Glossary of expatriation

A.

Absolute and definitive disability

100% loss of ability to work for payment and assistance from a third-party person needed to undertake daily tasks. Any individual who, following personal injury, accident or illness, is absolutely incapable of working in any way whatsoever and needs assistance from a third-party to undertake daily tasks, is considered as being completely and totally disabled by French Social Security. ADD is classified as death in most insurance plans. It may be included in the main coverage.

Accident

Any unintentional personal injury suffered by the insured member and arising from the sudden unexpected effect of an external cause. Incidents caused by illness in whole or in part are not considered accidents under the present contract (pathological cause).

Actual charges

Charges incurred by the Insured.

B.

Basic care

Usual care such as consultations, visits to paramedical professionals, laboratory tests, X-rays, etc. Major care is not included in basic care: dental prostheses, hospitalizations, maternity, etc.

Basic healthcare coverage

You may purchase basic healthcare coverage according to two different options: - Healthcare insurance in complement to the CFE or - Healthcare insurance as from the 1st Euro.

Beneficiary/-ies

Dependents, as opposed to the policyholder.

Benefits in kind

Sickness or maternity benefits paid by the French Social Security plan, the Caisse des Français de L'Etranger or complementary insurance plans such as ASFE in reimbursement of charges incurred by insured members for medical treatment and pharmaceutical expenses: fees of physicians, surgeons, dentists, midwives, paramedical professionals (masseurs, physiotherapists, nurses, podiatrists), medical or surgical hospitalization, medical equipment and devices, vision, dental prostheses, maternity-related care.

C.

Caisse des Français de l'Etranger (CFE)

The Caisse des Français de l'Etranger is a branch of French Social Security that provides optional health insurance for French nationals (and European citizens under certain conditions) living or working abroad.
www.cfe.fr

Cash benefits

Benefits paid by the French Social Security plan in the event of incapacity for work (daily benefits for total temporary disability), disability (partial permanent disability and total permanent disability benefit) or death, which shall be considered as a compensation for the loss of income or a death.

Certificate of coverage

Document indicating: names of insured member and his/her dependents, date of enrollment, type of coverage and policy number. You will also find on your certificate of coverage your personal ID number and password to access the “Participants’ Pages” of our website.

Complementary healthcare insurance to CFE coverage

ASFE offers a wide range of healthcare insurance plans for individual expatriates seeking complementary coverage to the Caisse des Français de l’Etranger. This type of coverage acts like a French mutuelle, or complementary insurance, providing reimbursements in addition to those provided by the CFE. Go to Our Solutions to view our entire range of complementary healthcare insurance plans for expatriates.

Co-payment (patient’s fixed contribution or Ticket Modérateur)

Insured’s out-of-pocket expenses. Difference between French Social Security standard fee and amount reimbursed by French Social Security plan. Amount not reimbursed by French Social Security plan which can be covered by a complementary health insurance ("mutuelle"), e.g.:
physician: 30%; laboratory: 40%; vision care: 35%; paramedical professionals: 40%; pharmacy expenses: 65% or 35%, medical equipment and devices: 35%.

Coverage termination

Healthcare insurance plans complementary to CFE coverage and First Euro plans may be terminated at the end of each calendar quarter (end of March, June, September or December), provided a letter is sent via certified mail, return receipt requested, at least two months before the requested date of termination.

However, JUNIOR’EXPAT plans are fixed-term contracts and therefore cannot be terminated once they go into effect.

Coverage zone

Geographic zone covered by the insurance plan:

- in the countries included in the coverage zone chosen by the insured member:

Zone 1: worldwide excluding countries from zones 2 to 5
Zone 2: Angola, Argentina, Aruba, Azerbaijan, Bahrain, Barbados, Belarus, Belgium, Bolivia, Bosnia and Herzegovina, Bulgaria, Chile, Colombia, Costa Rica, Croatia, Cyprus, Czech Republic (The), Denmark, Djibouti, Dominican Republic (The), Ecuador, Finland, France, French Polynesia, Georgia, Germany, Guatemala, Hungary, Iceland, Kazakhstan, Kuwait, Latvia, Lebanon, Liechtenstein, Luxembourg, Malaysia, Mexico, Mozambique, Netherlands, Nigeria, Norway, Oman, Panama, Peru, Saint Barthélemy, Saint Martin, Saint Pierre and Miquelon, Saudi Arabia, Slovakia, South Africa, Sweden, Thailand, Ukraine, Uruguay, Venezuela, Vietnam, Wallis and Futuna
Zone 3: Australia, Austria, Canada, Greece, Ireland, Israel, Italy, Japan, Monaco, New Zealand, Portugal, Qatar, Russia, Spain, Taiwan, Turkey, United Arab Emirates, Vanuatu
Zone 4: Bahamas (The), Brazil, China, Hong Kong, Jersy, Singapore, Switzerland, United Kingdom
Zone 5: USA
- in the insured member’s home country for trips (travels, holiday) of less than 60 days,
- in all other countries for emergency medical services to be provided following an accident or an unforeseen illness and requiring a surgical procedure or medical treatment before returning or repatriation to the home country. Depending on events likely to occur (civil or foreign war, rebellion…), coverage in some countries may be subject to the insurer’s prior approval.

