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President's Council

Healthcare

Healthcare in America

The sometimes disparaged European health systems, such as the French National "Sécu", are soon missed in the United States – where the cost of treatment is particularly expensive. Living without such the strong European social welfare system can be a shock, and much that is paid for by the state in Europe will have to be contracted for privately or by the employer. In the United States, the patient must pay all medical costs, so it is essential to have medical assurance. Some companies help fund medical insurance for their employees, though this coverage is usually costly, incomplete, and can only be used while you are earning a salary from that company.

Despite similar names, the French and American social security systems are not the same. A 1987 contract between France and the United States allows French citizens to avoid a double contribution to social security, but it only concerns three branches: disability insurance, old-age pension, and reversion pensions for surviving spouses. Pregnancy benefits, work accidents, unemployment insurance, and family benefits are thus not paid for by the state; the expatriate must thus make his or her own decisions about coverage in these areas.

Transferred Employees and Expatriates

The social welfare system is governed by the principal of territoriality: the system from which the worker benefits is the one of the country where the work takes place. There is one exception to this rule, however: job transfer. Acquiring the status of “job transfer” requires four conditions: the worker must be employed and paid by a French enterprise, as part of a temporary project – the duration of the transfer to the United States is limited to five years (non-renewable), or two years for an unpaid worker – and the contribution but be paid by the French employer. The transferred employee may then retain French social security, as if they had not left the territory, and are exempted from paying American social security. The system of “transfer” is not obligatory -- taking the initiative is the responsibility of the company, and not to the worker. If the worker does not fulfill the conditions of transfer, he or she will be considered an “expatriate” and must pay under the local system.

Le Caisse Des Frances de l’Étranger

The “Social Security for Expatriates” (Le “Sécu des expatriés”) allows French citizens in the private sector to contribute to the general system of social security, and also to avoid the loss of annual installments for their pension. The CFE covers three risks – pregnancy, work-related injuries and illnesses, and old age – and it is possible to buy insurance for each area separately, according to the needs of the expatriate. For example, a single person may decide to save their money and have less insurance, whereas a family may choose to minimize their risk and buy more insurance. Using the CFE service is subject to three conditions: you must be of French nationality, reside in a foreign country, and not receive benefits from French Social Security. The contribution is due from the expatriate, who could may negociate their price as a total charge or a partial by the employer, at the time of signing the contract. The contributions are also flexible in the area of company contracts, and reduced rates are given to those under 35 years old. There are both advantages and disadvantages of this system. The CFE is voluntary, as opposed to hte “classic” system of social security, and tailored to the individual needs of the contributor. However, the CFE reimburses according to the French rates: the higher medical costs of America generally requires getting another assurance, according to the companies who have agreements to CFE, or among other organizations such as local insurance companies.

Local Organizations

Several types of medical insurance exist in the United States; of them, PPOs and HMOs are the most common. PPO (Preferred Provider Organization) policies permit open access to care. If a patient chooses a doctor from a recommended list, they will receive the best payment (around 90% of total cost, as opposed to 70% for doctors outside of the network), but they are allowed to see any doctor they wish. In this way, health decisions remain mainly up to the patient, and the access to specialists is more direct than with an HMO. HMO (Health Maintenance Organization) policies are generally less expensive, but access to treatment has many more constraints. The patient must choose a Primary Care Physician from the HMO’s proposed network. This PCP supervises treatment and acts as a kind of gatekeeper: when the patient is sick, they must first see their PCP, who will then refer them to a specialist. Treatment is, in some sense, prepaid on the base of a given sum – so doctors may adjust their treatment the amount they know they will receive for the care. In large cities, Primary Care Physicians are often overbooked, and it can be difficult to even get an appointment.

It is also important to know that Dental and Vision insurance often requires separate costly policies, and coverage is rarely complete. It is a good idea to compare the benefits of different companies to choose and insurance that covers your needs.

Doctors

It is a good idea to find a doctor soon upon arrival in America, and to make an appointment to get acquainted. Doctors often like to have a complete file on the patient before treatment. Consulates often have lists of doctors who speak the language of their citizens. Be wary of physician referral services, which will give you names of doctors and specialists, but bases advice on geographic proximity, rather then on professional competence. American doctors generally do not make house calls, though some will give advice on the telephone.

Please note AmCham is open: Monday-Thursday 9:30-13:00, 14:00-18:00, Friday 9:30-13:00
AmCham France is not open to the public. Please call to make an appointment if you would like to come by.

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Healthcare