~ff) Department of Health

Richmond House 79 Whitehall London SW1A2NS

Tel: 020 7210 4850

Mr Brian Cave Le Fourquet Gourdon 46300


Thank you for your further letter of 20 July about the healthcare agreement between France and UK.

As you may be aware, European Union (EU) legislation in this area is extremely complex but in essence, it requires the co-ordination of social security systems rather than uniformed healthcare systems. Health is within the scope of these regulations as it is a benefit in kind. Member States' healthcare systems vary considerably, with the UK NHS being a residency based scheme whereas other Member States choose to operate insurance-based schemes. Within that context, the French national system operates a co-payment element for healthcare provision whereby French residents are required to pay 20 per cent of health care costs.

State pensioners from all member states who visit France, and those living there, are therefore subject to the same conditions on the level of health care provided, and any costs due for that treatment, as a French pensioner who lives in France

-would be who received treatment there. Top-up insurance is a benefit available under the French state healthcare system which some residents choose to join, while others do not, and is a product of the way the French state system has been set up concerning the co-payment or patient contribution. These conditions apply in exactly the same way as they do in Germany, for example, where a patient contribution is also payable for treatment received.

This follows from the final sentence of Article 24.1 of Regulation 883/2004, which directly follows that which you quoted in your correspondence, which states:

The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 [that which pays your state pension] by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of the Member State.

As you know, in accordance with ED regulations (EC) 883/2004 and its implementing regulation (EC) 987/2009, which entered into force on 1 May 2010, France has chosen to claim reimbursement for the actual cost of the treatment provided to citizens from another member state, including those in receipt of a state pension from another member state. In practice, this means that France will claim reimbursement only for the cost that was incurred upon the French authorities, which, in France, is normally 80 per cent of the total cost of the treatment or healthcare provided. In addition, the UK scrutinises all claims from other member states as they are received to ensure that they correspond to a person who is registered on our system as entitled to such healthcare. I hope that this reassures you that the UK is only paying for the cost of health care that is provided by the French authorities, and is not paying for the co-payment or contributions that are covered by the patient being treated in France.

I hope you feel this reply answers your questions fully and that you find this information helpful.

Nicolette Hartell Customer Service Centre