I have to admit it was the most difficult one to summarize so far; it is the most integrated healthcare systems I’ve studied yet, its admin side is awfully messy, and its “patient” one is so dead simple it was difficult to follow the structure I set up for the previous pieces. Still, I am happy with the end result, which you can check here: British NHS.

Need a teaser like last time?
By reading it you’ll discover that the British System:

1. Is most cashless;
2. Is so good private insurances only insure 11% of britons;
3. Is much more efficient than the French or the Australian one at managing its cost

The French social security system, which we familiarly call the Sécu, is widely considered to be one of the best in the world – The World Health Organization (WHO) ranked the health system of its 191 member countries in 2000 and France tops the list for providing the best overall health care. Many do think that the Sécu just is a healthcare system, when in fact it encompasses much more than that. But what sets the French system apart IMHO is that it did not stop at covering people living in France, it also offers the possibility to continue enjoying some of our Sécu when working abroad as expatriates thank to the CFE – Caisse des Français de l’Etranger.

Quick review on the French Securité Sociale

Our system is rather complex and bureaucratic in its functioning, but remains quite simple from a user point of view. It divides itself in different categories, which can become quite confusing when digging deep, but the general category is the one which interest us here as it covers 80% of the population, and is the one on which the Caisse des Francais de l’Etranger (CFE) is based upon. For this category, the four main type of benefits are:

• Health insurance - medical, maternity, invalidity and death benefit non linked to a professional activity
• Professional accidents and disability – medical, invalidity and death benefit for accident arising from a professional activity
• Unemployment - income replacement when unemployed
• Retirement – defined income scheme on a national level

The system for French residents also encompasses benefits which are not listed here above (such as family benefits, and financial support to those who don’t have the resources to face handicap, age, medical, social and economic difficulties when other social benefits are insufficient or non existing) but understandably those benefits are not replicated by the CFE, so I won’t discuss them further.

The Piece de Resistance – The CFE !

The CFE stands for Caisse des Français de l’Etranger. It is an organization of the Social Security system set up in 1978 by the Legislature to handle the French expatriates’ social security needs. It provides cover for the four risks related here above (health, professional, unemployment and retirement) and you can choose to be covered against one or several of these risks.

To be able to apply for cover under the CFE, you need to be French, reside abroad, and not be covered by the French Social Security system. A non French can be covered only if he/she is dependant of a French resident – ex: A children or a spouse or common-law spouse who:

• is dependant to his/her French spouse and live under the same roof as the insured;
• does not receive any personal income, be it from employment, pension or allowance;
• and is not covered by any mandatory French or other Social Security regime.

If you work for a French company, your insurer usually is affiliated with the CFE and you are therefore automatically covered by the CFE. Your company pays for your premium and your life is easy. Should you not, or are working on a local contract without CFE benefits, you can chose to opt-in as an individual member. You then have to pay for your own cover. Note that subscribing to the CFE does not exempt you from paying mandatory contributions in your country of residence.

Premium will be calculated based on your income or, in if you are unemployed, based on your family resources. France being France, if your income is below a certain threshold for the medical cover, you are entitled to assisted premiums (Yes, the French system remains generous even to its expatriates !). Should you be curious, you can easily calculate your CFE premiums on their website by clicking here.

Following the options you chose to opt in, your cover will enable you to:

• Get your medical expenses reimbursed as per the French rates. This means that in a country like Malaysia or Thailand, where the cost of care is decent, the cover is pretty good on its own, while in countries like the US or Switzerland you better get supplementary protection (APRIL and GMC are the two provider I usually recommend)
• Ensure that you and your family are covered should something ominous happen to you such as unemployment, a long term disability or death.
• Accumulate pension trimesters which will enter in the calculation of your French pension when you retire.

My take on the system

We French are lucky to have such a comprehensive and versatile system; it enable us to enjoy our dear Sécu even when we are abroad. Even better, a new expat do not have to worry about waiting period for illness insurance or lost quarter-years of pension premium for retirement benefits as they can follow us word wide. But for all its advantages, I do not subscribe to the CFE myself. Why?

1. I do not believe the French retirement system will last. We set the system’s retirement age at 60 when our life expectancy was of 62 years. Nowadays, we easily live past 80 and I don’t believe we can sustain the present system; especially with unions who will fight tooth and nails to keep the retirement age set at 60.As a result, I prefer to prepare my retirement on my own. A good read on the Age crisis is the latest Economist Special Report: A slow-burning fuse
2. The unemployment, long term disability and death options are interesting but international providers do offer better options and rates.
3. Finally, my company do provide me with a good 1st Euro healthcare system from a French insurer. I enjoy pretty much the same benefits without having to go through the CFE itself.

I easily recommend the CFE for healthcare needs – even though I don’t receive any commission from them. I believe it is a great system, with many benefits. But its other options are not as competitive or interesting IMHO. Professional benefits are only interesting if they are provided by your company – i.e. you don’t pay for them; and I don’t believe in our pension system. Now, should you have worked for 20 or 30 + years in the French system and consider subscribing to the CFE for their pension option, you should do it just because of your sunk costs.

In the end you only can know whether you need to be covered by the CFE or not,  and which option make sense for you. If you need help, you can contact the CFE directly or simply post a question here under.

Let’s quickly review the scope of a good social security system – I’m not talking US here

Medical Cover – Covers everything related to medical (duh!), maternity, Emergencies etc.

Retirement – Help you plan your retirement. Some system promises you a specific monthly benefit at retirement, others provide you an individual account from which you can draw an income later on.

Critical Illness Cover – Kicks-in and provide you with a regular income should you suffer from a critical/incapacitating illness – i.e. you can not work anymore but still need to make a living

Income Protection – Provides you with an income were you to lose your job

Family Cover – Helps you with some reduction or tax benefits in order to ease the burden of raising childs

Social Aid – Financial help for those who are in difficult situations due to their handicap, health, social or economic difficulties when other system can not cover them or are insufficient.

I put them down in order of importance from an expat point of view.

The Medical cover is maybe the easiest to grasp for everybody.

The retirement one also is quite obvious for many, usually those whose social security system provide them with an individual account grasp this concept very fast- they are already used to be responsible for their own future income.

Critical Illness cover and income protection are less top of mind for many. Yet they are very important. Especially the critical illness cover. Statistically, we have more chances of suffering from an incapacitating trauma than we have of dying young. Yet most people are familiar with life insurance, but not with critical illness.

The last two are more macro concerns. They are paid for by our taxes and we pay for those in our country of residence.

So – did you cover the 4 pilars of social security? Or did you simply go for the adventures?