Moving to Spain, Portugal, Italy or Greece does not necessarily mean cutting ties with France. French expatriates often return to visit family, for work, for holidays… and sometimes for medical care.
This is precisely where an often-overlooked limitation of some local health insurance policies can become apparent.
A policy may be perfectly suited to everyday life in the country of residence, providing quick access to doctors or a network of private clinics, yet offer significantly more limited protection once the insured crosses the border.
What happens if you want to consult your specialist in France? Undergo surgery in Paris or Marseille? Seek a second medical opinion in France following a serious diagnosis? Or if you need to be hospitalised while travelling in another country?
For a French expatriate, the right question is therefore not simply: “Am I properly covered where I live?” It is also: “Where can I actually receive medical treatment, under what conditions, and with what level of reimbursement?”
Local health insurance is primarily designed to meet the needs of residents within a specific country.
In Spain or Portugal, for example, private health insurance can provide efficient access to doctors, specialists and private healthcare facilities within the insurer’s network. For someone who lives in that country throughout the year and has no intention of receiving medical treatment elsewhere, this type of solution may be entirely appropriate.
However, the life of a French expatriate is rarely so geographically confined.
They may wish to keep their doctors in France, have children studying there, divide their time between several countries, or simply prefer to return to France if a serious medical condition is diagnosed.
International health insurance follows a different philosophy: coverage is designed around the insured person’s mobility and a defined geographical area, rather than around a single national healthcare system.
This distinction may seem theoretical—until a serious health issue arises.
The European Health Insurance Card (EHIC) provides important protection for people affiliated with a European public healthcare system when they are temporarily staying in another covered country.
According to the European Commission, it provides access to medically necessary healthcare during a temporary stay in EU countries, as well as Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom, under the rules applicable in the country where the treatment is provided.
However, three important limitations need to be clearly understood.
Firstly, the EHIC covers treatment that becomes medically necessary during a temporary stay. It is not designed for travelling deliberately to another country in order to receive planned medical treatment.
Secondly, it does not cover private healthcare when the provider is outside the relevant public healthcare system.
Thirdly, it does not cover certain costs such as repatriation to the country of residence in the event of a serious illness or accident. The European Commission explicitly states that the EHIC is not an alternative to travel insurance.
In other words, holding an EHIC does not mean having genuinely European-wide health insurance in the sense that many expatriates might assume.
Consider the example of a French citizen who is permanently resident in Spain.
They have satisfactory local health coverage and usually receive medical treatment there. They then develop a serious orthopaedic condition, and after several examinations, surgery is recommended.
They know an excellent surgeon in France and would prefer to have the operation performed there.
Can they simply make an appointment and assume that their treatment will be covered as though they were still insured under the French healthcare system?
Not necessarily.
European regulations do provide mechanisms for accessing planned healthcare in another EU Member State, but these operate according to specific rules.
For certain treatments, prior authorisation may be required. When granted under the European coordination regulations, the insured person may receive an S2 form allowing them to obtain treatment in another country under the conditions provided for by the applicable system.
European Directive 2011/24/EU also allows, under certain conditions, reimbursement for cross-border healthcare. However, reimbursement is not necessarily equal to the amount charged by the doctor or healthcare facility chosen by the patient: the rules and reimbursement rates of the competent healthcare system continue to play a determining role. Some treatments may also be subject to prior authorisation.
This is an essential distinction.
Having the right to receive healthcare in another European country and having an insurance policy that reimburses that treatment according to clearly defined contractual benefits are two different things.
For many French expatriates, the need goes far beyond receiving medical care in an emergency.
A retiree living in Portugal may be perfectly satisfied with Portuguese doctors but still prefer to return to France for major surgery.
A family living in Spain may choose to receive routine care locally while retaining the possibility of consulting certain specialists in France.
A working professional dividing their time between several European countries may need health insurance that genuinely reflects their lifestyle.
In all these situations, the geographical scope of the policy becomes just as important as the reimbursement levels.
At IFO Global, this is one of the first aspects we examine when reviewing an existing health insurance policy: where can the insured person actually receive treatment?
