2016 - 2017 smerep.fr

* Except in specific cases
Student social
security
Complementary
health insurance
Insurance
Health prevention
Special offers
The SMEREP club
Personal and free space
My SMEREP
2016 - 2017
smerep.fr
* Except in specific cases (see table opposite).
3
• 8 Ile-de-France reception centres
including the centre in Paris open
Thursdays until 8pm, on Saturdays and
offering a multilingual service throughout
the week.
4
• The only social security scheme with
a call centre open all week from Monday
to Saturday inclusive.
• A freephone number guaranteeing a
reply in under one minute.
5
• A personal space MY SMEREP with
access to online reimbursements of
your healthcare, downloading of your
entitlement certificate, ordering of your
EHIC, etc.
GOOD REASONS for
choosing Centre
617 - SMEREP
1
2
• A SINGLE point of contact
With SMEREP, you deal with a
single contact person who treats
your dossier in its entirety, from
initial registration to healthcare
reimbursement.
• Healthcare reimbursed
- Everywhere in France in 48HRS
with your Carte Vitale, in Europe and
overseas.
- Immediate settlement at the
Saint-Michel reception with your
healthcare form.
48
hours
EDITORIAL
5
REGISTERING FOR STUDENT SOCIAL SECURITY IS COMPULSORY*
IN ORDER TO VALIDATE YOUR ENROLMENT IN HIGHER EDUCATION
8
6 days / 7
until
8pm
Thursdays
@
My SMEREP
HOW TO REGISTER FOR STUDENT SOCIAL SECURITY
1
To register with SMEREP, when you are enrolling in your higher education
establishment, tick or indicate “Centre 617- SMEREP”.
Whether you register in writing or via the internet, you will find a section dedicated to student
social security.
Method of registration
via internet
for your higher
education
establishment
2
3
4
5
CENTRE 617 - SMEREP
PAYMENT CENTRE
Choose a Social
Security centre (compulsory)
Centre 617 - SMEREP
Paper registration
procedure of your higher
education establishment
Cerfa form S 1205g,
available for download in
the smerep.fr, section:
Student social
security
You pay your contribution directly to your establishment*
Your further education establishment receives payment of your fixed-rate student social security
contributions for 2016/2017 at the same time as payment of your tuition fees. It then pays your
contribution to URSSAF and registers you with the SMEREP student scheme.
Dear Students,
Throughout the year, SMEREP supports
you in managing your social security
reimbursements and offers you
complementary insurance tailored to both
your health needs and your budget.
Firmly convinced that successful
university studies are dependent on your
well-being, we are constantly innovating
in order to offer you services of an
ever higher quality. For 2016, we have
introduced an e-cabin which enables you
to establish your bill of health in under 10
minutes and we have also published our
annual health survey. The survey enables
us to better understand your needs so
that we can tailor our services to your
healthcare requirements.
As of 2016, you can find us at our
centre on the Boulevard Saint-Michel. It
is now open until 8pm on Thursday, and
is also open Saturday. Our advisers are
multilingual and so can assist students of
all nationalities.
SMEREP wishes you an excellent university
year.
* Except in specific cases (see table opposite).
You collect your proof of your SMEREP affiliation from your higher education establishment
Hadrien Le Roux
President of SMEREP
Your healthcare expenses will be covered by your Centre 617- SMEREP for student social security
for the 2016/2017 university year, which BEGINS ON 1st SEPTEMBER 2016 barring special
dispensations.
Confirmation of your registration with Centre 617- SMEREP student social security
You will receive a welcome letter or email asking you, in particular, to update your Carte vitale, if you
have one.
To finalise your registration
It is COMPULSORY to send us or drop off at a SMEREP centre the documents
listed in the table below:
DOCUMENTS TO BE SUBMITTED
To your educational
establishment
To SMEREP
According to your age
Between 16 and
19 years old
Between 20 and
28 years old
To be added if you do not
have a Social Security N°
Born in
France
Born
overseas
Proof of your affiliation issued by your higher education establishment (copy of your registration certification,
payment of your contributions or section No. 2 of the form Cerfa S 1205g, indicating Centre 617- SMEREP as
the social security payment centre)
The original of your Relevé d'Identité Bancaire (bank account details) or those of a third party(1)
Declaration form of your choice of general practitioner
A copy of your old social security certificate, or that of the person who is responsible for you (parent,
guardian, etc.) and which you appear on
Provisional or final grant decision for the coming year; or the final grant decision for the previous year
Photocopy of a valid identity document (national identity card, passport, resident's permit
or receipt for resident's permit, OFPRA certificate)
You were born in France (mainland, overseas departments, St-Pierre-et-Miquelon, St-Martin, St-Barthélémy):
Photocopy of a civil status document (national identity card, updated family record book, passport)
You were born overseas, in an overseas territory, French Polynesia, Wallis and Futuna or New Caledonia:
2 documents are required: 1 civil status document (copy or extract of birth certificate(2), document issued by a
consulate) and 1 identity document (copy of identity card, passport, resident's permit, long-stay visa).
