Saturday, February 11, 2017

Healthcare...

Jude recently spent 4 hours in ER at a local hospital here in Paris.  A couple weeks later a bill for the visit arrived.  It was less than 28Euro.  This included medications, doctors analysis, and treatment.

The cost of the visit comes as something of a surprise.  It's a pleasant surprise, to be sure, but still, it's a surprise.  Ten years ago in the USA we paid over 1200USD for a very similar ER visit.  The US ER costs these days are surely higher, right?  How is the number one ranked healthcare system in the world able to charge so little?  One possible answer is that the French government is actively involved in negotiating the best trade-off between cost and quality.  Another possible answer is that healthcare in Europe is not run as a for-profit business.  However one looks at it, the costs of being tended to are significantly less here than in America.

Jude did a little research and one day said we needed to apply for French healthcare.  What she found was that part of being an immigrant in France includes the right to ask to participate the in single-payer state-sponsored health care system.  It's called l'assurance medicale or securite sociale.  When successful, the insured persons receive their carte vitale, which is the insurance card issued by the French government.  It's not free, but it might be a lot less than what a person pays in America.

In our case the process took us two years to complete.  This isn't "normal" in that the process should have taken only three to six months after meeting certain basic conditions.  We were turned down the first time we submitted our papers and that cost is over a year to figure out where we went wrong.  The devil was in the details.

French law grants immigrants the right to ask for their carte vitale three months after arriving.  That's how one of the laws reads.  But there's a second law that says an immigrant needs to reside here six months after the start of the civil calendar.  The civil calendar starts on January 1.  So you can start the process three months after January 1, but we needed to prove we lived here at least six months over the course of the year.

This means that when they ask you for scanned pages from your passport, if you have a stamp from a non-Schengen country, you might be denied your health insurance request.  This happened to us.  We went to a friend's wedding and cleared out our Plan B storage unit back in the States in May, five months into the French civil calendar year.

Even though we hadn't left the country for the two prior years, our health insurance request was not valid since we couldn't prove we'd been here six months in the year we filed our request.  A friend of Jude's has a very kind husband who helped us understand what went wrong.  In retrospect is all seems so simple.

In short, here's what we did.

  1. We visited the local CMU office and asked for an application.  We filled it out, attached the requested documents, and mailed the application to the address found on the application.  
  2. We answered the French state's further requests for documentation.  In our second attempt we were asked to provide two additional pieces of information.  One of these was a request for our tax information.  It was our income that was used to calculate what we pay.  I had wrongly assumed the calculation of what we were to pay was what we spent living here, but it's not.  This was an important distinction for us.  What we spent was more than what we earned in interest.  Happily, the number on the letter was given to our doctors and the benefit of the French healthcare system was immediately realized (by reducing our already very low out of pocket expenses). 
  3. Some time after we received our letter which stated we were being granted health insurance, we were asked to send our photo to another part of the French processing system.  Within a month we received our cartes vital, complete with the aforementioned photo.


Sculpture ~ Paris, France

Wednesday, January 4, 2017

So you say you want to move here...

Let's say you have your reasons for moving some place else.  Let's say you've chosen France as your destination.  Well, today's your lucky day.  Um, well, most likely not.  However you see the outcome of your day (luck vs no luck), we've been encouraged to share our experiences in following the immigration process to legally live here.

As background, we are retired from our working lives.  We have what we hope are sufficient financial resources to live in retirement.  We were looking to "get out" while the "getting was good."  More properly said, we wanted to experience something new and different and knew that wherever we landed we'd be putting down new, perhaps strong, roots.  Leaving the US for us was not a halfway, uncertain thing.

We recognized immediately that we would become immigrants.  And in becoming immigrants we made a conscious decision to set aside our American "exceptionalism" and to try as best we could to follow all of the rules and laws of immigration of our new home country.  We did not want to run any risk of being told we could not live here.

