In short. One clarification first, because the confusion is a common one: not having a carte Vitale is not the same thing as having no entitlement. If you are affiliated to the French system but your card is lost, out of date or not yet issued, an attestation de droits (a certificate of entitlement) is enough and you remain an ordinary insured patient; this page is addressed to those whose rights are not open. Having no French health cover does not stop you from being operated on. What it changes, and by how much, depends entirely on the procedure: for refractive surgery (LASIK, PRK, SMILE, ICL phakic implant), your status changes nothing at all, because these operations are reimbursed for no one in France. For cataract surgery it changes a great deal, because that operation is normally covered by l’Assurance Maladie, the French statutory health insurance scheme.
What changes, and what does not
| Procedure | Reimbursed for an insured patient? | With no French cover |
|---|---|---|
| LASIK, PRK, SMILE | No, never | No difference: same package price, and a complementary insurer can be used in exactly the same way |
| ICL phakic implant | No, never | No difference: identical quote, and a complementary insurer can be used in exactly the same way |
| Cataract | Yes | The Assurance Maladie share disappears: substantially higher cost |
| Ophthalmology consultation | Partly | Payable in full |
| Refractive pre-operative work-up | No, never | No difference: it is included in the package |
Refractive surgery: your status does not change the price
L’Assurance Maladie does not reimburse refractive surgery, whatever the sight defect corrected and whoever the patient is: it considers that the operation replaces glasses or contact lenses. A patient who has been in the French system for thirty years and a patient with no cover at all therefore pay exactly the same. The full price list is set out on the page devoted to refractive surgery prices.
| Technique | Price | What it covers |
|---|---|---|
| PRK | €2,500, both eyes | Package: procedure and first month |
| LASIK | €3,000, both eyes | Package: procedure and first month |
| SMILE | €3,300, both eyes | Package: procedure and first month |
| ICL EVO phakic implant | Individual quote | Surgeon’s fees €1,200 per eye, Clinique Sainte-Geneviève facility fee €650 plus €48 (both eyes), implant €790 to €1,250 per eye, anaesthetist’s fees in addition |
Two consequences follow, and both are widely misunderstood:
- The AME cannot pay for refractive surgery. The Aide médicale de l’État (AME), France’s state medical aid scheme, covers care “within the limits of Sécurité sociale tariffs”. These procedures have no agreed tariff, so there is nothing to reimburse.
- A European S2 form does not apply either. Authorisation is granted only where the treatment is among the benefits provided for by the legislation of your country of residence, which is not the case for a procedure that is not therapeutic.
Your complementary health insurer, on the other hand, can contribute, exactly as it would for an insured patient. This follows directly from the point above: since l’Assurance Maladie reimburses nothing to anyone for these procedures, the insurers that do cover them pay a fixed allowance expressed in euros, not a percentage of a reimbursement base. That allowance, of the order of €200 to €1,000 depending on the contract, therefore does not depend on your being affiliated to the Sécurité sociale. Three routes can be approached: a French mutuelle (complementary health insurer) that you already hold, through an employer, a spouse or an earlier policy, since taking one out generally assumes that you are attached to a statutory scheme; a foreign health insurer; or an international “first-euro” policy, a type of cover designed for people outside the French system. The itemised devis (written quote) you receive after your work-up is the document to send them; ask for their agreement in writing before a surgery date is fixed.
Cataract: this is where the absence of cover really counts
Cataract surgery breaks down into three items, two of which are normally covered. Without open rights, it is precisely those two that fall to you. These three items, with the implant price grid, are detailed on the cataract surgery prices page.
- The surgical package and the clinic’s charges (operating theatre, day-case stay, anaesthesia): covered for an insured patient, payable in full without open rights. The amount is set by the facility, not by the surgeon.
- The intraocular lens: the standard monofocal lens is listed on the LPPR (the national list of reimbursable medical devices) and is covered on that basis. So-called premium lenses (multifocal, EDOF, toric) are excluded from that list and remain payable by you, whether or not you have open rights. Without open rights, the monofocal reimbursement base disappears in its turn.
