The CPAM is the Caisse Primaire d'Assurance Maladie, an arm of the French Sécurité Sociale system. The main office for our département is in Blois, our administrative "capital" for government services. There are branch offices open just one or two days a week in smaller towns like ours.
If you enlarge the picture by clicking on it, you can see Walt
and Callie leaving for their afternoon walk in the vineyard.
and Callie leaving for their afternoon walk in the vineyard.
Here's what happened. We signed up with the French national health service in early 2006. Before that, we didn't know we qualified for coverage, and we had taken out expensive policies with private U.S. insurance companies that didn't cover much — only "major medical" and I think means hospitalization. No doctor's or dentist's fees, or prescription medications, were reimbursed, and there were restrictions having to do with pre-existing medical conditions. There were also very high deductibles.
When Walt read on a Sécurité Sociale web site one day that we were eligible for national health insurance because we were legal French residents, we got the necessary papers together, filled out applications, and sent everything off to the CPAM. A few weeks later, we got a notice that we had been granted basic coverage at 70%, and not only for hospitalization but for all those things the U.S. policies didn't cover.
For a couple of years, things went along smoothly. We soon each received a Carte Vitale, which is the national insurance card you present at the doctor's, dentist's, and pharmacy to prove you are covered. Doctors and dentists require you to pay the full fee and then get reimbursed, but at the pharmacy you pay only your portion of the cost of prescription drugs.
Then in late 2007, we started getting letters and phone calls from the CPAM asking us to provide, over and over again, the same documents having to do with our income and resources. We sent in copies of tax forms and bank statements time and time again. At first I was the one they targeted, and then they started asking Walt for the same kinds of documents.
The upshot of it all was that the CPAM inspectors eventually realized that Walt and I live a the same address. They said that in cases like ours, people are required to enroll in the insurance system on a single social security number, not two separate numbers.
In other words, we had enrolled as individuals, thinking that was the right thing to do — officially, our only relationship is a business partnership, since we are joint owners of, and equal partners in, the real estate corporation that owns our house. But the CPAM wanted us enrolled as a household.
Why? Because when you enroll under the plan we qualify for, as people who do not have employers in France, you pay a percentage of your worldwide income as an insurance premium. But the first $10K of your income is exempt, whether you are an individual or a household. Now we will pay a premium based on our combined worldwide income, I believe, minus the $10K (€8K) exemption.
In December, we learned that one of us had to surrender his Carte Vitale temporarily, while our accounts were being consolidated. We decided that it made sense for both of us to enroll under my SS number, because I also have a small French retirement pension on my Sécurité Sociale account. I wouldn't want that to get lost in some administrative shuffle if I enrolled under Walt's number.
So they took Walt's card away. They never gave us a clear answer as to whether they had other reasons for asking so many questions about our income and financial resources. We waited.
In the interim, they gave Walt a certificate that he could present at the doctor's and the pharmacy to show that he had coverage. That worked fine through January and February, but about a month ago he got a new certificate in the mail. It said it superseded any earlier certificates he had received, and that the latter should be destroyed.
When I went to the pharmacy a couple of weeks ago, Madame Smith, our pharmacist, looked at the new certificate (an « attestation ») and said it wouldn't do at all because it didn't show a date when coverage started. In that box, instead of a date, it said « à justifier ». "To be justified," but how?
Mme Smith went ahead and processed our order, putting the paperwork for Walt's in a special "pending" file she keeps. She asked me to come back as soon as I got any new documents from the CPAM. A few days later I ran into her on the street in Saint-Aignan, and she told me she had called the CPAM about Walt's case. "It isn't easy to get the information you need from them," she told me. I said I knew that.
A few days later I did get a letter from the CPAM. It said I had been enrolled for basic coverage and that I should go the the pharmacy to have my Carte Vitale updated — the pharmacist runs it through a special card reader and the update is done. I showed the letter to Mme Smith yesterday morning, and she was mystified.
The letter didn't say why my card needed updating, Mme Smith said. But after she ran it through the machine, she opened my social security file on the Internet and saw that under my number both Walt and I are now covered. She said it seemed strange that the CPAM didn't specify that change in the letter.
Anyway, Mme Smith was able to process Walt's pending reimbursement claim using my card. And when I got home the mail came, bringing a new insurance certificate from the CPAM. It shows both our names under my Sécurité Sociale number. Now when Walt goes to the dentist's next week he can have his claim processed normally.
He just needs to wait for his new card to come in the mail — every adult who's covered by the national system has his or her own card.
And then we will see what the CPAM decides after they've examined the documents we've sent showing our income and resources. They looked through our passports and took photocopies to make sure we really are living more than six months of the year in France. That's a requirement for coverage.
So far we haven't paid anything for health insurance coverage since 2006. That may change, I think. The French government is tightening up the system. If the charge is too high, we might have to look into private insurance again.