Here's an overview of the process we've followed -

  • Researched immigration requirements through a French Consulate website
  • Discovered we could not simply move to France on our travelers visa (3 months automatically granted to US citizens).  We had to apply for our long stay visas through a French Consulate in our country of origin.
  • Rented an apartment for three months (so we could show the contract to the French Consulate officials)
  • Purchased one-way airline tickets (to show the French Consulate officials we meant business)
  • Visited the French Consulate nearest us with all of the documentation they asked for on their website
  • Received our passports with a large page filling Visa sticker (valid for one year)
  • Sold our home in the US
  • Boarded a plane and left
After landing in France
  • Greeted our short stay apartment owners, went through the contract and details they felt important to point out and moved in
  • Sent required documentation to the immigration authorities and received our appointment time/date
  • Visited OFII for a medical exam and receipt of a second page filling sticker (seems like it's good for a long time)
  • Opened a French bank account (to pay for utilities)
  • Found a long term (in our case furnished) apartment and moved in
Eight months on...
  • Made our first appointment with the Prefecture de Police
  • Gathered required documentation and had translated into French, using a state approved translator ONLY, all documents originating in English
  • Visited the Prefecture de Police and received a récépissé that granted us permission to remain in France until our Carte de Séjour (Visiteur) had been prepared a few months later
  • Picked up our Carte de Séjour (Visiteur - valid for one year)
Annually thereafter - 
  • Make an appointment with the Prefecture de Police
  • Gather required documentation and have translated into French, using a state approved translator ONLY, all documents originating in English
  • Visit the Prefecture de Police and receive a récépissé that grants us permission to remain in France until our Carte de Sejour (Visiteur) had been prepared a few months later
  • Pick up our Carte de Séjour (Visiteur - valid for one year)
We understand that after ten years the French state might grant us without our asking a version of the Carte de Séjour that is valid for ten years.  They also may allow us to apply for the ten year Carte de Séjour after five years, but we have yet to test this.

Reading the list of steps we've followed to living legally here hides the very many details and small dramas that arise at seemingly each and every stage.  There are language issues.  There are process issues (usually stemming from our lack of understanding of why something is being asked for).  There are personality issues (though these are very rare and we've only encountered two, perhaps three, nasty fonctionnaires in all our time here).

Taking all this into consideration you might wonder if it's worth it?  Afterall, a made famous by TV person who lives here has been known to advise Americans to not worry about all that silliness and just come live here without a proper visa.  Their contention is that the authorities leave Americans alone and won't bother them.

For us there are two ways of answering the question of "is it worth it."  The first is very practical.  When you look at the list in it's entirety it's easy to forget that all of this unfolds over the months and years.  There is plenty of time at each stage to do what is needed.  Sure, it can feel sometimes like you'd rather be out enjoying the day than sitting at home working through all the things immigrants are demanded of.  But if your experience is anything like our's, there will be plenty of time in a day to do the needful.

The second way of looking at it is from the perspective of emotion and experience.  When looked at this way, following all the details of processing an immigrant's stay here is a small price to pay for living in a truly civilized place.  The quality of food and drink is second to none.  Art museums, monuments, and cultural experiences simply can not be duplicated anywhere else.  The beauty of our surroundings extends many times from the biggest, grandest things all the way down to the smallest detail.  And then there's the people.  After you get to know the locals and after the locals get to know you, friendships can bond you in a way never before imagined.  For us it's been very much worth the effort to stay "legal" in living here.  The peace of mind is worth every minute spent on the details required by the French state.

We took a look elsewhere around Europe to see what their immigrant processes were.  We wanted to see how difficult it might be to move to a different country (the French Carte de Sejour is only good for living in France).  What we found is that the processes are largely the same.  Though we're sure there are differences in the details.  For instance, when looking at the visa requirements for Portugal there seem to be no requirement to have English documents translated by a state licensed professional.

We hope this blog entry helps.  We can't vouch for how this would go for you.  We're not immigration professionals, so take all this with a grain of salt.  Still, we would like to give people some idea of what they might go through and to give them hope that it will all work out OK in the end.


Autumn in Paris