carte vitale

How to Get a Numéro Provisoire or How to Sign up for Assurance Maladie

For the first year after I arrived in France, every time I went to the pharmacy or doctor, they’d ask for my carte vitale. This is the health insurance card every French person has which allows them to be reimbursed for medical expenses, and each time I politely explained I didn’t have one, the person checking me out would be shocked. To be paying out of pocket for my medical costs was unheard of, even though they were fractions of what I was used to in the U.S.

It took me longer than it could’ve to realize I also qualified for medical insurance or assurance maladie. After going through the process, the first document I received was a temporary social security number or numéro provisoire. If you’re in France on a carte de séjour visiteur, this is the only number you’ll be assigned. However, if you are here on a visa talent or visa vie privée, you’ll be eligible for a permanent social security number, as well as a carte vitale.

Who Qualifies?

Anyone living in France in a “stable and regular manner” qualifies to be covered by France’s healthcare system. This means you do not have to be born in France, married in France, or even working in France to register. However, it means you do have to have spent at least three months in the country and have a valid titre de séjour.

How do I Register?

To register you need to send copies of the following documents to the closest health insurance office. You can look up which one that is here.

Required Documents:

  • National Identity Card or passport or residence permit, as well as any documentation of your civil status.
  • Extract of birth certificate with filiation or full copy of birth certificate
  • Completed “Demande d’ouverture des droits d’assurance maladie.” (The second page of the form also lists the necessary documents to include.)

In my case, I sent copies of my passport and current titre de séjour, as well as the récépissé of my PACS — all documents which showed I was a ‘permanent’ resident in France. I also included a long form copy of my birth certificate which had an apostille and had been translated into French, as well as a letter d’hébergement saying I lived with Fred. Luckily, I was doing this process soon after being PACSed and had all these documents on hand. Proving you live in France usually all boils down to the same set.

Why is it Taking so Long?

  • The Short Answer: Assurance Maladie is a single government health agency which serves the entire country of France. Unsurprisingly, it can take them a long time to process documents, especially since you’re required to mail in your application.
  • The Long Answer: There are many reasons why an application can be deemed incomplete –– perhaps you sent an abbreviated version of your birth certificate, perhaps you forgot to sign a certain form, perhaps your dossier is inexplicably missing. This was the case for my first attempt, and after waiting three months and without a word from the health insurance office, I went back and discovered they had no record of my ever having filed for a numéro provisoire. Whenever possible, try to keep track of who you’re speaking to, their name and contact info, and any trace that could be helpful in tracking down your file. In my case, I simply resubmitted everything and waited a few more months. As you can see, it’s always worth it to follow up and be on top of these processes.

Bonus Question: What’s the difference between a temporary and permanent number?

Your temporary number allows you to be reimbursed for expenses, assuming to keep the form the doctor or pharmacy fills out, as well as any prescriptions, and mail them to assurance maladie. The reimbursement is done directly to your French bank account on file, though the entire process can take up to a month.

With a permanent number, you qualify for a carte vitale which acts as a debit card and means the French government is paying the up front costs, or at least the percentage of costs covered by the health care system.  You can create an online account on Ameli (the French government’s healthcare site) which means you no longer have to mail completed forms and proof of doctor visits to be reimbursed. That said, as I’ll talk about in a future article, being reimbursed doesn’t mean that one hundred percent of the costs are covered.

If, like me, and you’ve assumed that you don’t qualify for healthcare because you’re not French, I hope this article is helpful. As you can see, the process of applying is relatively straightforward and worth it from a financial sense and for the mental relief of being “covered.”

Photo is of my new card finally arriving!

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flying during lockdown

Flying During Lockdown

While many of my planned trips this year evaporated in the Spring, there were still some trips I chose to take for business and personal reasons.  During a brief window in the summer when PCR tests weren’t required, I went to visit family and friends in the States.  Inside Europe I managed short trips to Croatia, Mallorca, and Andorra.  I did all this on my US passport, despite the alleged “American ban” in Europe, and even without my French Carte de Sejour.  But I still had a final business trip in the calendar for 2020: Salzburg in November.

As you do when traveling in Europe these days, I was checking the ReOpen EU site regularly, to see what new regulations were in place.  I don’t remember exactly when I found out I was going to need to take the dreaded PCR test, but when I did, I immediately made an appointment at a lab in the 11th.  In early October the appointments were at least 2 weeks out and I needed a test that was done fewer than 72 hours before my arrival in Austria, in early November.  I managed to get an appointment for the right day and time and I showed up to a virtually empty clinic.

Covid-19 Testing

This was to be my third Covid-19 test.  The first had been at my doctor’s request during lockdown, when I described the flu-like symptoms I had earlier in the year.  The second had been before a summer trip to Croatia, when I thought they might ask for a test even though I was coming from France, not the US.  But those had been blood tests.  The PCR test was “invasive,” I had heard, but I hadn’t really read much more about it.

When I came to the clinic I was ushered right to a receptionist who verified my appointment and asked for my Carte Vitale.  Since the summer the French government had started fully covering the cost of Covid testing so I wasn’t asked for any money out of pocket.  After a few minutes I was handed a printout and some stickers which would ostensibly go to the lab with my swab.

