What Is a CFE Top-Up?

One of the main questions French expats ask is whether or not it is worth joining the Caisse des Français de l'Étranger. Private healthcare systems abroad often incur significant medical costs. Then it is only natural to ask whether you need to take out top-up insurance. Here are a few explanations to help you make your choice.

What are the advantages of joining the Caisse des Français de l'Étranger (CFE)?

The CFE has several advantages:

• It gives you the same cover as French social security (Sécurité sociale) for the whole of your expatriation.

• It does not discriminate against pre-existing conditions. You are therefore covered whatever your medical history.

• When you return to France, you immediately rejoin French social security without any waiting period or exclusion.

• During temporary stays in France of less than 6 months, your healthcare costs are reimbursed just like those of anyone insured under French social security. This can be handy if you want to see your regular doctor during your holidays in France.

Are CFE reimbursements enough for French expats ?

As the CFE reimburses according to French social security prices in France, the answer depends on whether you choose public or private care.

Is the CFE Enough for Public Healthcare abroad?

If you choose to be treated in the public healthcare system of your host country, your out-of-pocket costs will depend entirely on your local residency status and whether you are eligible for subsidized rates. While some countries grant expatriates access to low-cost public care (where CFE reimbursements are usually sufficient), many nations require foreign residents to pay the full, non-subsidized price. In these instances, the CFE's baseline reimbursements may not be enough to cover your medical bills.

Is the CFE Enough for Private Healthcare abroad?

No. If you prefer to be treated in the private sector, or if you live in a country where expats are required to use private international clinics, relying solely on the CFE leaves you exposed to massive financial shortfalls. In premium medical markets across North America, Asia, and the Middle East, routine consultations, specialist visits, and hospitalizations cost exponentially more than the French baseline. Receiving a €18.55 reimbursement for a private consultation that costs upwards of €150 renders the CFE's coverage nearly negligible for day-to-day care.

CFE top-ups

To solve this problem, French insurers came up with products based on the same principle as French mutuelles (complementary health insurance). In short, the CFE works like French social security, and the insurance works like a mutuelle by reimbursing the remaining costs.

The advantages of CFE top-ups

Here are the main advantages of this type of product:

• They are attractively and competitively priced, and annual premium inflation is lower than for other products.

• You get all the CFE advantages mentioned above without the drawback of limits that are too low.

• The top-up insurer or the CFE acts as a single point of contact for claims. You do not need to send your claim to both the CFE and your insurer. Thanks to an agreement between them, your insurer or the CFE handles everything.

The disadvantages of CFE top-ups

Here are the main disadvantages of CFE top-ups:

• The main disadvantage of top-ups is that there is generally no 'cashless' (direct billing) network for routine care. This means that for all your routine healthcare costs (excluding hospitalisation), you will have to pay up front and then make a claim. Reimbursement then takes a little longer than the average among insurers.

• The CFE has waiting periods for new members. This means that during the first 3 or 6 months of your policy, no healthcare costs will be covered. Also this is because the top-up can only start to apply once the CFE cover is fully in effect. To get around this, some insurers offer to enrol you in their "first-euro" product for the duration of the waiting period and then switch you to their "CFE top-up" product once your CFE rights are open.

Did you know? Alea is the advisor for French expats in Hong Kong, Singapore, China, and beyond. As the CFE's exclusive representative for Hong Kong, China, Taiwan and Singapore, Alea has unique expertise in every CFE plan and in the plans French insurers such as Allianz, April, Henner, MSH and Assur-Travel offer alongside the CFE. We work with more than 50 international partners, such as AXA, Bupa and Cigna, to find you the best option!