Your question is somewhat perplexing. Why if you are paying the astronomical rates charged by Helsana would you want to have cover in Ain. Are you living there?

We have to undergo the same procedure with an attendant E121 - without one of these, it will be much more difficult. It took a long time to obtain a Carte Vitale, but now of course we utilise this for everything medical, GP, hospital, pharmacy etc. We were under the impression that if you wish to utilise the CPAM system, you have to be resident here?

We live in Ain, yes. We live close to the border, so could visit the doctor in Switzerland, but we may occasionally need to use a doctor in France, so I feel that we should be signed up for that.

Incidently, Helsana's rates are not astronomical for us. In fact, it's much cheaper to pay for Swiss health insurance than to enter the French system if you have a good Swiss salary.

Hi, with your "frontalier" contract with Helsana and the Swiss health insurance card, you can go freely to a doctor either in CH or in France. On the back of your card figures the European card and in general doctors / pharmacies etc accept it. Your registration at the CPAM helps you and can make it easier to handle your medical bills from France. But if a doctor in France should not accept your card, you can also send the detailed bill directly to Helsana for reimbursement. I work in health insurance in CH and the administrative exchange with the CPAM can be very exhausting indeed. 

Thanks very much Daniella.

So when I went to the doctor in France (just to get a form signed to say that I'm healthy enough to join a climbing club - crazy!) I just had to pay 25 euros and I have a bill. I guess that's normal?

Should I send the bill to Helsana? or to the CPAM?

If I have to send the bills to Helsana, what's the advantage of registering with the CPAM?

Also, as it is less than the 300chf deductible, I guess that I won't get the money back anyway, so it doesn't really seem worth the hassle of sending it?

Sorry for all the questions - but I've googled and looked on so many forums and I just can't find this kind of information - it's amazing that it's not out there already.

Luke

Sorry for all the questions - but I've googled and looked on so many forums and I just can't find this kind of information - it's amazing that it's not out there already.

Amazing indeed. The reason you won't find the answer to your questions by doing google searches is because the answers are so self-evident. Or they are there, but you just did not read them. For example:

Should I send the bill to Helsana? or to the CPAM? 

Uhhh, who is your health insurer? Read Daniela's post again "if a doctor in France should not accept your card, you can also send the detailed bill directly to Helsana for reimbursement"

If I have to send the bills to Helsana, what's the advantage of registering with the CPAM?

Are you really asking that question? Hmmm, maybe the advantage is that you will have to do an enormous amount of additional paperwork?

Ok, I understand. You were covered by the NHS in the UK before, so maybe this is all foreign to you. But then, incredibly, you ask:

Also, as it is less than the 300chf deductible, I guess that I won't get the money back anyway, so it doesn't really seem worth the hassle of sending it?

OK, let' say you don't send any claims until you have reached 300cfh in medical expenses, and then you send your first claim to Helsana. What do you think they will reply? They will not cover it until you have reached 300 chf in submitted claims.

Sorry if this sounds harsh, but really.... after Daniela's post it should be clear. If not, let me write it again. Helsana will cover your medical expenses in Switzerland and with the doctors and pharmacies in European countries as specified in your card and your contract. Whenever you get a medical service or product, if the provider does not simply take your card and bill Helsana directly, get a receipt and necessary documentation, as per your policy, and submit it to Helsana. The only reason to bother with the CPAM, is that some providers in France may agree to bill Helsana directly, or more likely, bill the CPAM, which will then bill Helsana, but, in my experience, that is very rare.

I'm sorry for being such an idiot, JR M.

Should I send the bill to Helsana? or to the CPAM? 

Should and can are not the same. The doctor himself told me to send it to the CPAM, even though I said that we had Swiss Insurance.

Are you really asking that question? Hmmm, maybe the advantage is that you will have to do an enormous amount of additional paperwork?

I take it by this you mean there is no advantage? This isn't obvious when Helsana sent me some documents and specifically requested that I send them to the CPAM to register. How am I supposed to know that I should ignore such a request?

OK, let' say you don't send any claims until you have reached 300cfh in medical expenses, and then you send your first claim to Helsana. What do you think they will reply? They will not cover it until you have reached 300 chf in submitted claims.

It is not clear that the 300 chf was a total, summed up over several claims. For every other type of insurance I have ever taken, the deductible would apply individually to each claim.

Hy Luke, there is a lot of confusion about health insurance in Switzerland and each country is dealing it so differently. So don't be discouraged and go ahead and ask your questions...That's why we have this forum;-) 

Yes, send the detailed bill directly to Helsana. It is true that they will deduct it from your yearly franchise. You can also wait and send them all together once you have reached the CHF 300.00 of medical expenses per calendar year.  

The only advantage with the inscription at the CPAM is that you are officially registered by the French providers and they will not send the bill to you but directly to your CPAM. The CPAM checks the bill, reimburses it and then send it to l'institution commune LAMal in CH and they send it further to Helsana. And at last, Helsana will send you the bill with your participation. 

I am not sure if in case of hospitalization, you would have some advantages too...

If you have the intention to stay for a long time with this status, I would do the paper work with the CPAM. But if not, there is no absolute need. 

Kind regards 

Daniela

If I have understood you correctly, you have asked a medical doctor to certify that you are physically able to practice mountaineering with a local climbing club and you now expect the cost of this service to be reimbursed by your health insurance provider?

Is that really how the National Health Service works in the UK?

Hi Ritchie,

I wasn't expecting it to be reimbursed at all, hence why I thought that there was no point in sending the bill to Helsana. I'm quite surprised to learn that it in fact counts towards my "yearly allowance".

Frankly the idea that a climbing club would require a medical certificate is totally alien to the UK. If for some reason it was reiqured, then I am fairly certain that the NHS would not charge for such a service.

Daniella,

Thanks so much for your kind advice. It's useful to know that I can keep the bills and only send them if I surpass 300chf. As I've hardly ever needed a doctor so far in life, I think it's unlikely that I'll reach that point! Of course, life is unpredictable so I'll keep the bill just in case.

Do you know if the 300chf is per calendar year or does the year from when you sign up?

We plan on staying here long term so maybe it is worth registering with the CPAM. I'll give them a call next week to ask them why they need so many details.

Luke

Dear Luke, the deductible is always from the 01.01. to the 31.12. independently when you started the insurance. So each 1st of January every one starts at CHF 0.00. 

Kind regards Daniela

..no idea why some of the above came out smaller than all the rest....

Just fyi - I had to get a similar sort of medical certificate when I wanted to scuba dive in France. I had it done by a Swiss doctor & it was covered by the Swiss insurance with no issues.