D.

Daily benefits

In the event of a sick leave for total temporary incapacity for work, the insured receives a lump-sum payment from the insurer for each day on sick leave. A deductible is generally applicable for such benefits.

Death & Disability

ASFE provides its insured members with death & disability coverage in complement to basic benefits or within the framework of death & disability packages:
- In the event of death or absolute and definitive disability of the insured, a lump-sum death or disability benefit is paid.
- In the event of permanent disability following an accident, the insured is entitled to benefits to help him/her organize his/her life.
- In the event of medically assessed work disability, daily benefits are paid. A disability annuity is paid in the case where disability is recognized as being permanent.

Dependent

Dependents of the insured member include, as a general rule:

- the insured’s SPOUSE, provided they are not divorced or legally separated, or, if the insured is not married, his/her common-law spouse or partner under the French Pacte Civil de Solidarité (PACS);

- the insured’s CHILDREN, as well as those of his/her spouse, common-law spouse or PACS partner, under 20 years of age;

- the insured’s CHILDREN, as well as those of his/her spouse, common-law spouse or PACS partner, between 20 and 26 years of age and enrolled in a secondary or higher educational program, provided they are not gainfully employed for more than three months per year (applies to comprehensive “First Euro” plans);

- the insured’s CHILDREN, as well as those of his/her spouse, common-law spouse or PACS partner, between 20 and 26 years of age, alternately studying and working as a trainee or apprentice within the framework of their scholastic curriculum, and paid by their school or internship/apprenticeship company, provided pay does not exceed 65% of French minimum growth wage.

Please note that general conditions concerning dependents may vary from First Euro plans to CFE plans. Please Contact ASFE for more information.

Détaché

You are considered a détaché (employee on assignment) by French Social Security provided that you meet the following requirements:

- You have been hired in France

- Your employer’s head office is located in France

- You are sent on assignment by your employer for a fixed-period

- Your employer pays the contributions related to your salary to the compulsory French Social Security plan. You will benefit from French Social Security coverage as long as you are on assignment. In that case, you will pay contributions in France.

Disability (or permanent incapacity)

Permanent incapacity is due to an injury or illness resulting in a permanent impairment that decreases the ability to compete in the open labor market. Permanent incapacity is determined by the nature of the physical disability, the general state of health, physical and mental capacities, abilities and professional qualifications of the insured according to the “Industrial accidents” scale of the French Social Security system.

E.

Emergency medical assistance and repatriation

Medical transportation and repatriation by airliner or air ambulance; round trip for a relative visiting from home country; return trip to country of expatriation; round trip for person accompanying the insured; repatriation of body to home country in case of death; shipment of necessary medication.

ASFE offers emergency medical assistance and repatriation coverage in addition to the health coverage provided by the comprehensive plans (1st Euro plans) or CFE complementary plans. This coverage is automatically included in our Junior’Expat plans.

European Health Insurance Card

The European Health Insurance Card (EHIC) confirms your eligibility to health insurance in Europe. During temporary visits to a member state of the European Union, this card enables you to receive necessary medical treatment.

The EHIC permanently replaces E111, E110, E119 and E128 forms which were previously used for temporary trips in Europe.

The card is issued free of charge upon request from the Insured within a 7-day period by the health insurance organization (CPAM). The EHIC is a non-electronic plastic card which is different from the French carte Vitale. Each separate member of a family traveling should have their own card.

The card is valid for a maximum of one year.

