Social security reimbursement

SMEREP reimburses you everywhere in FRANCE

You will be reimbursed for your care anywhere in France, from 48 hours and up to 5 days, simply by presenting your Carte Vitale to healthcare professionals or by sending us your care sheets.

Refunds are made by bank transfer directly to your account.

SMEREP reimburses you everywhere in Europe and in the world.

You will be refunded everywhere in Europe and worldwide on the basis of rates and French refund rates.

How do I make my first refund claim?

In my first request for reimbursement for care, I also send to SMEREP:

The original of my Banking Identity Statement - in I BAN format,

- My declaration form of my general practioner

- My proof of affiliation issued by my institution,

- A copy of my old social security certificate or that of the person who is responsible for you (parents, guardian ...) and which your appear on,

- A photocopy, double-sided, of my identity document (national identity card, passport, residence permit or receipt of residence permit, certificate of OFPRA).

 

How do I complete my care sheet?

I am the person receiving the care and I am the insured: I enter my Social Security number and my address.

I am the person receiving the care but I am not the insured, I write my name and my first name, my Social Security number if I have one, my date of birth, the surname and first name of the person, insured person to whom I depend, as well as his address and Social Security number.

In addition, if my care sheet corresponds to:

- Glasses / lenses: I enclose a copy of the prescription that allowed me to buy my glasses / lenses,

- Medical analysis: I enclose the copy of the prescription that allowed me to do these analyzes,

- Care provided by a medical assistant (nurse, masseur-physiotherapist, speech therapist, orthoptist, pedicure-chiropodist): I enclose the copy of the prescription written by my doctor to carry out this care,

- Transportation: I enclose a copy of my physician's prescription for this transportation, a passport or a status card attesting to the care performed on the date of transportation.

In any case, I sign my care sheet before sending it to the Centre 617 - SMEREP - 16 Boulevard du General Leclerc - 92115 CLICHY CEDEX.

 

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I am an affiliate and member, what should I do for my refunds?

You are in SOCIAL SECURITY + Complementary insurance cover SMEREP

The SMEREP reimburses you in one time the part Social Security and the Complementary insurance cover part.

You are in SOCIAL SECURITY + Complementary insurance cover other than SMEREP

The SMEREP will reimburse you for the part Social Security and send directly your count to your Complementary insurance cover through the Noémie transmission system if it has signed an agreement with the SMEREP.

Where do I send my reimbursement requests, my care sheets?

For my requests for refunds, I can either deposit them in a reception SMEREP, or send them by mail to: SMEREP - 16 Boulevard du General Leclerc - 92115 CLICHY CEDEX.

I am affiliated with the Center 617 - SMEREP and a member of another Complementary insurance cover, how can I be reimbursed the Complementary insurance cover share?

 

Thanks to the remote transmission of your deductions by the NOEMIE system, the reimbursement of your health expenses gains in simplicity and in rapidity.

What is the Noémie system?

It is a computerized system allowing the direct transmission of your social security accounts to your Complementary insurance cover: your repayments are made in one single step:

- you send your care sheets to the SMEREP or you use your Carte Vitale,

- the SMEREP reimburses you and transmits the deductions directly to your complementary insurance cover by electronic means.

What is the approach to be taken?

 Simply print and complete this coupon and send it to your Complementary insurance cover company with a copy of your attestation of rights:

- if your Complementary insurance cover company has already signed an agreement with the SMEREP, it will take care to inform us that you are covered by it,

- if your Complementary insurance cover company has not signed an agreement with SMEREP, it can contact us if it wishes to establish one.

To see the list of Complementary insurance cover companies that have signed a partnership agreement with SMEREP, click here.

 

What are the steps to take before performing my orthodontic care?

Before the beginning of my care, I apply for a preliminary agreement established by my dentist to the following address: SMEREP – Monsieur le Dentiste Conseil - 16 Boulevard du Général LECLERC - 92115 CLICHY CEDEX. Failure to reply within 15 days shall constitute acceptance. In the event of refusal, I shall be notified by letter indicating the remedies available to me to contest the decision.

If I have already had the agreement of my previous affiliation fund, it is advisable to attach to my requests for refunds either a history of your treatment established by your dentist surgeon or the previous statements of reimbursements of the CPAM.

I verify that my orthodontic care fee sheet must be completely completed and signed before sending it to SMEREP - 16 Boulevard du General LECLERC - 92115 CLICHY CEDEX.

What about my refunds when I'm pregnant?

After my doctor has made my declaration of pregnancy, I address the 3rd part of my declaration of pregnancy given by your doctor or the midwife to: SMEREP - Cellule Médicale - 16 Boulevard du Général LECLERC - 92115 CLICHY CEDEX mail, this address does not receive the public).