We then assess reimbursement limits, potential deductibles, hospitalisation rules, exclusions, the conditions applying to treatment outside the country of residence and assistance benefits.
A policy offering excellent reimbursement levels on paper may ultimately be poorly suited to the insured person if those benefits do not apply where they actually want to receive treatment.
This is precisely one of the reasons why Santé Libre EUGEN was developed: an international health insurance solution designed for French expatriates living within the European Union, in partnership with Swiss Life.
Its principle is particularly straightforward: allowing insured members to benefit from coverage both in their country of residence and in France.
For a French citizen living in Spain, Portugal, Italy or another eligible EU country, this dual coverage addresses a very practical reality: choosing to live abroad does not necessarily mean giving up the option of receiving medical treatment in France.
Santé Libre EUGEN also operates as first-euro international health insurance. This means there is no need to wait for prior reimbursement from the French Social Security system or the CFE before making a claim: the insurer reimburses eligible healthcare expenses directly, in accordance with the benefits and limits set out in the policy.
Coverage is not strictly limited to France and the insured person’s country of residence either: stays of less than 30 days elsewhere in the world are also covered under the conditions provided for by the policy.
This structure is particularly well suited to younger expatriates, families and retirees whose lives remain naturally divided between France and their new country of residence.
The role of an international insurance broker is precisely not to assume that one policy is suitable for everyone.
Age, family composition, country of residence, medical history, required geographical coverage and the decision whether or not to retain CFE membership may all make another solution more appropriate.
IFO Global therefore also works with other international health insurance providers, including APRIL International.
APRIL offers international health insurance solutions that can, depending on the policy and the insured person’s profile, operate from the first euro or as supplementary coverage alongside the CFE.
This alternative can be particularly relevant for expatriates who wish to maintain their CFE membership.
IFO Global’s approach is therefore to begin with the insured person’s actual needs before selecting a policy: where do you live, where do you travel and, most importantly, where do you want to be able to receive medical treatment?
The monthly premium should never be the only criterion when comparing health insurance policies.
Before purchasing or renewing local health insurance, a French expatriate should check at least the following:
These questions are especially important because expressions such as “European coverage”, “coverage abroad” or “international assistance” can refer to very different contractual arrangements.
The actual policy terms and conditions therefore need to be examined rather than relying solely on the product’s marketing description.
Local health insurance can be an excellent solution. The purpose is not to systematically oppose local insurance and international health insurance.
The real question is whether the policy matches your lifestyle.
For someone who lives exclusively in their country of expatriation, is satisfied with the local healthcare system and has no intention of receiving planned medical treatment in France, a good local insurance policy may be entirely appropriate.
However, if France remains part of your healthcare journey, if you travel regularly, or if you want to retain the freedom to choose the country in which you receive treatment in the event of a serious medical issue, the international dimension of your health insurance becomes a major consideration.
And this is a question that should be addressed before an illness or hospitalisation occurs—not when finding a solution suddenly becomes urgent.
Living abroad in Europe has never been easier. You can live in Portugal, work with a French company, spend several weeks each year in France and travel regularly throughout Europe.
Your health protection should reflect that reality.
European regulations provide valuable rights, and the EHIC is an essential tool during temporary stays. However, these mechanisms do not necessarily replace international health insurance when you want genuine freedom in organising where and how you receive medical treatment.
This is precisely where IFO Global adds value: we analyse not only the benefits displayed in a policy schedule, but also its geographical scope, reimbursement conditions, hospitalisation procedures and overall suitability for each insured person’s actual mobility.
For some French expatriates in Europe, Santé Libre EUGEN will provide the appropriate solution through its combined coverage in France and the country of residence. For other profiles, an APRIL International solution, potentially combined with the CFE, may be more suitable.
The essential point is not to discover the limitations of your health insurance on the day you actually need it.
If you live in Spain, Portugal, Italy, Greece or elsewhere in the European Union and would like to know whether your current health insurance genuinely protects you in France and during your travels, IFO Global can review your situation and help you identify a solution suited to your country of residence, family circumstances, healthcare habits and budget.