Documents in a foreign language must be translated by a sworn translator.
(1) In this case, you must send SMEREP a written statement dated and signed by both parties authorising the payment of your reimbursements to this third party,
2
(2) In accordance with international law and unless otherwise stipulated, overseas civil status documents and their extracts or official copies must be legally validated, or, if applicable, counter initialled in order to
be vaild in France. We invite you to contact your home country's diplomatic services (embassies) or consulates in France for further details about the procedure.
CONTRIBUTIONS TO STUDENT SOCIAL SECURITY
Your age during the academic year and your parents' profession determine whether you need to register for student social security and
whether you have to pay the student contribution or not.
Table updated on 01/03/2016
Your age during the academic year
(between 1 September 2016 and 31 August 2017)
PARENT’S PROFESSION
the person responsible for you in terms of social
security
Employee and equivalent:
Civil servants, local authority and hospital staff, artists, registered
social security medical practitioners and auxiliaries (except for
the self-employed professionals option), farmers and agricultural
employees.
Between 16 and 19 years old
20 years old
Born between
01/09/1997 and 31/08/2001
Born between
01/09/1996 and 31/08/1997
Student social
security compulsory
and FREE
Self-employed professions:
Tradesman, Retailer, Freelance Worker.
Special schemes:
Notary clerks and employees, Religious associations,
E.D.F-G.D.F, Military, Mines, R.A.T.P., Senate.
Other special schemes:
National Assembly, merchant navy (ENIM), autonomous port of
Bordeaux.
Student
social security
compulsory and
CONTRIBUTION
PAYABLE (1)
(free if you are a bursary student)
Parents’ social
security
FREE
Between 21 and under 28
years old
28 years and over
Born before
31/08/1988
Born between
01/09/1988 and 31/08/1996
Student
social security
compulsory and
You benefit from an
extension of entitlement or
continued entitlement in
some cases. (3)
CONTRIBUTIONS
PAYABLE (1)
(free if you are a bursary student)
Parents’ social
security
FREE
Student social security compulsory and
CONTRIBUTION PAYABLE (1) (2)
International civil servant
Parents’ social security
FREE
SNCF agent
Contact your school or
SMEREP.
Information:
01 56 54 36 34
Monday to Saturday
9 am to 6 pm
8 pm on Thursday and
5 pm on Saturday)
Website:
smerep.fr
section:
CONTACT
(1) The amount of the contribution, defined by ministerial decree and payable to URSSAF via your further education establishment, was €215 for 2015/2016 (pending the decree to be published for the 2016/2017
contribution). (2) In the absence of a certificate from the international organisation indicating that you benefit from health cover as a beneficiary. (3) Subject to the decrees applicable following the PUMA reform (decrees
N° 2015-1865 and N° 2015-1882 of 30 December 2015)
SPECIFIC CASES:
• Grant-holding student: compulsory registration, but free on presentation of the conditional or definitive grant award confirmation for the coming year.
• Student in work (with the exception of seasonal work): if you are an employee during your entire academic year and you work more than 600 hours a year or 150 hours a quarter,
you do not have to register for student social security and you are covered by the general scheme. If your employment is terminated or if you are unable to justify the number of hours
or the required amount of contributions, your registration with Student Social Security is compulsory and you must pay the contribution
• Overseas student: registration compulsory(1).
(1) Either contact your education establishment or SMEREP (see contact details on Page 6).
WITH CENTRE 617-SMEREP: FAST REIMBURSEMENT OF YOUR HEALTHCARE EVERYWHERE IN
FRANCE, IN EUROPE AND OVERSEAS.
WITH MY CARTE VITALE, I AM COVERED
EVERYWHERE IN FRANCE.
If you already have a Carte vitale 2 (with photo),
you will have to update it at a SMEREP centre or
with a healthcare professional.
