Conduct of hospitalization and coverage by the Health Insurance

Verified 13 February 2024 - Directorate for Legal and Administrative Information (Prime Minister)

Would you like to know what the admission formalities are in case of emergency hospitalization and what is the care? There are procedures related to admission and exit formalities. The Health Insurance (Social Security) reimburses you for part of the costs of hospitalization under certain conditions. There are several arrangements for covering your remaining costs. We'll lay out the rules for you.

The hospital stay is subject toa specific page.

You can choose:

  • A public hospital
  • A private clinic contracted
  • Or an unlicensed private clinic

On prescription of your doctor, you may benefit in some cases from a home hospitalization.

Warning  

If you choose an uncontracted private clinic, the remaining costs are higher, because the rates applied are higher than the conventional tariffs.

To help you in the choice of an establishment, you can:

The formalities are not all the same depending on whether you are admitted in an emergency or not.

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General case

If you are scheduled to enter the hospital in advance (for example, you have a specific date for an operation), it is done at the hospital admissions department.

Documents to be submitted

You must submit the following documents:

  • Identity document (examples: ID card, passport...) or family booklet
  • Vital Card (update) and your Letter of Rights
  • Card or certificate of supplementary health or health insurance if you have one
  • Accident at work accident at work If your hospitalization is linked to an occupational disease or illness, the “worksheet or occupational disease” provided by your employer or by your health insurance fund.

Depending on your situation, you will also need proof of entitlements:

If you don't have those documents, you must present in your case:  

  • Last pay slip (if you are an employee)
  • Or last attestation of payment of unemployment benefit if you are a job seeker compensated by France Travail (formerly Pôle emploi)
  • Or as a retirement or disability pension or permanent incapacity pension
  • Or the support issued by your social security body, if you are a national of another country (outside the EU-EEA-Switzerland)

Please note

if you cannot provide any of these documents, your health insurance fund may, under certain conditions, issue an emergency admission certificate to State medical assistance (AME). This procedure will be done at your request or at the initiative of the health institution to which you are admitted.

Information that can be given

Medical information may be helpful:

  • Examination results (examples: analyzes, radios...)
  • Health record book
  • Blood group and Rhesus card
  • Letter from the attending physician

You must also indicate the persons to be kept informed of your state of health (family, trusted person...).

Once your file has been registered, the admissions department will give you a status or hospitalization report. It serves as an advisory opinionwork stoppage.

You must send it within 48 hours who follows your hospitalization at:

  • Your employer if you are an employee
  • France Travail (formerly Pôle emploi) if you are a jobseeker
  • Your health insurance fund

Indeed, this bulletin allows your health insurance fund to calculate and pay you your daily allowances.

Please note

If your health does not allow you to meet this 48-hour deadline, the hospital takes the necessary steps.

Welcome booklet

A welcome booklet is given to all hospitalized persons.

It shall present the information concerning in particular the following points:

  • Establishment (organization, administrative formalities...)
  • Conditions under which complaints and complaints are examined
  • Conditions for visiting and welcoming relatives, rights and obligations of patients, procedures for deposits of money and value...
  • Activities, services and services of the establishment (schedule of social service, provision of a library, space of religious practice...)
  • Volunteer associations involved in the establishment

The charter of the hospitalized person and an exit questionnaire is attached.

Emergency entrance

Documents to be submitted

As soon as your medical condition allows it, you or one of your relatives must submit the necessary documents to the admissions office in particular :

  • Identity document (examples: ID card, passport...)
  • Vital Card
  • And Certificate of Rights

In any case, if you are working, you have to tell (or have told) your employer.

Please note

Access to public hospital services is guaranteed for the most deprived persons. Persons who cannot prove that they are covered by the State’s sickness insurance or medical aid are treated in public health establishments and private health establishments participating in the public hospital service for urgent care.

Welcome booklet

A welcome booklet is given to all hospitalized persons.

It shall present the information concerning in particular the following points:

  • Establishment (organization, administrative formalities...)
  • Conditions under which complaints and complaints are examined
  • Conditions for visiting and welcoming relatives, rights and obligations of patients, procedures for deposits of money and value...
  • Activities, services and services of the establishment (schedule of social service, provision of a library, space of religious practice...)
  • Volunteer associations involved in the establishment

The charter of the hospitalized person and an exit questionnaire is attached.

The hospital will provide you with a release certificate.

To be reimbursed for hospital expenses, you must send this document to your CPAM: titleContent as soon as possible.

Who shall I contact

Please note

The social service of your health insurance fund can meet you at your home to assess your needs and consider with you the adapted aids (domestic, technical, financial, housing adaptation...).

Contact your Pension Insurance and Occupational Health Fund (Carsat).

In a public hospital or a private clinic, the following costs are covered by the Health Insurance:

  • Costs related to your hospitalization at 80% of the conventional tariff (except in special cases)
  • Care taken before or after your hospitalization (such as consultation with an anesthetist). The rate of care varies by care provided

Please note

Your mutual can support 20% which remain as well as certain supplements or overpayments of fees.

Check with your mutual insurance company to see if your contract provides for this.

In some situations, you may benefit from a full coverage by the sickness insurance (except sometimes the hospital package and personal comfort supplements).

Support can also be complete in particular if you are in any of the following situations:

  • You are hospitalized for more than 30 consecutive days (your care at 100% then starts on 31e day)
  • You are hospitalized because of a long-term disorder.
  • You receive a disability pension, a disabled widow's or widower's pension, an old-age pension that replaced your disability pension, or a military pension
  • You're touching the complementary health solidarity or State medical aid
  • For your newborn, if hospitalized within 30 days of birth 
  • You depend on the local regime of Alsace-Moselle

The hospital plan represents your financial contribution to the accommodation and maintenance costs incurred by your hospitalization.

It is therefore not not covered by Health Insurance.

In principle, it is due for each day of hospitalization, including the day of discharge.

The amount is as follows:

  • €20 per day in hospital or clinic
  • €15 per day in the psychiatric ward of a health facility

However, you do not pay the daily fee if you are in any of the following situations:

  • You are hospitalized during the last 4 months of pregnancy, for delivery and 12 days after delivery
  • Your baby is hospitalized within 30 days of birth
  • Accident at work You are hospitalized due to an occupational disease
  • You're in home hospitalization
  • Your disabled child under the age of 20 is accommodated in a special or vocational education institution
  • You're on a military pension
  • You are the victim of an act of terrorism and receive full care for the care related to this event
  • You depend on the local regime of Alsace-Moselle

FYI  

some institutions are not covered by this package (e.g. Ehpad, long-term care units).

If you have a health supplement, on an individual basis or collective through your employerHowever, the remaining costs may be reimbursed in part or in full. Check with your health supplement.

FYI  

If you don't have a health supplement and you don't have enough resources to pay for hospitalization, you can ask:

This may include an extra charge for a private room, telephone, television, etc.

These costs are at your expense.

However, if you have a complementary health, on an individual basis or collective through your employerHowever, these costs may be reimbursed in part or in full. Check with your health supplement.

FYI  

If you don't have a health supplement and you don't have enough resources to pay for hospitalization, you can ask:

You must be informed of such overpayment.

These costs are at your expense.

If you have a health supplement, on an individual basis or collective through your employerHowever, the remaining costs may be reimbursed in part or in full. Check with your health supplement.

FYI  

If you don't have a health supplement and you don't have enough resources to pay for hospitalization, you can ask:

Who can help me?

Find who can answer your questions in your region

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