- The surgeon’s fees: these are set out in a devis, given to you before the operation.
Without open rights, you are given two separate quotes, which is particular to this situation. The clinic issues the quote for the day-case package and the anaesthesia, the items that are no longer covered; Dr Tourabaly gives you, separately, the quote for his surgical fees. The two documents come from two different entities and are both given to you before the operation.
On top of this come the clinic’s own admission requirements, which are a matter for the facility and not for the practice. No surgery date can be held before the clinic has given its agreement.
Your situation determines your entitlement
You live in France with a residence permit
You probably come under the Protection universelle maladie (PUMa), France’s universal health cover, which requires stable and lawful residence. If you work in France, affiliation is open with no qualifying length of residence. Otherwise you have to show three months’ residence in France. That is a condition of length of residence, not a waiting period in the sense used in private insurance contracts; the stability of your residence is a separate criterion, assessed over more than six months a year. In that case, the most useful step before any surgery is to open your rights with your caisse, the local branch of the health insurance fund: you then become an ordinary patient, with the cover that goes with it.
You live in France without a valid residence permit
The Aide médicale de l’État (AME) is intended for people who have been living in France for more than three months without a residence permit valid for more than three months, subject to a means test: €10,421 a year for a single person in mainland France, plus €4,169 per additional person in the household. It covers medical and hospital care in full within the limits of Sécurité sociale tariffs, is granted for one year, and the fund has two months in which to reply; if it has said nothing by the end of that period, the application is deemed to have been refused. It can therefore apply to a cataract, which is a therapeutic procedure, but never to refractive surgery. One important reservation, however: certain planned procedures of a non-urgent nature, cataract surgery among them, are only covered after nine months’ standing in the scheme, or sooner with the prior agreement of the fund’s medical service where the absence of treatment would have serious consequences. As these amounts and rules are revised every year, check the scale currently in force with your caisse.
You are insured in the European Union, the EEA or Switzerland
The European Health Insurance Card (EHIC, carte européenne d’assurance maladie or CEAM in French) covers treatment that becomes medically necessary during a stay; it does not cover a stay made for medical reasons. Coming to France in order to be operated on is exactly that, so the card does not apply. For planned treatment you need prior authorisation: the S2 form, which replaced the former E112. You apply for it to your own health insurance institution in your country of residence, never to the CLEISS, which provides information but processes no application. The time allowed for a reply is set by the rules of the country issuing the authorisation, not by any uniform European rule: ask your own fund, and file the application well ahead of the date you have in mind. Authorisation assumes that the treatment is among the benefits provided by your own country and that it cannot be given there within a medically acceptable time. Where an S2 is granted, you are treated in France on the same footing as a French insured patient, which in practice concerns a cataract and not refractive surgery.
You are not insured anywhere
The operation is then payable by you in full, and the quote is given to you before anything is scheduled. Private insurance remains possible: international “first-euro” policies reimburse without requiring affiliation to the Sécurité sociale, and they cover cataract surgery where it is medically indicated. Two limits are worth knowing. These contracts generally apply a waiting period and exclude conditions that pre-date the policy, so taking out cover after the diagnosis is rarely of any use; and travel insurance almost always excludes planned procedures.
How it works in practice
- An itemised quote is given to you after the pre-operative work-up, with no commitment on your part. For a cataract without open rights, this means two documents: the quote for Dr Tourabaly’s surgical fees, and the clinic’s quote covering the day-case package and the anaesthesia.
- A receipted invoice is issued to you after the operation: this is the document to send to a complementary insurer, French or foreign.
- Opening your rights remains the step that pays off most where your situation allows it. An appointment at your local caisse before the operation can change the amount payable on a cataract entirely.
