50€ cap? AMELI/CPAM paiement participations forfaitaires etc etc

Health Care & Carte Vitale
1

I wonder if anyone can shed some light on this?

In mid August 24 I received a message in my Ameli app regarding ‘le paiement de vos participations forfaitaires et franchises’. The total was about 50€, with 41€50 being generated from 01/01/24 until 26/07/24. This is made up of all the small participation forfaitaire and franchise charges charged on all medical matters. I paid immediately by bank transfer for which I received a receipt.

Then in October, I received a second similar communication, this time requesting 45€42 incurred between 26/07/24 and 30/09/24.

This makes a total of 87€02 for 2024, yet I understood that there was an annual cap of 50€ for these charges. I have not paid the second bill, but immediately sent Ameli an email asking for an explanation. They have just responded offering me a phone call to discuss in one month’s time. As the phone call could get too involved for my level of French, I tried to make an in-person appointment but in the obligatory list of motifs for the rendezvous, there is no category that seems remotely applicable.

Can anyone here please clarify the 50€ cap? If I’m in error then I’ll happily pay the second amount but I’d like to understand the facts.

Thanks in advance,
Brian

2

Yes, I made the mistake of looking at the documents on my Ameli pages and found 3 or 4 similar bills, from both CPAM Creuse and Manche, all (just) under €50, but some going back to 2022. Never had any reminder emails or texts. I just paid them, from experience they rarely get things wrong (and don’t want to rock the boat😉)

3

This is the page that I interpret as saying there is a 50€/annum limit…

4

I read that before, yes €50/ year. I’ve paid up to date now, but I’ll know to keep an eye out for future bills.

5

It’s €50 a year, but then are you sure first payment was for the current year? They can go back in time,

6

Thanks, @JaneJones (sorry for calling you ‘Have’ - clumsy fingers!)
Yes - the first letter did go back to 2023 but I added the contributions relating just to 2024 and they came to 41€50 as detailed in my first post on the thread. The second bill picked up where the first one cut off and brings the 2024 total to well over 50€.

7

Yes, I’ve fallen foul of this as well. When you want an appointment, no category fits your need and there is a warning that the appointment can only be used for the purpose you select. And, our CPAM will only accept online appointments.

8

Stella’s go to is the Mairie. Mine is France Services, so suggest you go see them with all your papers and see if they can help. Allegedly they have a hotline into CPAM.

2 Likes
9

I only have to walk to our Mairie… and, yes, our Secretaire, Maire and Adjoints(es) do have amazing hotlines :wink: :+1:

France Services are very helpful… but we have to get the car out and drive a while to get to our nearest one… so, in the main, it’s the Mairie which is our first choice…

10

I’ve tried the Mairie. 8 know then we’ll and they’re usually very helpful but their trouser this time was ‘Ameli - nightmare! Good luck.’

I’ll try phoning the Ameli English helpline again on Monday just in case I manage to get through. Failing that, I’ll take your suggestion and contact France Services.

Incidentally, do you think my interpretation of the 50€/year cap is correct or are there some arcane rules of which I’m unaware?

Thanks both.

11

Just wondering (and I haven’t looked/checked) if it’s a calendar year or a different start/finish :thinking:

12

When I checked - a couple of years ago - it was a calendar year.

13

I’ve just received a notice for my Ameli account and the “bill” runs from 23/5/2019 to 11/10/ 2024… so more than 12 months… and the total sum is (supposedly) 51,50€ but they’re only asking for 49,50€ to be paid within 30 days…

14

I found one of them from 2022 that I hadn’t paid :flushed:

15

Perhaps they’ve withheld payment from you, on another occasion… to cover.

I know they did that once to me… 'cos I queried why I’d paid upfront and not been refunded… aha… they said… we’ve held it against outstanding thingies… :wink:

16

It is an année civile, ie calendar year.

What I haven’t checked is wether the threshold is €50 for forfaits AND €50 for franchises. Does you bill say?

But is one gets CSS one should be exonerated from the lot.

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17

No, the bill doesn’t mention the cap at all, it’s simply a list of transactions, some marked as forfaits and some as franchises. I can’t find any online reference to there being 2 separate caps, and I don’t benefit from CSS

18

My Bill shows the Franchises and the Forfaitaires added together… then talks about the 50€ limit… so it seems that it’s both together rather than 50€ limit for each… but who really knows ?

19

It is as clear as mud

IMG_4043
IMG_40432388×1668 267 KB

IMG_4042
IMG_40422388×1668 344 KB

20

As does mine…

At least it’s clear on the dates!

Reading the final page of the bill for the first time (I’d stopped when I came to the end of the figures previously) I find this:

Screenshot_20241103-171157
Screenshot_20241103-1711571079×1586 107 KB

Which does, Indeed, suggest that there is a 50€ cap on forfaits then a second 50€ cap on franchises.

One lives and learns …

Thanks to everyone for their help.

Edit to add: I really don’t understand why Ameli (or ‘Smelly’ as my phone keeps suggesting) didn’t point me towards that page or give me a simple answer to my original question. :man_shrugging:t2:

1 Like