From the first day of my sixth month of pregnancy, all my reimbursable medical expenses (pharmaceutical, analysis, laboratory tests, hospitalization) are 100% covered, up to the basic rates of health insurance. I am also exempt from the lump-sum contribution of 1 euro and medical deductible on medicines, paramedical acts and medical transports.

At birth, I must not forget to send a photocopy of my updated family booklet to SMEREP or, failing that, a copy of the birth certificate of the child, accompanied by Form S3705 " « Demande de rattachement enfant ».

WARNING ! I must not forget to update my VITAL card to benefit from all my rights.

How to report an accident caused by a third party?

If you are the victim of a bodily injury caused by another person and who engages his / her responsibility, you must imperatively declare it to SMEREP as "Accident caused by a third party".

Indeed, your accident can generate a medical care more or less important (hospitalization, rehabilitation, pharmacy ...). As soon as SMEREP becomes aware of your accident, it will contact the third party responsible so that the expenses related to your accident are financially borne by the responsible third party and not by the community.

What is an accident caused by a Third Party?

This is a bodily accident of which you are the victim, which has been caused by another person and which engages its responsibility.

Why declare it?

Your accident can generate a medical care more or less important (hospitalization, rehabilitation, pharmacy ...). As soon as your Social Security and / or Mutual Insurance have knowledge of your accident, they contact the responsible third party that you designated or its insurer in order to be reimbursed the expenses they incur to treat you. Thus the costs related to your accident are financially borne by the responsible third party and not by the community.

How and to whom?

By filling in the accident report available on MY SMEREP / documents and returning it by post: SMEREP - 16, Boulevard du Général Leclerc - 92115 CLICHY CEDEX.

Also, when you consult with a health care provider as part of your accident, ask him / her to check the "third-party accident" box on your care sheet.

What should I do if I have a long-term condition?

My attending physician or the doctor following me for my affection establishes a protocol of care. This protocol of care must be granted by the Médecin Conseil of SMEREP. To do this, it is enough to address this protocol of care: SMEREP - Monsieur le Médecin Conseil  - 16 Bd General Leclerc - 92115 CLICHY CEDEX.

After studying my application, within an average of 2 months, I will receive by mail the notification of refusal or agreement. In the event of refusal, I shall have the right of appeal to challenge this decision. In case of agreement, I will receive a new attestation of rights showing the exemption of the co-payment (mutual part) for the care related to my protocol of care.

If my protocol of care has already been granted by the Medical Consultant of my previous affiliation center, I am addressing my previous notification of agreement or my previous attestation of rights mentioning this exemption from user fees to: SMEREP - Cellule administrative - 16 Bd du Général Leclerc 92115 CLICHY CEDEX.

WARNING ! I must not forget to update my Carte Vitale to benefit from all my rights.

 

 

How do I get a refund if I suffer from gluten intolerance?

After consulting the Medical Council of the Centre 617 - SMEREP or the Medical Consultant of my previous affiliation center (see: What steps should I take if I have a long-term illness?), I will receive by SMEREP twelve forms S3327 accompanied by your certificate of honor.

To get refund from gluten-free foods that I buy because of my intolerance, I send a S3327 form each month on which I attach the detachable labels on gluten-free food packaging. Each monthly form must be completed by purchases made during the month in question. Each form must also be accompanied by your certificate of honor showing the total amount of expenses incurred per month.

The whole must be addressed to: SMEREP - Cellule administrative - 16 Bd du General Leclerc - 92115 CLICHY CEDEX.

 

 

How does the teletransmission with my parental or personal complementary insurance cover?

In order to set up teletransmission of my accounts between Centre 617-SMEREP and my complementary insurance cover company under the Noémie standard, I download the coupon Noémie, I complete it and send it to my complementary insurance cover company with a copy of my attestation of rights:

-  if my complementary insurance cover company has already signed an agreement with the SMEREP, it will take care to inform it that I am covered by it,

- if my complementary insurance cover company has not signed an agreement with SMEREP, it can contact the latter if it wishes to establish one.

When the teletransmission of my counts will be effective, I will see the name of my complementary insurance cover company on my paper accounts. In the meantime, I have to continue to download them on my My SMEREP space and send them to my complementary insurance cover company.

What are the preliminary steps to be taken in case of medically prescribed transport?

I can be reimbursed for my transportation costs when they are prescribed by my doctor. In this case in order to obtain the reimbursement I address:

The medical prescription established by a doctor (Ref S3138c), except in the case of emergency transport by the SAMU-center 15,

The transport bill: for the use of a light ambulance and medical vehicle (Ref S 3601b), for a taxi (printed 606-13-01 and ref. 03606), for public transport and personal / private car (Expense statement: Ref S 3140b),

The report card of the hospital or any other document proving that the care was executed on the date of the transport.

