The concept of “ayant droit
A “ayant droit” is a person attached to a policyholder’s mutual insurance contract: he or she then has the “same rights” as the main policyholder, hence the name “ayant droit”. They are entitled to the same social benefits. The “ayant droit” may be a spouse, cohabitee, PACS partner or child (either of the insured or of the cohabitee, spouse, PACS partner or married person). Lastly, it can also be a parent or grandparent if they live in the same area and under the same roof, and if they devote themselves solely to running the home and/or raising the children. The term “ayant droit” is used by individual health insurers and for health insurance in France.
Minors
Children are accepted by some mutual insurers up to the age of 25 if they are studying, while other mutual insurers allow children up to the age of 18, the age of majority in France.
Note: a distinction is generally made between dependent and autonomous beneficiaries. Dependent beneficiaries are generally children under the age of 16, who do not yet have a carte vitale (in France) and are therefore dependent on the insured person’s carte vitale. Autonomous beneficiaries have their own carte vitale, their own ameli account and their own reimbursements.
Health insurance: what rights do spouses have?
It depends on the country (particularly in terms of visa requirements), and on the insurance company. Let’s take a look at social protection abroad, the CFE (Caisse des Français à l’étranger) and international health insurance.
Social security organizations abroad
As an expatriate or employee abroad, you are no longer covered by the French social security system. You must join the social security system of the country of expatriation. Of course, it all depends on the visa and the country of destination, but in the European Union, for example, it’s relatively straightforward. We recommend that you contact the CLEISS (Centre des liaisons européennes et internationales de sécurité sociale) to find out exactly what the social security situation is in your country, and the possibilities and terms of coverage for you and your dependants. Note: in all EU member countries, you can benefit from social security coverage thanks to an agreement signed with France. In principle, what applies to the insured person also applies to his or her spouse, but check with CLEISS to find out what the situation is in your destination country. Depending on the country, you can also apply to your future employer for social protection and health insurance, for yourself and for any family members (spouse and/or children) following you on this adventure.
Caisse des Français à l’étranger
In addition to local social security coverage, you can join the CFE (Caisse des Français à l’étranger). Membership is optional and subject to a fee. The CFE acts as a mutual insurance company, offering coverage similar to that of the French social security system: it covers medical expenses, maternity, sick leave, disability, death and retirement. Spouses, cohabiting partners and dependent children under the age of 20 are covered by the CFE, whether they live in France or abroad, as long as they are not covered by another compulsory social security scheme.
International private health insurance
When you take out private international health insurance, you can usually include a beneficiary, such as a spouse or children. However, conditions vary from policy to policy, and from company to company. There are several advantages to linking dependants to the same policy. Not only does it simplify the management of coverage, but it also allows each family member to benefit from the same guarantees, or to adapt coverage to suit individual needs. For example, it is possible to customize the contract to include specific benefits for certain members, such as maternity benefits or dental care for children. It is important to note that insurance premiums are often determined according to the age, state of health and country of residence of the beneficiary. What’s more, some companies offer discounts for families, or adapted formulas with flexible payments (monthly, quarterly or annual). Before adding a spouse or child, it is advisable to check the specific conditions of the contract, particularly for pre-existing conditions, which may not be covered immediately or may require a waiting period. Worth
knowing: in terms of pricing, private health insurance can either offer a global rate for the whole family, or a rate per entitled person added to the contract. It may be interesting to know how the payment is made: each person pays separately, or the rate is also paid jointly.
How do I add beneficiaries to a policy?
In France, to add beneficiaries to your insurance contract, you must first declare them to your health insurance fund (several forms are available for this purpose: spouse, children and beneficiaries other than a child). You must then present your social security entitlement certificate to the insurance organization that lists the beneficiaries, in order to declare them to your insurance company. For more information on the best insurance policies abroad, visit our website santexpat.fr. Our team of health experts will find the best deals for you.