Personne suivante,” came a calm voice from behind a mostly closed door.  I came in and sat down in the chair that she beckoned me towards.  She told me I would need to remove my mask, which I did.  She then asked if I had done this before.  I shook my head and she told me to sit back and relax and that it would not take long.

I assumed the pose that I normally do at my dentist’s.  Relaxed, head back, remembering that the person who is doing this does this all the time, professionally, and is not interested in hurting me.  For those of you who are unfamiliar with the PCR test, it involves sending a swab about three inches into your nose to grab some samples of upper respiratory mucus.  As you might guess, this is not a pleasant feeling.

This is not so much a question of pain as unpleasantness.  Your nerves in this area sound an alarm: what is this thing doing here?  When she had inserted the probe the entire way in she actually moved it around a bit, ostensibly to make sure she collected enough of a sample.  She saw me tighten up and after withdrawing it she waited a beat before asking if I was ready for the “next one.”

Then I realized she meant the other nostril.  Okay, I know what to expect this time.  I braced myself and a few moments later it was over.  I thanked her, got my stuff, and headed home.  I got the results by email the next day, which I then printed out so I could present it in Austria when I landed.

Arriving in Austria

As I said, the trip was originally planned for Salzburg, and had the trip occurred one week before that would have been fine.  But in the days leading up to the trip Austria announced a lockdown and this led to many hotels and airbnbs closing their doors (as the government promised to make them mostly whole if they complied).  Not wanting to take a risk of being in Salzburg without a place to stay, I decided to improvise and go to another location where I knew I could stay, outside Vienna, close to where my colleague on this trip actually lives.  But there was an additional wrinkle.  Austria had asked for a 10-day quarantine on visitors, even those with a negative test.  I decided to chance it.  My trip was scheduled for 7 days and if they made me stay an additional 3 days in Austria, I wouldn’t fight them.  Though, my business involved me working in the same room as my colleague, so if they actually planned to enforce this quarantine, my trip would be pointless.

The flight was about 80% full and during the flight we filled out contact tracing paperwork (which they collected) as well as an “Entry and Transit Declaration” (which they did not collect).  This document asked for:

  • Name, Nationality, Date and Country of Birth
  • Flight Details
  • Stays in the previous 10 days
  • Address in Austria for the next 10 days
  • Contact details

I was asked to sign and date this form, next to a declaration that said, “I hereby confirm that I will self-quarantine at home or in suitable accommodation for a period of ten days, that I will cover the costs of any such accommodation and that I will not leave home or this accommodation for the duration of the quarantine.”  The flight attendants said to keep this form on us and that we might be asked for it at anytime.  I considered that curious, as if the form were true, the only place I could be asked for it would be inside an isolated accommodation.

At the very bottom of the document it said, “The details provided here will be sent to the health authorities of the province where you will be staying for the next ten days and, at the end of this time, destroyed.”  So, this form was supposed to be turned into someone, not carried with me inside an isolated accommodation in case a police officer stopped by, who couldn’t possibly know I was staying there unless I had turned it in in the first place.

No matter, the main concern for the Austrians for those of us arriving was a valid PCR test.  They had military personnel, not customs agents, looking at our passport and PCR test.  Because of the perfunctory manner in which the soldier dealing with me looked at my paperwork, I realized he was looking for two things: a name match, and a valid 72-hour window.  That meant that anyone who wanted to forge up an official-looking test could easily do so.  There was no electronic scanner to verify that this was an actual lab which had administered an actual test.  It was a simple check of paperwork using the technology of 1920, not 2020.  He handed back my paperwork and my passport.

I then proceeded to the passport window.  Surely, I’ll be checked, I thought.  Vienna had just had a terrorist attack the previous week.  But no, the lady at the window was busy on her phone and just waved me through.  The Austrians didn’t care what my purpose was in their country or if I even had a valid purpose to be there.  They only worried if I had a valid PCR test, which I could easily have forged, it seems.  As has been the case for most of this year, I was watching biosecurity theater, and not even good theater at that.

“Lockdown” in Austria

A friend picked me up at the airport and we headed back to his place to have lunch.  As we walked into his apartment building I marveled at the people not wearing masks.  “Is there no mask mandate?” I queried.   “Not outdoors, that’s weird!” he said.  Indeed it is, I thought to myself, but felt like a kid on Christmas day just because I wouldn’t have to wear a mask outdoors all week.  We had had an outdoor mask mandate in France for some months now.

Later in the week I was walking around Vienna with another friend when I realized that pretty much all the shops were open and a lot of restaurants were offering takeaway service.  I tried to explain that in France “lockdown” meant I couldn’t leave my house without a permissible reason, that I could be stopped and asked to justify myself at any time, and all this was to take place within 1km of my house, outside of particular extenuating circumstances (although, just as in late Spring, the French were not taking this seriously at all).  He wrinkled his nose.  “We had something like this back in the Spring, but not now.”  While it seems that since my visit Austria has been put into a much stricter lockdown, I was happy to take the opportunity to, among other things, get my hair cut while I was there, as I didn’t know when I would have the opportunity again in France.

