You are halfway through a holiday in France. A fall on a coastal path, a sudden abdominal pain at night, a child with a high fever that will not come down. You end up in a French emergency department, and at the admissions desk (bureau des entrées) someone asks for your carte européenne d’assurance maladie or, since Brexit, your UK Global Health Insurance Card, and then asks you to pay. Many British visitors assume the card means treatment works exactly like the NHS. It does not. France treats you under French tariffs, asks you in most cases to pay first and claim back afterwards, and leaves several flat-rate charges on you in every case. This guide explains, step by step, what your GHIC actually buys you in a French surgery, pharmacy or hospital, what part of the bill stays with you, how to file the reimbursement claim with the right caisse primaire d’assurance maladie (CPAM, the local health insurance fund), what to do when you travel to France specifically for treatment, and how to challenge a refusal.

I. Unplanned treatment during your stay: the GHIC, the upfront bill and the CPAM claim

A. Showing your GHIC, paying first and claiming back from the local CPAM

The legal starting point is simple and comes from European coordination law, which continues to apply to British visitors through the social security protocol of the EU-UK Trade and Cooperation Agreement. Article 19 of Regulation (EC) No 883/2004 provides that an insured person staying temporarily in another Member State may receive the benefits in kind that prove medically necessary during the stay, taking into account the nature of the benefits and the expected length of the stay. The French Cour de cassation has repeated this formula word for word: « une personne assurée peut bénéficier des prestations en nature qui s’avèrent nécessaires du point de vue médical au cours du séjour, compte tenu de la nature des prestations et de la durée prévue du séjour » (Cass. civ. 2e, 24 January 2019, No 17-19.936, ECLI:FR:CCASS:2019:C200112). The same decision adds the second half of the mechanism: the care is provided by the institution of the place of stay, under the legislation it applies, « comme si les personnes concernées étaient assurées en vertu de cette législation », as if you were insured under French legislation. In concrete terms, a British visitor with a GHIC is treated like a French insured patient: same tariffs, same reimbursement rates, same leftover charges.

French domestic law mirrors this rule in Article R.160-1 of the Social Security Code (Code de la sécurité sociale): « Les soins dispensés aux personnes bénéficiaires de la prise en charge des frais de santé au titre des articles L. 160-1 et L. 160-2 et aux personnes qui leur sont rattachées au sens des règlements européens qui s’avèrent médicalement nécessaires au cours d’un séjour temporaire dans un autre Etat membre de l’Union européenne ou partie à l’accord sur l’Espace économique européen ou en Suisse font l’objet, en cas d’avance de frais, d’un remboursement par les caisses d’assurance maladie dans les conditions prévues dans l’Etat de séjour » (Article R.160-1). Read carefully, this article already tells you the whole procedure: where you have paid upfront (avance de frais), the fund reimburses you under the conditions of the state where the treatment was given. The Rouen Court of Appeal applied exactly this logic in a recent dispute about a hip operation performed during a temporary stay in Romania, holding that the hip-operation costs counted as medically necessary care received during a temporary stay in another Member State within the meaning of Article R.160-1, and recalling that a European Health Insurance Card evidences the holder’s cover and opens reimbursement under the rules of the country where the treatment was given (CA Rouen, social chamber, 19 June 2026, RG 25/01752). The card proves your entitlement; the country where you are treated sets the tariff.

In practice, the French liaison body Cleiss (the Centre des liaisons européennes et internationales de sécurité sociale) runs a dedicated English-language page for visitors from the United Kingdom: by presenting your GHIC to a French healthcare provider you are covered under the same conditions as members of the French scheme (Cleiss, health cover on holiday from the United Kingdom). Three practical points follow. First, always carry the physical card and show it at every step: surgery, pharmacy, hospital admissions desk, together with an identity document. Second, if the card is forgotten, lost or stolen, ask the NHS Business Services Authority for a Provisional Replacement Certificate (PRC), which works the same way for a shorter validity period; a GHIC applied for through the NHS before departure remains the simplest option. Third, and most important for your budget, you will generally have to pay first and claim back afterwards. The doctor gives you a feuille de soins (the brown or green treatment form), the hospital gives you a bulletin de sortie (discharge statement), and you send those papers, with your prescriptions and a copy of your GHIC, to the CPAM of the place where you received the treatment (la caisse du lieu des soins), stating your permanent address and your bank details with IBAN and BIC or SWIFT code. Keep a copy of everything you send. If you never filed the claim while in France, the fallback is to send the invoices to the NHS on your return, through the NHS Business Services Authority route for claiming refunds of treatment costs.

