How The Health System Works For Auto-Entrepreneurs, Micro-Entrepreneurs and Commercants

Once a small business has been created and the various pieces of ID sent to the authorities (RSI), you are issued with a temporary Immatriculation number (national insurance number), later followed up by a permanent one.  The RSI forwards the information to the organisme conventionné chosen when you created your business so you can apply for Cartes Vitales for yourself and family members as dépendants.  As soon as they log you into the system, you can request an Attestation, pending the issuance of a Carte Vitale which can take anything from three to nine months.  The Attestation is what you can show doctors, dentists, etc. in the meantime.

You are covered as of the date you created your company. 

Note: each time someone is added as a dépendant, you should ask for a new Attestation listing them. 

Meanwhile, you should keep all medical, optician, pharmacy bills, etc. as you can send them off once you are properly registered with the organisme.  Bills can date back to when you created your company.  Note: any pharmacy bills need to be attached to the relevant doctor's prescription (Ordonnance) and any vignettes (small stickers from medicine packaging) stuck to the Feuille de Soins (bill) though most pharmacists do this for you. The organisme only accepts ORIGINAL Feuilles de Soins so be sure to keep everything safe.

Your organisme will reimburse a proportion of any medical, dental, pharmacy expense (up to 70% of the cost) though it reimburses less if you haven't chosen a GP (30%).

A.      Most people take out complimentary top-up medical insurance so that they are covered for the difference. If you don’t already have medical top-up insurance your financial adviser should be able to get a quote for you? Under a law called the Loi Madelin applicable to small businesses, you are entitled to a tax deduction on part of your contributions - it's always a good idea to pay less if you can!

B.      If both of the above are working properly, all you need to do is:

• a.Show your Carte Vitale or Attestation to the doctor, pharmacy, etc.
• b.He/she makes a note and asks you to pay or not, depending on the case (standard doctor’s rate is €23) and enters the details in the database. They will issue you with a Feuille des Soins showing the amount you paid.
• c.Assuming the details are correctly entered/scanned, you are automatically reimbursed by the organisme. The organisme sends out a monthly statement (Décompte de Prestations) listing all reimbursements to your account.
• d.If you have a top-up medical insurance company, you should send a copy of your RIB and a copy of your organisme’s Attestation to them.  Each time the organisme makes a reimbursement to you, your top-up insurance will automatically be notified and will, in turn, reimburse you on the difference. If you are in doubt as to whether or not you have been reimbursed on the top-up portion, you can always ask and, if not, send them the ORIGINAL monthly Décompte de Prestations issued by your organisme (photocopies not accepted).

Note: There are rare occasions such as pharmacy labs or clinics (e.g. mammogram) where you may be asked to pay 100% upfront. In order to be reimbursed, you should send the ORGINAL papers to the organisme who will then go through steps c & d above.

Thus, if all is correctly set up, you are automatically reimbursed by both the organisme and your complimentary insurance company without having to do anything other than flash your Attestation or Carte Vitale when getting treatment.

  © Pascale Florin of Peter Johnson sarl

Part 1 deals with  "Getting into the System"