The invoice: the document your reimbursement depends on
This is the point that is most often discovered too late. When you pay for the operation yourself, it is not the quote but the facture acquittée, the receipted invoice, that allows you to be reimbursed, and an insurer, particularly a foreign one, will turn down an incomplete document. Here is what the invoice you are given contains, and what each item is there for.
| Item shown | Why it is required |
|---|---|
| Practitioner’s name and RPPS number (the registration number of every doctor practising in France) | Establishes that the procedure was carried out by a doctor registered with the Ordre des médecins, the French medical council |
| Patient’s name and date of birth | Must match your insurance policy exactly, including the spelling used on your passport |
| Date of the operation | Shows that it falls within the period of cover, after any waiting period |
| Description of the procedure, and its CCAM code where one exists (CCAM is the French classification of medical procedures) | Allows the insurer to identify the procedure. Refractive surgery is outside the classification and has no code: the description alone is the reference |
| Amount, currency and method of payment | The basis on which reimbursement is calculated |
| The word “acquittée” (paid in full) and the date of payment | Proves that the sum was actually paid, which is a condition of reimbursement |
Two practical points. First, each entity invoices what concerns it: for a cataract you will receive the invoice for the surgical fees and, separately, the clinic’s invoice, just as with the quotes. Send both to your insurer, failing which it will reimburse only part of what you have paid. Second, keep the originals: many foreign organisations ask for them and do not return documents. If your insurer requires a translation, the cost is yours; plan for it rather than discovering it when you file the claim.
Frequently asked questions
Can I be operated on if I have no carte Vitale?
Yes. Not being covered by the French health system is neither a medical nor an administrative obstacle to surgery. It determines only who pays, and how much.
Is the price different if I have no French health cover?
No. Fees and package prices are the same for every patient. What changes is not the price asked, but the share reimbursed, which is nil where no rights are open.
Can the AME pay for a LASIK?
No. The AME reimburses within the limits of Sécurité sociale tariffs, and refractive surgery has no agreed tariff. It can, on the other hand, apply to cataract surgery, which is a therapeutic procedure.
I am insured in another EU country: does my European Health Insurance Card cover the operation?
Not for planned surgery. The EHIC, or CEAM in French, covers care that becomes medically necessary in the course of a stay. For planned treatment you need an S2 form issued by the institution you are insured with in your country of residence.
Will my foreign insurer accept a French invoice?
It must show the practitioner’s name and RPPS number, your own identity, the date and description of the procedure, the amount paid and the word “acquittée”. For a cataract you are given two invoices, the surgeon’s and the clinic’s: send both. Keep the originals, and allow for a translation if your policy requires one.
Who draws up the quote if I have no French health cover?
For a cataract, you are given two quotes. Dr Tourabaly draws up the one for his surgical fees. The clinic draws up the one for the day-case package and the anaesthesia, items that are no longer covered in the absence of open rights. These are two independent documents, issued by two separate entities.
Can my complementary insurer contribute if I am not in the French system?
Yes for refractive surgery, and on the same terms as for an insured patient: since these procedures are reimbursed by no one, the insurers that cover them do so through a fixed allowance in euros, independent of any Sécurité sociale base. For a cataract, however, benefits calculated as a percentage of the Sécurité sociale base will not be triggered if your rights are not open. Send the quote to your insurer and ask for its agreement in writing.
Can private insurance cover the operation?
Yes. A French mutuelle, a foreign insurer or an international “first-euro” policy, a type of cover designed for people outside the French system, can all contribute. One reservation for cataract: these contracts generally provide for a waiting period and exclude conditions already diagnosed when the policy was taken out. Subscribing after the diagnosis is therefore rarely of any use.
Cachan practice · Tel. +33 1 45 47 08 11
Paris 13 practice · Tel. +33 1 89 31 30 60
Sources
- Service-Public: Aide médicale de l’État (AME) (French-language page)
- Service-Public: Protection universelle maladie (PUMa) (French-language page)
- CLEISS: Formulaire S2, droit aux soins programmés (French-language page)