The scope of what the French scheme covers is set by Article L.160-8 of the Social Security Code, which lists « La couverture des frais de médecine générale et spéciale », dental care, pharmacy, laboratory tests, hospitalisation and surgical procedures, transport and related items (Article L.160-8). So a GP consultation, a prescription, an X-ray, an ambulance ride ordered by a doctor and a hospital stay all fall in principle within the cover. But couverture never means the whole bill, which brings us to the part visitors consistently underestimate: the lawful remainder.

Two evidentiary precautions decide many disputes before they start. Ask the surgery or hospital for an itemised, dated invoice showing the tariff applied and whether the practitioner works in secteur 1 (regulated tariff, tarif opposable) or secteur 2 (regulated tariff with authorised extra billing, dépassement d’honoraires). Keep the prescription even for medicines you paid for in full, because reimbursement of pharmacy items depends on the product being prescribed and listed for reimbursement. And if you attended a hospital emergency department without being admitted, keep the specific emergency statement: since 2021 the old flat charge has been replaced by the forfait patient urgences (FPU, the emergency patient flat rate), currently 23 euros, described below. These papers are what the CPAM and, if needed, the judge will read. The Cour de cassation quashed an appeal decision precisely because the judges had ordered full reimbursement without stating the reimbursement terms laid down by the applicable legislation for the disputed treatment (Cass. civ. 2e, 24 January 2019, No 17-19.936, cited above). Tariffs and modalities are not background detail; they are the whole case.

B. What stays on you: tariffs, the patient’s share and the flat-rate charges

French health cover works by reimbursement against regulated tariffs, not by payment of whatever the provider charged. Article L.160-13 of the Social Security Code states the principle: « La participation de l’assuré aux tarifs servant de base au calcul des prestations prévues aux 1°, 2°, 5° bis, 6°, 8°, 11° et 12° de l’article L. 160-8 et aux 2° et 3° de l’article L. 160-9-1 peut être proportionnelle auxdits tarifs ou être fixée à une somme forfaitaire. » (Article L.160-13). The patient’s share left after reimbursement is called the ticket modérateur. For a standard GP consultation at the regulated tariff of 30 euros, the fund reimburses 70 percent minus a 2-euro flat contribution (participation forfaitaire), leaving 19 euros reimbursed and 11 euros on you; children under 18 and pregnant women from the sixth month are exempt from the 2-euro deduction. The same 2-euro deduction applies to consultations with specialists, X-rays and laboratory tests. Medicines prescribed by a doctor and listed for reimbursement are reimbursed at 15, 30, 65 or 100 percent depending on their assessed therapeutic value, with a 1-euro franchise médicale (medical excess) deducted per box. Dental treatment reimbursed by the scheme is covered at 60 percent of the regulated tariff, with no cover for any amount above the tariff. Paramedical procedures such as nursing care must have been prescribed by a doctor and are reimbursed at 60 percent, minus a 1-euro excess per procedure capped at 4 euros per day and per professional. Doctor-prescribed medical transport is generally covered at 55 percent, with a 4-euro excess per journey capped at 8 euros per day for the same carrier, except emergency transport arranged by the Samu (the French emergency medical service), which escapes the excess, and except children under 18.

Hospitals follow the same logic with higher stakes. For an emergency department visit without admission, you owe the forfait patient urgences of 23 euros, reducible to 9.96 euros or zero depending on your situation as published by the Assurance Maladie. Where you are admitted, hospitalisation costs are generally covered at 80 percent, rising to 100 percent in some situations, notably from the thirty-first day of the stay. But two charges always remain yours. The first is the daily hospital flat rate, the forfait journalier hospitalier: Article L.174-4 of the Social Security Code provides that « Un forfait journalier est supporté par les personnes admises dans des établissements hospitaliers ou médico-sociaux, à l’exclusion des établissements mentionnés à l’article L. 174-6 du présent code et au 6° du I de l’article L. 312-1 du code de l’action sociale et des familles. Ce forfait n’est pas pris en charge par les régimes obligatoires » (Article L.174-4). Cleiss states the current amount at 23 euros per day of hospitalisation, 17 euros in psychiatric departments. The second is the 24-euro flat contribution (forfait de 24 euros) that applies to certain major procedures. Personal comfort costs, a private room (chambre particulière), telephone and television, are never reimbursed by the scheme. For an external hospital consultation, the reimbursement rate and flat contribution are the same as in a private surgery.

