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HEALTH

What’s a ‘feuille de soins’ in French healthcare and what do you do with it?

If you do not have a carte vitale in France or the medical professional is not automatically linked up to the social security system, you can still qualify for reimbursement. Here is how a 'feuille de soins' works.

What's a 'feuille de soins' in French healthcare and what do you do with it?
You can access healthcare in France without a carte vitale. AFP PHOTO / FRED TANNEAU (Photo by Fred TANNEAU / AFP)

The carte vitale (French healthcare card) is a vital part of everyday life in France. It helps smooth the business of healthcare by making the whole payment-reimbursement process straightforward and painless.

Foreign residents of France who have been legally resident in the country for more than three months can be eligible for a carte vitale, but requesting one can be time consuming.

READ ALSO How to get a carte vitale in France and why you need one

While you wait for your carte vitale after having applied, you are still entitled to reimbursements. Enter the feuille de soins (care sheet) – a useful surviving relic of the days before computers.

Technically, one of these is completed every time anyone in France goes for a health appointment – but, for most people, the whole process is taken care of electronically thanks to the wonders of 21st-century technology and their plastic carte vitale.

When would you get an old paper feuille de soins?

If – for whatever reason – you don’t have your carte vitale or cannot use it (perhaps because technology has temporarily failed), then you can pay upfront and ask the doctor or pharmacist for a feuille de soins.

Feuilles de soins are also given by medical professionals to visitors to France using Ehic or Ghic cards, who need to apply for reimbursement later. 

And some medical professionals use feuilles de soins rather than the standard carte vitale system. So, if you receive treatment from them, you will be given one of these documents. 

It is, for all intents and purposes, a receipt confirming you have received certain medical care at a certain price.

What do you do with a feuille de soins?

Complete the document. You will need to fill in your first and last name, your social security number (if you have one), as well as your birth date.

The healthcare professional will have already completed the first part with:

  • Their professional number, known as the Adéli number;
  • The nature of the procedure and the date performed;
  • The amount of the service and validation of payment by the patient (known as an acquittée invoice);
  • The healthcare professional’s signature.

Don’t forget to sign it. Even if the treatment form is pre-filled, it’s a good idea to check the information is accurate before signing. If the patient is a minor, their legal guardians are responsible for this section.

Then you send it to the social security organisation to which you are attached.

For most people in France, this is the general Health Insurance scheme – certain professions, such as farmers, have a different set-up.

Meanwhile, the majority of people should send the paper feuille de soins to their primary health insurance fund (CPAM) either by prepaid post or by dropping it off at one of the nearest office. To find out the address of your primary health insurance fund, consult the Ameli website.

READ ALSO Carte vitale: What your French health insurance card entitles you to

Do I have to do this every time?

No. You may amass a number of feuilles de soin if you are in need of regular health visits, or if you visited a medical professional while waiting for your carte vitale to arrive. The good news is that they are valid for up to two years, so you don’t need to buy many extra stamps, or make repeated trips to your nearest CPAM office.

Be aware that it may take up to three weeks for any reimbursement to be paid this way, compared to the seven days or so it takes via the modern, automated carte vitale system. 

How much will I be reimbursed?

This depends on the sector of the doctor you visited, as well as whether or not they are a specialist. 

READ MORE: ‘Conventionné’: Why you should find out what ‘sector’ your French doctor is

Appointments with Sector 1 physicians are reimbursed at the standard rate of 70 percent by French social security. If you have a mutuelle (top-off private health coverage), then your plan may cover the remaining fees. 

While appointments with Sector 2 doctors are also reimbursed at the same 70 percent rate as Sector 1 practitioners, the reimbursement does not take into account any extra fees (dépassement honoraires) added on. 

On top of the reimbursement from Assurance Maladie, you will receive an additional reimbursement if you have top-off health insurance (a mutuelle).

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SCHOOLS

Are packed lunches really banned in French schools?

School children in France are entitled to a lunchtime meal of three, or even four courses – but what if you prefer to provide meals yourself? 

Are packed lunches really banned in French schools?

French school meals are, famously, pretty good – children get a three or even four-course meal of properly prepared dishes and the menu (including cheese course) is usually published in the local town newsletter so everyone can see the types of meals being served.

The concept of a proper meal at lunchtime is an important one. “The diet of a school-age child is essential for their growth, mental development and learning abilities,” the French Education Ministry says in a preamble about school meals on its website. “It must be balanced, varied and distributed throughout the day: for example 20 percent of total energy in the morning, 40 percent at midday, 10 percent at four o’clock and 30 percent in the evening.”