Expatriate

You can benefit from expatriate status from the moment you are no longer covered by the compulsory French Social Security plan. In that case, you must pay contributions to the insurance plan of your country of expatriation, should that plan be compulsory. You can also decide to either:
- enroll with the Caisse des Français de l'Etranger and purchase complementary health insurance with ASFE or
- purchase health insurance from ASFE from the 1st Euro.

Expatriation - Expatriate (status)

An employee is considered an expatriate by French Social Security when they work overseas and their employment contract falls under foreign legislation. As the expatriate is not bound by any legal obligation with regard to social benefits (retirement or death & disability), they do not benefit from extension of coverage from the French Social Security plan.

H.

Health insurance for expatriates

Individual and personal insurance plans, complementary to the CFE or First Euro plans that guarantee the reimbursement of all healthcare expenses. Reimbursed healthcare expenses include: medical and hospital fees, vision and dental care, specialist fees, X-rays, etc. In addition to this type of plan, optional death and disability coverage is available to ensure the maintenance of a certain level of income or payment of annuities in case of sick leave or other disability, or death.

Health insurance plans are also available for young people overseas: students, trainees, those on a working holiday visa. This type of insurance reimburses medical and hospital expenses incurred following an accident or infectious disease as well as emergency medical assistance and repatriation.

Health insurance as of First Euro

ASFE offers individual comprehensive healthcare coverage to expatriates not wishing to enroll with the Caisse des Français de l’Etranger. These policies are called “First Euro” policies, as ASFE reimburses as of the first euro. Go to Our Solutions to view our entire range of “First Euro” healthcare plans.

Hospitalization

Following an accident or illness, medical treatment received in a hospital facility for a stay of 24 consecutive hours minimum or for a shorter stay including a surgical procedure. Hospitals or clinics qualified to perform medical procedures and treatments on ill or injured persons, possessing local administrative authorization to perform such practices and having a sufficient number of adequate personnel are considered as hospital facilities.

I.

Impatriate

Any foreign individual living in France who does not benefit from the French Social Security plan.

Infectious diseases

Diseases caused by bacteria, viruses, fungi or parasites.

Insured

Any individual enrolling himself, and any dependents, in a healthcare insurance plan.

Insured member/Policyholder

Any person enrolled in an individual health insurance plan for expatriates with ASFE. In exchange for premiums paid to ASFE, ASFE plans provide insured members with healthcare coverage and reimbursement of healthcare expenses in case of accident or illness.

L.

Legal protection

Legal and financial means required by an insured member and/or his/her dependents to be provided with the necessary information, be assisted and defended in the event of a dispute covered by the policy and claim his/her rights and have them enforced.

M.

Minimum policy period

All ASFE health insurance plans remain in effect for a minimum of six months for the First'Expat and Relais'Expat contracts and three months for the Junior'Expat contract.

Misrepresentation

ASFE healthcare plan will be null and void in case of intentional misrepresentation by the insured. Premiums paid will not be reimbursed and premiums owing may be requested as damages. The insured is liable to prosecution.

P.

Permanent disability

An injury which impairs the physical and mental ability of the insured and is likely to be permanent.

Period of consideration

An insured member who has signed the enrollment form and paid his/her first premium may cancel his/her enrollment by certified mail, return receipt requested, within 30 days.

If the insured member cancels enrollment within the first 7 days, ASFE is obliged to reimburse the premium in full. After this 7-day period and within 30 days maximum, ASFE will not reimburse the part of the premium corresponding to the duration of coverage.

Personal third-party liability coverage

In France, included in household insurance but rarely the case in other countries. Personal third-party liability coverage insures you abroad against the financial consequences of bodily injury, material damage and consequential loss caused to third-parties. Expatriate personal liability coverage offered by ASFE can be purchased in complement to another insurance plan or in the event you have not purchased any other insurance. Important: car and house-related risks are not covered.

Policyholder/Insured member

Any person enrolled in an individual healthcare insurance plan for expatriates with ASFE. In exchange for premiums paid to ASFE, ASFE plans provide insured members with healthcare coverage and reimbursement of healthcare expenses in case of accident or illness.

Precertification

Hospital precertification:
- In case of scheduled hospitalization, the insured must contact ASFE, who will send a letter of guarantee to the hospital. Via this procedure, the insured member will not have to pay upfront for his/her expenses. Only expenses not covered by the expatriate healthcare plan, and in all cases, personal expenses (telephone, TV, etc.) will be payable by the insured.

- In case of emergency hospitalization, the insured must show their ASFE insurance card to the admissions department, which will need to contact ASFE within 72 hours following your admission. ASFE will then issue a letter of guarantee.

