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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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HEALTH

How serious is the threat from dengue fever in France?

As tiger mosquitoes are now present in over 80 percent of mainland France, health authorities are worried that local transmission of tropical diseases, like dengue fever, will increase.

How serious is the threat from dengue fever in France?

As of January 2024, tiger mosquitoes – known for their ability to carry diseases such as dengue, chikungunya and Zika virus – had been detected in 78 of France’s 96 mainland départements, including the Paris region.

This has left public health authorities concerned about the spread of dengue fever in France, particularly this summer as large crowds are expected amid the Olympic Games.

READ MORE: MAP: Tiger mosquitoes reach northern France

How common is dengue fever in France?

In the first four months of 2024, 1,679 cases of dengue fever were identified in mainland France, a number that is 13 times higher than the same period last year, Le Parisien reported.

Crucially, however, none of these are believed to have been contracted in mainland France – they were all reported among patients who had recently travelled from the tropical regions where dengue fever is common.

The majority of cases were from people who had visited the Caribbean islands of Martinique and Guadeloupe – where the disease is endemic.

These islands are for administrative purposes part of France – so often show up in French health data – but they are roughly 7,000km away from Paris.

So far, there have not been any indigenous cases (autochtone – or people infected on mainland French soil) yet this year.

Local transmission of the disease remains relatively rare. In 2023, nine separate outbreaks of indigenous dengue transmission were identified, one of which occurred in the Paris region. These led to 45 cases of local transmission (in mainland France).

Most were in southern France – in the Provence-Alpes-Côte d’Azur, Occitanie and Auvergne-Rhône-Alpes regions – though one outbreak occurred in the Paris region, according to French public health authorities.

This is less than 2022, which was a notable year with 66 total cases of indigenous dengue fever were recorded. In comparison, between 2010 and 2021, only 48 cases (total) were recorded.

What to expect for 2024

Experts believe that the number of cases in France, including indigenous ones, will grow this year, as tiger mosquitoes now occupy more territory in mainland France.

On top of that, the number of cases has increased significantly in Martinique and Guadeloupe.

“What we see in France is a mirror image of what is happening in the French Caribbean, and more widely in Latin America and the rest of the Caribbean, where dengue fever has been circulating since the start of the year at unprecedented levels”, the head of Santé Publique France, Dr Caroline Semaille, said during a press conference.

The Olympic Games will also bring an influx of tourists from all over the world, and weather conditions are expected to be conducive to mosquitoes – a year with a lot of rainfall, and potentially high temperatures. 

What is dengue fever?

The disease is spread to people from bites by infected mosquitoes.

The most common symptoms are high fever, chills, abdominal, joint and muscle pains, and vomiting. It can also cause a skin rash that resembles measles, according to France’s Institut Pasteur.

Symptoms usually begin three to 14 days (with an average of four to seven) after being bitten.

However people are asymptomatic in 50 to 90 percent of cases (depending on the epidemic), which can make monitoring difficult.

At-risk groups include the immunocompromised, children and the elderly, who are more likely to suffer from severe forms of the disease.

Deaths from the disease are very rare, occurring in around 0.01 percent of all cases, almost all in countries that have poor healthcare systems.

How can I avoid tiger mosquitoes?

Female tiger mosquitoes lay their eggs in water, and they can lay several hundred eggs at once. Therefore try to avoid having any standing water outside your home and be aware of the items that might collect rainwater.

This includes regularly emptying vases, flower pots, as well as watering cans and pots. If you want to collect rainwater, you could cover water butts with mosquito nets or fabric to keep the mosquitoes from getting inside.

READ ALSO 5 plants that (allegedly) repel mosquitoes

You can also keep your gutters clean – this helps to keep the water flowing when it rains, and it avoids any stagnant pools from building up.

To protect yourself, try to wear long, loose and light-coloured clothing, in addition to insect repellent. You might also consider wearing a mosquito net head gear.

The main difference between tiger mosquitoes and other species would be getting a bite during the day, and the fact that tiger mosquitoes are likely to bite several times. You can tell for sure if it was a tiger mosquito by seeing the insect itself. They are also silent.

There is no immediate cause for alarm if you are bitten, in almost all cases the bites are just itchy and annoying. In very rare cases, tropical diseases can be spread by the mosquitoes – seek medical help if you develop a high fever and rash.

READ MORE: How to prevent the spread of tiger mosquitoes in France

What do tiger mosquitoes look like?

They are very small, about 5 mm, and they have a highly contrasting colour, with black and white stripes on their body and legs.

If you believe you have spotted a tiger mosquito, you can report it to public health authorities online.

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