Coming Home

When I came back home to France I presented my passport at the border.  The agent scanned it and after some time my linked Carte de Sejour showed up digitally on his screen and he waved me through.  No tests, no quarantine, and not even any paperwork pretending to enforce either.

So, traveling during lockdown?  If you’re worried about how to do it, don’t (the authorities clearly have no idea what they’re doing).  Just have your paperwork in order and be ready to be patient and smile.

Photo by Ashim D’Silva on Unsplash

Getting My French Carte Vitale and Going to the Doctor…Finally

It felt futile. I knew the French didn’t operate this way, but I was feeling worn out and was reverting to American habits.  I was writing, in French, on a post-it note, the following message:

I am very happy to send another yet another check to cover my health insurance charges, but I still have not received my Carte Vitale.”

I knew as I sealed the envelope that some French functionary processing my cheque would see this note, laugh scornfully, then peel it off and place it delicately into the circular file.

So you can imagine my surprise when, one week later, I received a letter in the mail letting me know the only thing missing to process my Carte Vitale was a photo and my signature, after I had verified some information they had on me.  It is one of those times I was quite happy to be wrong.

This was the only part of my paperwork processing that had gone sideways as I left visitor status and transitioned into my profession liberale life.  But, since I’m not a frequenter of doctors anyway, it simply remained a slight irritation.  When four months had passed without any sign of my Carte Vitale, I made a copy of my translated birth certificate, as well as a copy of the original, and sent it to RSI with a pleasant cover letter.  No reply.  Another four months passed.  That’s when the wry (but polite) post-it note was written, which just goes to show you that every now and then an unexpected tactic might just work.

* * *

The visit to the doctor felt like an interstitial in an Inspector Clousseau skit.  I had crowdsourced a good doctor from my Paris network, one who had a decent command of English, though I made the appointment in French.  I made the mistake of not asking how to find the place (surely an address is good enough?) and when I walked into the vestibule of the apartment building that was the address for my doctor, I searched in vain for signage that would indicate my desired destination.

Not quite willing to admit defeat yet, I decided to climb the stairs (surely the doors will be marked?).  But by the time I reached the 3rd floor (American 4th) I realized that this was a fool’s way to figure things out.

Humbled, I turned around and went all the way back down the stairs.  Thankfully, on the ground floor, a resident was having her door locksmithed and I asked if she knew where the “medecin” was (on a side note, “doctor” is one of those words in French that doesn’t change ending whether you put a “le” or “la” in front of it).  She responded insouciantly (as if she gets this all the time) that “all the doctors are on the fifth floor.”

Bingo.

I took the elevator up to the fifth floor, found her office and checked in, roughly ten minutes after my original appointment time.  Ten minutes after that, I heard a gentle, “Monsieur Heiner, S.V.P” from the hallway and went in.

Her room was cheery and welcoming and full of books.  I felt like I was in a comfy study, not a doctor’s office.  She took out a clean sheet of paper, wrote my name down at the top, drew a straight and clean black line under it, then looked up at me, smiled, and asked how she could help me.

Puis-je parle avec vous en anglais?” I queried.  She smiled down her glasses at me.  “Yes, of course.”  “I just don’t have the vocabulary to speak well about my health in French.”  She nodded.

Ten minutes later she was asking for my Carte Vitale and 40€.  The carte goes into a card reader just like a chip-and-pin card, but with no pin.  “Cash or cheque?” she asked.  “Oh, you don’t take bank card?”  “Non,” she gave the slightest of pouts and shook her head.  “Is this the case for all medical appointments?” I asked.  “Non, it is a choice,” she said.  I had just enough cash on me: “You cleaned me out,” I laughed.

On the way out she handed me a form which designated her as my “medecin traitant” which in American parlance is “primary care physician.”  Getting this form to La Ram/RSI would make sure I got properly reimbursed.

I was off to the lab after that for some testing and I thought I had understood her directions about how to get there (it was in the same structure, just down a different hallway) and seven minutes and a few dead ends later I was in front of the receptionist at the lab.  Twenty minutes and roughly ten glasses of water later, I was prepared for my lab work.  When it came time to draw my blood, the nurse gazed at all the vials which had been set aside for me (around 11) and asked if there was a reason I needed all the tests.  I responded in French that I hadn’t been to a general doctor for 2-3 years and I figured why not check on everything?  We both laughed.

I went back to the waiting room and five minutes later the receptionist called me.  A swipe of my Carte Vitale and 80€ on my bank card later, and I was done.  I went home, dropped the form for my new “medecin traitant” in the mail, and went back to my day.

Two weeks later, to the day, an envelope arrived in my mailbox.  I had completely forgotten that I had some money coming back.  There was a check for 15€ against the 40€ I had paid for the visit, as if even 40€ was “too much” (as an aside here I’ve mentioned in the past that you can acquire a “mutuelle” policy that tops up even this copay so you are 100% reimbursed all the time, but I don’t go to the doctor enough to add that extra cost to my budget).

My first encounter with the French medical system: easy, painless, friendly, efficient, and inexpensive.  Against the roughly 700€ a year I pay to cover my national health insurance, not too bad.