Precertification for other medical services over €400 or US$400:
precertification is also available for medical expenses incurred abroad which are greater than €400 or US$400 (physicians, clinics, maternity, out-patient surgery, serious medical treatment such as chemotherapy or expensive exams). The healthcare provider will send the corresponding invoices to ASFE who will pay for expenses incurred (according to the provisions of the applicable contract).

Prior approval

You need to request prior approval from ASFE and, as the case may be, from the CFE, before receiving specific medical treatment or services such as assistance, hospitalization, orthodontics, series of treatment (more than five medical treatments performed by one practitioner in a short period of time), prostheses of any nature or medical check-ups. If you do not request prior approval from ASFE, expenses will be reimbursed with a penalty of 20% or may not be reimbursed at all.

R.

Reasonable and customary costs

ASFE covers healthcare costs that are considered “reasonable and customary”, up to the limits set forth in each policy.

The notion of “reasonable and customary” is assessed according to medical practices prevailing in the country where medical treatment is received (type of treatment, quality of care and equipment, geographic zone, country, etc.).

The International Coding Diagnostic (ICD) sets the standard for what is “reasonable and customary”, establishes rates based on a classification of healthcare treatment and services administered in each country. In the US, for example, Usual and Customary Reasonable Fees (UCR fees) are determined by the Current Procedural Terminology (CPT) Physician Guide; in France by the CCAM (Classification Commune des Actes Médicaux).

Reimbursement for fees that are considered unreasonable and not customary may be refused in whole or in part.

Reimbursement basis

Value of the French Social Security reimbursement as determined by the latest agreement reached between French Social Security and health practitioners.

Review

Healthcare premiums are reviewed on January 1 of each year by the insurer, according to the results reported for the previous financial year.

S.

Series of treatment

Any medically prescribed treatment requiring multiple sessions and performed by paramedical professionals (physiotherapists, orthoptists, nurses, etc.). Prior approval is required for more than five sessions.

Social benefit plans

All plans intended to provide coverage to individuals or families for the main risks of life: illness, maternity, disability, accident, death, retirement, unemployment, lack of job security. Although often compared with health insurance, coverage provided by social benefit plans is more comprehensive since it includes family allowances, complementary retirement plans, and social welfare. Social benefit plans can be widely different from one country to another, both in their organization and the range of coverage provided. In some countries, as some risks benefit from little coverage or are not covered at all, it is essential for expatriates to purchase individual healthcare insurance to be protected from the risks of life. Also, some countries have a Social Security organization in charge of health insurance whereas some others do not offer such a system. That is why it is necessary, before going overseas, to compare the social security benefits provided by the home country with those offered in the country of destination, in order to make sure you will benefit from equivalent coverage overseas.

Social Security reimbursement

Percentage of the French Social Security reimbursement: this percentage varies according to medical procedures or products, e.g.: physician: 70%; laboratory: 60%; vision care: 65%; paramedical professionals: 60%; pharmacy expenses: 35% or 65%; medical equipment and devices: 65%.

T.

Temporary incapacity

The insured is declared as being temporarily disabled when they are physically incapable of working following an illness or accident. A physician is responsible for deciding whether the insured’s physical incapacity prevents him/her from continuing to work or is able to return to work.

Termination

The contract shall be automatically renewed on an annual basis on December 31 unless terminated by November 1. The plan may be terminated in the event the insured permanently goes back to their home country, in case of non-payment of outstanding premiums, or when the insured member is 65 years of age for death & disability coverage. Coverage is terminated at the end of the quarter considered.

Total permanent disability

The Insured is recognized as being permanently incapable of practicing any type of profession for benefit or profit and has a functional disability level of 100%.

U.

Unforeseen illness

An unexpected and unforeseeable illness which is unrelated to an illness or hospitalization prior to the date of enrollment.

W.

Waiting period/Qualifying period

Individual health insurance for expatriates includes a waiting period or qualifying period. In other words, coverage begins only after the waiting period, which can be up to ten months, is over. This concerns coverage for vision care, dental prostheses, hospitalization and pregnancy and maternity care.

In the event of medical care or hospitalization following an accident or infectious illness (rubella, peritonitis…), the insured member and his/her dependents are immediately covered.

In that case, the waiting period is waived, except in the event of maternity if coverage was previously provided by another health insurance. A supporting document indicating valid coverage through another insurer within the preceding month must be submitted.

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