All about this Social Security case

by Charlotte Bedon August 5, 2022
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Get social protectionUse third party payments, get your healthcare costs back (everything you need to know When registering for CPAM) … in France, It is the right of all those who reside in the territory regularly and stably. This insurance covers holder or catcher, that is, a person who meets the eligibility criteria, who unlocks this right and receives benefits. But she can also Extend to other relatives : rights holders.

Before the entry into force of universal health protection in 2016were the rights holders in general husband and children. So it was enough for someone to work or work to be registered with health insurance and to see all his small family members protected. But to avoid too much inconvenience (Confidentiality of costs related to health, administrative procedures, etc.), the Boma system eliminated the status of the beneficiary.

Thus, all the joint heirs received a new status: statusIndividually insured. The only condition? Living in France legally and several months in a row a year! As for children, if the minors are still heirs of their parentsAdults should Request to open their right to CPAM.

Finally, it is necessary to Don’t confuse Social Security recipients with Mutual Insurance recipients. And for good reason, supplemental health insurance continues to offer insurance contract holders their own Possibility to cover their family membersThus turning them… into rights holders!

To find out all about the beneficiary concept, and about the consequences of the puma on spouses and children, just keep reading this article.

Definition of the beneficiary

A rights holder is a person who benefits from another person’s right. This term applies to many areas: social security, mutual insurance, inheritance, etc. In this article, we only focus on social protection. And therefore , Health costs to the beneficiary (Consultations with a doctor, costs related to medical work, treatments and medications, etc.) Payable or redeemed in the name of the insured attached thereto : holder or holder.

So it is important to understand the difference between owner and beneficiary. On one side there Holder: The person who opened the rights and who receives them. On the other hand, there is Beneficiary: Who benefits from the same guarantees by extension from its owner.

Originally, the rights holders were mainly spouse or partner (whether it is related to the bearer by marriage, PACS or not), and children. But Since 2016 and the entry into force of PUMA (Universal Health Protection), The rules have changed.

Social Security Beneficiary: PUMA has overturned the old rules

Until December 31, 2015to be covered by health insurance, You had to be an employee Or worked long enough to qualify. Otherwise, to cover the costs of health care, several solutions were possible:

  • Claim to maintain his previous rights (if the applicant has already worked)
  • Apply for basic CMU (Universal Health Coverage) every year
  • To be a beneficiary of the insured (i.e. the spouse or son of the insured)

The disadvantages of this system were several:

  • Cumbersome and regular administrative procedures
  • Loss of privacy protection
  • Possible violation of rights in the event of a change in professional or family situation

with puma where Comprehensive health protection, everything has changed since then All adults are insured on an individual basis. Therefore, the new insured can:

  • Receive refunds to their own bank account (while previously to the cardholder’s bank account)
  • Receive your payment statement
  • Have your own Ameli account to improve data privacy

Changes in personal circumstances (And divorce in particular) so they do not have No more effect It no longer imposes tedious procedures or loss of Social Security coverage.

Good to know: The concept of beneficiary is still present in some schemes Individuals such as MSA or Alsace-Moselle Schema.

Co-beneficiaries: What has changed?

Prior to Puma, any change in status had an impact on the rights of the beneficiary. Therefore, it was necessary Notify health insurance immediately In order to find out if it will be preserved and if so, for how long. some examples :

  • In the event of divorce with the insured: Beneficiary rights are retained for one year. However, if the beneficiary has or has 3 dependent children, he benefits from these rights ad vitam aeternam.
  • If PACS is terminated with the insured partner: Beneficiary rights are retained for one year. It does not matter the number of dependent children.
  • In the event of the death of the insured: The rights of the legal claimant are preserved for one year or indefinitely if the latter has 3 dependent children (and this, regardless of the ties that unite them – marriage, PACS, cohabitation -).

Anyway, it was necessary Fill out a form and send a file With supporting documents. And when there was an extension of rightsthe ex-husband continued to access all the information related to the health care costs of the beneficiary and received on his own account Refunds Possible… which could be a concern in the event of a conflict!

With the introduction of universal health protection in 2016It’s all over since then Shared beneficiary status no longer exists. Any adult who resides in France on a fixed and regular basis is now insured on an individual basis..

What if I was a co-beneficiary prior to the Puma app? Don’t worry, since 2016, CPAM has been looking for all adult rights holders to make it Switch to the correct mode. Quite simply it was on it Justify their regular and stable presence in the region Through official documents or residence certificate signed by the document holder.

For blogging: To see if you still qualify Your partner or partner is enoughGo to your Ameli space In the “My Information” section. Rights holders are listed there.

Child rights holders: minors or adults, what is the difference?

If the Puma leads to the disappearance of the co-beneficiary, it is a little different for the children. explanations.

For minors with rights

Minors retain their beneficiary status until they reach the age of majority. They can be carelessly attached to their father, their mother, or even both. For this, you must complete CERVA Form No. 14445*02 regarding the enrollment of minors in health insurance.

Good to know: From the age of 16Probably Apply for the title of independent beneficiary In CPAM in your home. A simple letter is enough, and there is no evidence to attach it. This special mode will allow you to reimburse your health costs directly into your bank account (not your parents’ account).

for adults

to the majority, Children can be secured individually : They no longer need to be associated with a companion (their father, their mother). Therefore, qApplying for affiliation as an insured on the basis of residency is essential.

So it is necessary complete Health insurance claim form and theSend to the health insurance fund from your home. Depending on your situation, supporting documents may be required:

  • A copy of a valid ID card or passport
  • Residence certificate from your parents
  • Rental agreement or electricity or gas bills if you no longer live with your parents
  • etc.

Good to know: If you enter higher education after the baccalaureate, you will be secured with CPAM. In fact, Student Social Security Scheme It has been permanently deleted.

The status of the beneficiaries of the synergies

Unlike health insurance, Mutual companies retained the concept of the beneficiary.

Each supplemental health insurance provides a list of people who may be covered by the owner’s contract. most looking spouse or partneras such their children as rights holders. As for the latter, their affiliation often depends on:

  • their status: A student, with an apprenticeship or vocational training contract, looking for a job, etc.
  • their tooth: Some subscribers agree to go to 25 or even 28 if they continue to study in high school.

Finally, some supplemental health insurances offer cardholders the possibility to integrate origins as rights holders.

Good to know: Rights holders can be added affect the amount of your contribution.

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