The whole of my request for reimbursement of care should be addressed to: SMEREP – Cellule Administrative - 16 Bd du General Leclerc 92115 CLICHY CEDEX

I pay attention to the following points:

  • To obtain the refund I must have used the means of transport prescribed by my doctor for the journey defined on the medical prescription,
  • If I call a taxi I have to make sure that it is agreed by the Health Insurance,
  • In the event that prescribed transportation requires the prior agreement of the Medical Consultant, I must obligatorily send my request for prior agreement (Ref S3139a) at least 15 days before carrying out my transport, failing which my request for refund will be refused. These include: transport to a location more than 150 km, serial transport (at least 4) within 2 months for the same treatment to a location more than 50 km away, and transport by air or boat of regular line.

My request for prior agreement should be addressed to: SMEREP – Cellule Medicale - 16 Bd du Général Leclerc - 92115 CLICHY CEDEX

 

 

What are the preliminary steps to take if I have to do a spa treatment?

According to my pathology and under certain conditions, I can send to the Centre 617 - SMEREP, a request to take care of my medical expenses, my transport and accommodation expenses related to my thermal cure. To do this, I consult my doctor who alone can define the need for a thermal cure and its place of performance according to my pathology.

I address the following two documents before performing the thermal cure at SMEREP – Cellule médicale - 16 Bd du General Leclerc 92115 CLICHY CEDEX:

  • the treatment questionnaire completed by the doctor who prescribes the cure: it indicates in particular the affection of which I suffer and the chosen thermal cure.
  • the declaration of resources completed by me: I must enclose all my proofs of resources for the calendar year preceding the prescription of my cure in order to be able, if necessary, to benefit from the assumption of the expenses of transport and of accommodation. If necessary, I can receive daily subsistence allowances from the Caisse Primaire d'Assurance Maladie depending on my situation (salaried student).

After studying these documents, Centre 617-SMEREP will send me a notification of agreement to take care of my spa treatment, and if I meet the conditions of resources, the payment of my accommodation and transport costs . I will receive the form entitled " Prise en charge administrative de cure thermale et facturation  ".

In case of refusal, the Centre 617-SMEREP will send me a notification of refusal indicating the possible avenues of appeal.

Upon receipt of the form " Prise en charge administrative de cure thermale et facturation  ":

  •  I must submit the first part entitled " Honoraires médicaux  " to the thermal doctor,
  • I must submit the second part entitled " Forfait thermal " to the thermal cure,

If I fulfill the conditions of resources, I am addressing the third part, entitled " Frais de transport et d'hébergement ", to SMEREP - Cellule Administrative - 16 Bd du General Leclerc 92115 CLICHY CEDEX, upon my return from cure, all evidence of expenses incurred.

 

 

What do I need to do if I need medication while abroad?

I can get my medicines for more than a month in case of departure abroad, if I am likely to encounter difficulties to access my treatment in my place of stay. In order to leave with the quantity of medicines necessary for the total duration of my stay, I must send my order to the SMEREP - Cellule Médicale - 16 Bd du General Leclerc 92115 CLICHY CEDEX on which will be notified by my doctor " foreign countries ". In the absence of this mention must be attached to the order an attestation on the honor specifying my name, first name, telephone number, Social Security number, nationality, place of stay, date of stay, duration and reason for the stay.

Upon receipt of this document (s), SMEREP will notify me of its agreement on the medical prescription. I would then be able to go to the pharmacy with this prescription in order to obtain the delivery of medicines according to the dosage indicated by my doctor and for the duration granted by SMEREP.

Please note that the drug delivery agreement can not exceed 3 months. If my stay abroad lasts longer I have to finish the same process at the end of treatment.

 

 

 

 

What are the pre-requisites for scheduled care abroad?

If my state of health requires care abroad, because I can not find a hospital in France allowing me to treat my pathology. I must then apply to the Medical Officer of the Centre 617 - SMEREP at: SMEREP – Monsieur le Docteur Conseil -16 Bd du General Leclerc 92115 CLICHY CEDEX. Be careful, this is not the same as unannounced care during a stay abroad.

My request must be made up of an explanatory letter from my doctor (medical reasons, duration of treatment and desired treatment site) and a reasoned letter from me.

Centre 617 - SMEREP will notify you of the decision of the Medical Consultant. In case of agreement, you can send us your requests for reimbursement of expenses by sending the invoices paid in full, the proofs of payment, the medical prescriptions and the form - S3125 a " Soins reçus à l'étranger " duly completed and signed at the following address: SMEREP - Service Pôle Technique - 16 Boulevard du General LECLERC - 92115 CLICHY CEDEX.