S1 cover in France in a no deal Brexit - fact or fudge?

With the recent media interest in S1 health care cover in a no deal scenario, and some conflicting info running in various places about how it might or might not affect us here in France, we thought it was time for a bit of a reality check.

While we’d love to be able simply to reassure you and say that there will be no change at all from the present, we don’t think it’s necessarily as simple as that. There is no question that everyone currently holding an S1 will continue to receive health care under the French system - that's a given, so please don't worry about that - it's more about the conditions of receiving that health care - the small print, if you like.

The UK government / embassy’s view ... and our view

Here’s what the embassy has to say: Healthcare after Brexit. Taken at face value, it’s rather reassuring ... but although we believe that France does have our interests at heart here, in our view there are some gaps that are either not addressed at all, or somewhat glossed over.

We’ve been working on all this for almost 3 years now and because of that have a depth of understanding that perhaps others don’t - we’ve presented to both UK and French government select committees, with our British in Europe hats on have been involved in the writing of complex reports as well as analysing the no deal legislation across the EU27 and in the UK, and we’re supported by the legal eagles who are our BiE steering committee colleagues. We’re independent of the UK government and are not chasing funding from it, so we don’t have a conflict of interest and can be critical where that’s needed and where it’s in your interest for us to do so.

Put simply, here at France Rights we like to dig deep and have every i dotted and every t crossed ... and we're aware from the background work we do that there are still some unanswered questions. We also believe in transparency and would far rather you were aware of what these are and what we're doing to get them answered.

What we know

  1. The French no deal ordonnance states that those who currently hold S1 forms will have their health cover continued for 2 years (or until a reciprocal agreement with the UK is in force) under the same conditions as for other members of the French healthcare system. 
  2. Everything in the ordonnance is ‘subject to reciprocity’ - if the UK doesn’t match the provisions of the ordonnance its provisions can be withdrawn.
  3. Holding an S1 form issued by the UK means that the UK is responsible for paying your health care costs - it is your 'competent state', to use the jargon.
  4. The UK government has guaranteed to meet the health care costs of all current S1 holders for 6 months after a no deal Brexit, and for those already 'receiving treatment' for 12 months (or until the end of that treatment if earlier).
  5. The UK government is also negotiating with EU member states to continue S1 cover on a reciprocal basis until 31 December 2020. To our knowledge no such formal bilateral agreements are yet in place.
  6. We have been assured by ministers that it is still UK government policy to try and secure ongoing/permanent bilateral agreements on health care, although the UK is being rather 'reticent' about saying this publicly.
  7. France has a universal health care scheme called PUMa that is open to anyone who has lived stably and legally in France for at least 3 months and whose health care isn’t covered in any other way (S1, work, self-employment etc). So even if S1 health care were to stop altogether, S1 holders and those who anticipated holding an S1 in future would migrate to PUMa, which is administered by CPAM just like current S1 health care so a transfer should be seamless.
  8. There are two basic things you need to know about PUMa. Firstly, there may be contributions for some to join this scheme (cotisations maladie subsidiaires), but these are income dependent and most people will not pay (pension income is exempt). Secondly, social charges (CSG,  CRDS and others) may be payable on pension income, as they are for French pensioners. This is because France is the 'competent state' for those who receive their health care via PUMa - you don’t have to pay them if you have an S1 because your health care is funded by another country. From 2019 there is a sliding % scale for these charges, depending on your income, and those with the lowest incomes are exempt altogether.

Where the gaps are and what still needs to be confirmed

Questions for France

  1. Does the 2 year cover referred to in the ordonnance still apply if the UK only agrees to fund the health care of S1 holders for 6/12 months?
  2. What exactly does the phrase used in the ordonnance ‘on the same conditions as other members of the French health care system’ mean?
  3. Are we correct to assume that the UK will stay the ‘competent state’ (see above) of S1 holders for as long as it is funding their health care? And therefore that during this period no contributions or social charges would be levied, as now?
  4. If there is no policy change, the UK will stop funding S1 holders’ health care before the end of the 2 year period. Are we correct to assume that at this point France would become their ‘competent state’ as their health care costs would no longer be reimbursed by the UK?
  5. If this is the case, would (former) S1 holders have to migrate to PUMa at that point in order to assure continuity of health care? If so, would social charges then become due on pension income - or does the ordonnance effectively give an ‘amnesty’ on these for the whole 2 year period?
  6. Would S1 holders / former S1 holders be able to apply for a CEAM (carte européenne d'assurance maladie - the French equivalent of an EHIC) to cover travel elsewhere in the EU?

And a question for the UK

  1. What exactly does “who have applied for, or are undergoing, treatments in the EU prior to and on exit day” mean? Does ‘treatment’ include being on long term medication, for example - or having regular consultations with a GP to monitor a condition? Or are there more specific requirements that you have to meet to be covered by this?

What is France Rights doing?

We’re continuing to press both sides for answers and for clarifications.

We’ve asked the French Ministry of the Interior the questions above; our contact there has passed them onto his counterpart at the Ministry of Social Security as he himself doesn’t know the answers to what he calls some ‘rather technical’ issues. As soon as we have a response we’ll let you know.

At the same time we’ve taken the opportunity of asking some questions on PUMa, specifically how the rules on cotisations maladie subsidiaires and on social charges would relate to those in receipt of UK pensions, as it’s not at all clear from the legislation. Again, we’ll bring you up to date when we get a response.

Please rest assured that we won’t take simple reassurances at face value and we’ll continue to delve deep until we’re absolutely certain that there are no potential gaps.

If you have questions about anything in this article, pop over to the France Rights Facebook page and ask us there. You'll need a Facebook account but it's not a group and you don't need to join anything.


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