Three cost traps deserve special attention from British visitors. First, the sector of the practitioner. In secteur 2, the doctor may lawfully charge above the regulated tariff, and the excess is never reimbursed by the compulsory scheme; only a voluntary top-up insurance (mutuelle or complémentaire santé) or your travel insurance can pick it up. Before a non-urgent consultation or a planned admission, ask whether the doctor works in secteur 1 or secteur 2 and, in hospital, ask for the tariff information sheettariff information sheet the establishment must display. A few private clinics are entirely non-regulated (non conventionnées), and their bills fall almost entirely on you. Second, branded medicines and products not on the reimbursement list: if the pharmacist dispenses a product outside the list, or you buy pharmacy items without a prescription, there is nothing to reimburse. Third, the coordinated care pathway (parcours de soins coordonnés). French insured patients must normally designate a médecin traitant (nominated GP): Article L.162-5-3 provides that « tout assuré ou ayant droit âgé de seize ans ou plus indique à son organisme gestionnaire de régime de base d’assurance maladie le nom du médecin traitant qu’il a choisi » (Article L.162-5-3). Missing the pathway reduces reimbursement for French patients. Cleiss confirms the good news for visitors: unlike French members, you are not subject to the coordinated pathway, and presenting your GHIC to the doctor you see avoids any surcharge for disregarding it. One less formality to worry about, provided the card is actually shown.

Emergency numbers and access points are worth memorising before you need them: 112, the European emergency number, works everywhere in France, and 15 reaches the Samu directly. Emergency departments (urgences) must take you in; the argument is never about admission but about the bill that follows. If you need regular treatment such as dialysis, chemotherapy or oxygen therapy during your stay, check availability and book before travelling; the hospital directory lists dialysis centres, and your GHIC covers only medically necessary care linked to the stay, not a treatment plan built around the holiday. The UK government’s own guidance on healthcare in France says the same from the British side and points visitors to French reimbursement information and to top-up cover (gov.uk, healthcare in France), while the NHS explains how to apply for a GHIC and how the card works abroad (gov.uk, applying for a GHIC). Read both pages before departure, not from a hospital bed.

II. Coming for treatment and fighting a refusal: prior authorisation, evidence and remedies

A. Planned treatment needs an S2, not a GHIC: the prior-authorisation rule

Everything above concerns care that becomes necessary while you are already in France. Travelling to France in order to be treated is a different legal regime, and confusing the two is the most expensive mistake a British patient can make. Planned treatment in another state requires prior authorisation from your home institution, documented by the S2 form (formerly E112). Article R.160-2 of the Social Security Code states the French version of the rule plainly: « Les caisses d’assurance maladie ne peuvent procéder que sur autorisation préalable au remboursement des frais de soins dispensés aux personnes bénéficiaires de la prise en charge des frais de santé au titre des articles L. 160-1 et L 160-2 et aux personnes qui leur sont rattachées au sens des règlements européens dans un autre Etat membre de l’Union européenne ou partie à l’accord sur l’Espace économique européen ou en Suisse, dans le cadre d’un déplacement aux fins de recevoir un traitement adapté, lorsque ces soins » (Article R.160-2). No prior authorisation, no reimbursement: the fund is not merely entitled to refuse, it is bound to refuse.

The courts apply this strictly, including against sympathetic claimants. The social division of the Vannes judicial court rejected a patient’s claim for an operation and aftercare received in Belgian clinics of the Europe group, holding that the treatment plainly required prior authorisation and that, with no such application on file, the fund had rightly refused to pay for the operation and the aftercare. The judgment adds a warning every claimant should read twice: however worthy the patient’s arguments, the social court cannot decide in equity and cannot set aside the applicable texts (TJ Vannes, social division, 22 September 2025, RG 24/00734). The same rigour appears at appeal level: where the national centre for treatment abroad (CNSE, Centre national des soins à l’étranger) had reimbursed prescribed medicines but refused the hospitalisation costs of a hip prosthesis performed abroad, the litigation turned entirely on whether the stay was a genuine temporary stay with unforeseen necessary care or a planned treatment without authorisation (CA Rouen, 19 June 2026, RG 25/01752, cited above). The court’s answer shows the test operating in both directions: genuine medically necessary care during a temporary stay is covered under Article R.160-1; a journey undertaken to obtain the operation is covered only with the S2.

A related boundary fixed by the Cour de cassation concerns the patient who starts treatment in the state of stay and then moves elsewhere at his own request. In the 2019 ski-accident case, the insured man was evacuated by helicopter to Aosta in Italy, then transferred two days later, at his own request, to a hospital in Germany. The Court quashed the appeal decision that had granted full cover for the transfer and the German hospitalisation, recalling that Article 19(1) of Regulation 883/2004 and Article 25(3) of Regulation 987/2009 govern only benefits provided in the state of stay, under that state’s legislation (Cass. civ. 2e, 24 January 2019, No 17-19.936, ECLI:FR:CCASS:2019:C200112). For a British visitor this means: if a French hospital proposes a transfer to another establishment, check who decided it and why. A medically ordered transfer stays within the cover; a transfer you demand for comfort or proximity to home may fall outside it, and the German leg of that 2019 case shows how courts treat the difference.