And it’s not all about nutrition, the social aspect of sitting together and eating a meal is also important – the ministry continues: “Mealtime is an opportunity for students to relax and communicate. It should also be a time for discovery and enjoyment.”

All schools provide meals in a canteen and most pupils take up the opportunity – however it’s also possible for pupils to go home at lunchtime so that they can eat lunch with their parents.

The idea of taking in a packed lunch (panier-repas) is much less common in France – but is it actually banned?

The rules on lunch

At écoles (up to age 11), the local authority or établissement public de coopération intercommunale (EPCI) is responsible for providing quality school meals. This generally involves meals being provided via a central kitchen, and then delivered to the school’s kitchen, where it can be kept warm, or reheated as necessary.

The system is slightly different in collèges and lycées (attended by children aged 11 and up). In those establishments, catering falls into the purview of the wider département or region – and is routinely managed directly by individual establishments, which will have catering staff on site to prepare meals. Often, meal services are outsourced to private businesses, which operate the kitchens.

There are various rules and regulations in place regarding what food is offered, and how long a child has to eat – which is, in part, why the school lunch period is so long. Children must be allowed a 30-minute period to eat their meal, from the moment they sit down with it at the table. 

Then, they’re given time to play and relax before afternoon classes start.

READ ALSO What you need to know if your child is starting school in France

At a minimum lunch must include a main course with a side dish, a dairy-based product, as well as a starter and/or a dessert. Meals must also, the government says, be composed of 50 percent sustainable quality products (including 20 percent organic).

Some local authorities go further and serve only or mostly food that is organic, locally sourced or both.

Water and bread must be freely available, but salt and condiments can only be added in preparation – no sauce bottles or salt and pepper on the tables. 

Daily menus are generally available to view on school websites and many town newspapers or newsletters also publish them.

Parents pay a fee for the school lunch, which is calculated according to income and can be free in the case of low-income families.

Packed lunch

But what if your child doesn’t like the school lunches and you don’t have time to pick them up, cook a full lunch and take them back in the afternoon everyday? The obvious solution would seem to be to send them in with a packed lunch, as is common in the UK and USA.

In theory this is possible, but only in certain circumstances and with very strict rules and caveats. 

The Ministry, in a written response to a Senator’s question in 2019, said: “The use of packed lunches [home-supplied meals] by primary school students can provide an alternative to school meals. This method of catering is authorised in particular for children with a medically established food allergy or intolerance, requiring an adapted diet.”

READ ALSO How to enrol a non-French speaking child in school in France

It added: “the preparation and use of packed lunches in schools must follow certain rules. First of all, it is important to respect the cold chain”.

The cold chain is a term applied to food handling and distribution – it’s usually used by food-preparation businesses, but in the context of a packed lunch it means that food prepared at home must be kept in appropriately cool conditions until it is ready to eat. It would be the responsibility of parents to ensure that the food is delivered to school in containers appropriate for the job (ie an insulated cool bag).

Once at the school, it is up to whoever manages the kitchen to ensure that food is properly reheated. This becomes the sticking point at which many parents’ requests to send their children to school with a packed lunch, rather than go to the canteen, or eat back at home, are refused.

The reheating concern suggests that schools are also expecting parents to prepare a proper meal – rather than just throwing some sandwiches and a cereal bar into a bag.

Unless there’s a genuine and proven health reason for your child to eat a home-prepared meal, most parents will probably find the school won’t budge on this – even in cases of a strike by kitchen staff or lunch monitors.

READ ALSO Just how much do private schools in France cost?

The Ministry’s written response explains: “[A]s this is an optional public service, the municipality can justify its refusal to admit the children concerned by objective material and financial constraints, such as the need to equip itself with additional refrigerators, or for additional supervisory staff to supervise them during lunch.”

As well as the practicalities, for some schools this is an equality issue – because of the varied fee structure for school lunches what happens in effect is that richer parents are subsidising a good quality lunchtime meal for poorer students in the class; if everyone brought in a packed lunch and therefore stopped paying the fee, the lower-income kids would miss out. 

What about allergies or other health issues?

Children with allergies or other health issues that require a particular diet must be accommodated. An individual meal plan – known as a projet d’accueil individualisé (PAI) can be set up. More details (in French) are available here, on the government’s website.

It also becomes easier for parents to provide home-produced meals in such instances. As ever, it is up to the parents to ensure any meals are appropriately packaged and transported to school.

Not all schools

Some individual schools in France do permit pupils to bring in meals from home. They must be taken to school in an appropriate cold-storage container, and they will be stored in the kitchen area until they are needed, when meals will – if necessary – be reheated.

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