançon BORDEAUX Maison des Jeunes et de la Santé 45, rue Vital Carles Bordeaux Centre de Santé Etudiant - SIMPPS 13, avenue Pey Berland Pessac Pavillon de la Mutualité 45, cours du Maréchal Gallieni Bordeaux cedex BREST Arnaud GUIGANTON Jacqueline LAGUIN 179, rue Jean Jaurès Brest CAEN Jean Louis NOTINI 6, avenue du 6 Juin Caen CLERMONT FERRAND Isabelle FLAGEOLET Alain BOYE 32, rue Alexandre Ribot Clermont Ferrand Health Insurance 11/2011-5

6 DIJON Bruno LOUIS 32 bis, boulevard de l'université Dijon GRENOBLE Isabelle & Thierry ROUGIER 13 bis, avenue Général Champon Grenoble LA ROCHELLE Dominique PERRIER Frédéric BOSSE Résidence Must - Les Minimes 5, rue Lucile La Rochelle LE HAVRE Matthieu BLONDET 3, rue Jean Mascoet Le Havre LE MANS Laurent SIZARET 16, place de l Epéron Le Mans LIMOGES Fabrice DURAND 35, avenue Berthelot Limoges LYON MGEN 44, rue Feuillat Lyon Métro : Montplaisir / Lumière MARSEILLE Didier FAREAU 23, boulevard de la Concorde Mazargue Marseille MARSEILLE Yves CHEMLA 19, boulevard Sakakini Marseille METZ Olivier SAUZE 123, avenue André Malraux Metz MONTPELLIER Patrick FORNOS Immeuble Le Mail-J. Cartier 75, place de Québec Montpellier NANCY MGEN 6, rue Désilles Nancy ORLEANS Patrice RUET 9, avenue Bolière Orléans PAU Bruno BORDACARRE 3, place Albert 1 er Pau POITIERS SIUMPPS Campus universitaire 2 allée Jean Monnet Poitiers REIMS Cabinet médical des Jardins de la Vesle Claude FENAUX Emmanuel MASSART 18, chaussée Bocquaine Reims RENNES Jean Yves GUILLO 1, place du 5 e Régiment d'artillerie Rennes ROUEN Alain ROTBARD 72, rue Jeanne d Arc Rouen STRASBOURG MGEN 4, place du Pont-aux-Chats Strasbourg TOULOUSE ACZEL / UZAND / SAINT-DIZIER / GARIPUY Hôpital Joseph Ducuing 15, rue de Varsovie Toulouse TOURS Corinne ROLAND 197, avenue Grammont Tours VICHY Claire PAVAN 36, rue Callou Vichy Health Insurance 11/2011-6

7 Campus France accredited Pharmacists in Paris and the Paris Region PARIS Pharmacie Colonel Fabien 65, rue de la Grange aux Belles Paris Pharmacie du Sénat 42, rue Monsieur le Prince Paris Pharmacie de la Sorbonne 49, rue des Écoles Paris Pharmacie Jourdan 109, boulevard Jourdan Paris Pharmacie Kellermann 71, boulevard Kellermann Paris Pharmacie Mutualiste 5, rue Palestro Paris CANNES ECLUSE Pharmacie FORTIER 6, rue Saint Georges Cannes Écluse MONTEREAU Pharmacie Victor Hugo 90 rue Jean Jaurès - 4 rue Victor Hugo MONTEREAU CRETEIL Pharmacie de l Université 25, rue des Mèches Créteil Campus France accredited Pharmacists outside Paris and the Paris region AIX-EN-PROVENCE Pharmacie Rotonde-Mirabeau 3, cours Mirabeau Aix-en-Provence AMIENS Pharmacie FORGET 16, rue Saint Leu Amiens BESANCON Pharmacie du Stade 13, avenue de l Observatoire Besançon BREST Pharmacie DENNER 172, rue Jean Jaurès Brest CLERMONT FERRAND Pharmacie DUREL BOUISSOU 39, boulevard Claude Bernard Clermont Ferrand CAEN Grande Pharmacie du Progrès 2, place St Pierre Caen DIJON Pharmacie de l Université F. Compain 95, boulevard Mansard Dijon GRENOBLE Pharmacie PASTEUR 3, place Pasteur Grenoble Pharmacie PICCO RANC 1, rue Barnave Grenoble LIMOGES Pharmacie BONNAFY place des Bancs Limoges Pharmacie BOUSQUET GIROL 1, place des Bancs Limoges Health Insurance 11/2011-7

8 LYON Pharmacie de l Avenue 73, avenue Jean Jaurès Lyon Métro : Jean Macé MARSEILLE Grande Pharmacie Castellane 11, place Castellane Marseille Pharmacie BELSUNCE 10, cours Belsunce Marseille METZ Pharmacie JACQUES 32, rue Serpenoise Metz MONTPELLIER Pharmacie de la Gare 2, rue Serane Montpellier NANTES Pharmacie JOSSO 90, rue de la Bourgeonnière Nantes NICE Pharmacie DE LA BUFFA 27, boulevard Gambetta Nice PERPIGNAN Pharmacie Notre-Dame 5, quai Battlo Perpignan REIMS Pharmacie GELARD 33, rue du Colonel Fabien Reims RENNES Pharmacie DUVAL GUIHARD 24, place du Vieux Colombier Rennes ROUEN Pharmacie CLEMENT-DUBOIS 63, rue Jeanne d Arc Rouen ST MARTIN D HERES Pharmacie du Campus 37, avenue Gabriel Péri St Martin d Hères Pharmacie Gabriel Péri 94/98, avenue Gabriel Péri St Martin d Hères TOURCOING Pharmacie Mutualiste UDEV Pôle Santé 80, rue Nationale Tourcoing TOURS Pharmacie CHAUVIN Didier 140, avenue Grammont Tours VICHY Pharmacie DEPREZ 1, rue Maréchal Foch Vichy Health Insurance 11/2011-8