Two further planned-care routes exist but should not be improvised. French social security bodies may conclude agreements with named care establishments in other Member States for patients who cannot receive appropriate treatment in France, with the joint authorisation of the ministers for social security and health or of the competent regional health agency: Article R.160-3 organises these conventions (Article R.160-3). That is an institutional route for specific treatments, not a letter you write yourself. And the European Health Insurance Card page of the Commission explains, country by country including France, how the card is used in practice (the European Commission country page for using the card in France). If you live in France rather than visit, none of this chapter applies to you: with a registered S1 as a state pensioner you join the French scheme through the CPAM, a position explained in our guide for British state pensioners using the S1 in France, while early retirees without an S1 enter through the PUMA residence route with its own contribution bill, described in our guide for British early retirees facing PUMA and the CSM levy. Visitor cover and resident cover are two different doors; use the right one.

B. Challenging the bill or the refusal: the file, the friendly appeal and the social court

Start from the document, not from the principle. Whether the hospital’s invoice looks wrong or the CPAM has refused reimbursement, the dispute is won with papers: the GHIC or PRC with its validity dates, proof that the care was given during the temporary stay (travel bookings, passport stamps where available, the French entry record under the Entry/Exit System), the feuilles de soins, prescriptions, the bulletin de sortie, the itemised invoice showing tariff, sector and flat-rate charges, and every letter from the fund with its date. The Rouen case shows why dates and residence evidence matter as much as medical evidence: the fund argued the claimant spent most of his time abroad and no longer met the residence condition, pointing to his own 2017 letter, unchanged address records, reimbursements paid only for treatment abroad since 2017, a carte Vitale (the French health insurance card) not updated since 2017 and no declared médecin traitant; the court ordered the proceedings reopened so the fund would explain why it had nevertheless kept paying until August 2024. Your file must tell a consistent story from the first page.

The procedural route for contesting a CPAM decision follows the standard social-security litigation path. First, the prior friendly appeal (recours amiable) before the fund’s own appeals board (commission de recours amiable, CRA): the Rouen claimant went through the CRA before seizing the court, and the Vannes judgment recalls that equity arguments cannot override the texts, so frame the CRA letter around the texts from the start, Article 19 of Regulation 883/2004 and Article R.160-1 for unforeseen necessary care, the S2 authorisation for planned care, the exact tariff provisions for a billing dispute. The CRA route is quick and keeps the dispute technical rather than judicial. If the CRA rejects expressly or implicitly, the next judge is the social division of the judicial court (pôle social du tribunal judiciaire) of the place of the fund, with strict time limits running from notification: two months for the appeal, and the same two-month foreclosure period (délai de forclusion) for a further appeal in cassation (pourvoi en cassation), as the Vannes judgment expressly records. Miss the deadline and the refusal becomes final whatever its merits.

Three parallel protections complete the picture. First, travel insurance: the GHIC is not a substitute for it, says the UK government guidance, because it never covers repatriation, mountain rescue billed outside the scheme, the ticket modérateur, flat-rate charges, secteur 2 excess fees or a private room; declare pre-existing conditions honestly or the insurer will use the omission against you. Second, the French top-up insurance logic: French residents bolt a mutuelle onto the compulsory scheme precisely because the scheme leaves the charges described above; as a visitor you cannot join one, which is exactly why the travel policy must cover them. Third, the NHS fallback for unclaimed costs: where you paid in France and never claimed from the CPAM, the NHS Business Services Authority route remains open after your return, with its own forms, deadlines and conversion of French tariffs. None of these routes repairs a missing S2 for planned treatment, and none of them pays for care the French tariffs do not recognise. The order of operations is therefore fixed: GHIC shown at every step, itemised papers collected on the spot, claim filed with the CPAM of the place of treatment, CRA appeal on legal grounds if refused, social court within the time limit if the refusal stands, insurer and NHS routes in parallel for what the scheme structurally leaves out.

Conclusion

A British visitor who falls ill in France is not treated under NHS rules transplanted across the Channel but as a French insured patient for the duration of the stay: medically necessary care at French tariffs, with the GHIC or its provisional replacement as proof of entitlement, payment upfront in most cases and reimbursement claimed from the CPAM of the place of treatment. The lawful remainder, the ticket modérateur, the 2-euro and smaller flat deductions, the 23-euro emergency flat rate, the 23-euro daily hospital rate and any secteur 2 excess, is not an error in the bill but the normal product of Articles L.160-8, L.160-13 and L.174-4 applied to a visitor exactly as to a resident. Planned treatment obeys the opposite logic: no S2 prior authorisation, no reimbursement, as the Vannes and Rouen courts have just confirmed again, and a transfer requested by the patient rather than ordered by the doctors can break the cover, as the Cour de cassation held in 2019. Collect the papers on the day, file with the right fund, appeal to the CRA on the texts and mind the two-month limits: that discipline turns an intimidating French hospital invoice into a solvable administrative file.