If you have a Carte vitale 1, or if you do not have a Carte
vitale, SMEREP will help you to obtain a Carte vitale 2. While
you are waiting to receive your card, you can send us your
treatment forms by post:
SMEREP - 16, Boulevard du Général Leclerc
92 115 CLICHY CEDEX
Your healthcare is reimbursed everywhere in France after 48
hours and within a maximum of 5 days on simple presentation
of your Carte vitale to healthcare professionals, or by sending
us your treatment forms.
Do not forget to update your card once a year, or whenever
your situation changes! This operation updates your health
insurance entitlements. You can obtain an entitlement
certificate on our website smerep.fr, section
My SMEREP
2
WITH MY EUROPEAN HEALTH INSURANCE CARD (EHIC),
I AM COVERED EVERYWHERE IN EUROPE
The EHIC covers your healthcare expenses in Europe
(including in Switzerland) when you travel as part of
your studies (Erasmus programme, work placements,
etc.) or on your holidays.
For further information and to receive it free of charge at home, apply
for it at smerep.fr / section My SMEREP or at a SMEREP centre, or
by telephone on 01 56 54 36 34.
@
Remember to apply for it at least 15 days before your departure.
PRACTICALITIES
1
@
YOUR PERSONAL AND FREE
SPACE MY SMEREP
Email alert and monitoring of your healthcare reimbursements.
Downloading of your ENTITLEMENT CERTIFICATE at SMEREP
for the year in progress and your civil liability document if you are a
SMEREP affiliate.
Registering of your bank account details (RIB).
Ordering of your European Health Insurance Card and downloading
of your temporary replacement certificate for the EHIC
(valid for 3 months).
Changes to contact details (postal address, telephone number and
bank details).
Registering of your choice of General Practitioner.
3
No increase in the tariffs of
our Indispensable and Totale
insurance schemes since 2014
SMEREP'S COMPLEMENTARY INSURANCE COVER:
as a means of reimbursing all or part of social security charges
Social security reimbursement + Insurance
based on the social security tariffs applied to
the programme of treatment (A) (B)
Social SECURITY
REIMBURSEMENT
RATES
Indispensable
SMEREP
8.25 €
/ month
99 € / year
Médiane
SMEREP
27.50 € /
month
330 € / year
Totale
SMEREP
49 € /
month
Sur-Mesure
SMEREP
(see page opposite)
588 € / year
Social security reimbursement rates
+ Health insurance
COMMON TREATMENTS
CONSULTATION / JUSTIFIED HOME VISIT
.....100 % ........ ...... 150% ........ ....... 200% .......
70 %
Generalist (GP and consulting physician) ............................................... ......................
.....100 % ........ ...... 150% ........ ....... 200% .......
70 %
Specialist (GP and consulting physician) ............................................... ......................
100 %
....................................................................................... ......................
Pharmacy 100%
65 %
......................................................................................... ......................
Pharmacy 65%
30 %
......................................................................................... ......................
Pharmacy 30%
15 %
......................................................................................... ......................
Pharmacy 15%
60 %
Medical analyses ................................................................................... ......................
70 %
..................................................................... ......................
Dental (treatment and prostheses)
70 %
. .......................................................................................... ......................
Thermal cure
70 %
Midwife ................................................................................................. ......................
70 %
Radiology / Medical procedures / Surgery without hospitalisation (with treatment < 120 €) ......................
60 %
Eye care recognised by social security.................................................... ......................
(2)
60 %
......................
Prostheses (excluding dental), dressings, accessories and small orthoses ...
65 %
Medical transport ................................................................................... ......................
60 %
Medical auxiliaries ................................................................................. ......................
.....100 % ........
..... 100% ........
..... 100% ........
........ 15% ........
........ 95% ........
........ 70% ........
........ 70% ........
........ 70% ........
........ 70% ........
........ 60% ........
........ 60% ........
........ 65% ........
........ 60% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
....... 100% ........
...... 200%........
....... 100% ........
....... 100% ........
....... 100% ........
........ 100% ........
........ 100% ........
........ 100% ........
........ 100% ........
........ 100% ........
....... 200% ........
....... 200% ........
....... 200% ........
....... 200% ........
....... 500% ........
....... 200% ........
....... 200% ........
....... 200% ........
HOSPITALISATION
Medical and surgical hospitalisation .................................................... ... 80 to 100% .. ....... 100% ....... .......100% ....... ....... 100% .......
(3)
Daily hospital fees of 18 € / day and 13.50 € / day for psychiatric care
.........
...................... ....... 100% ....... .......100% ....... ....... 100% .......
Contribution of insured............................................................................
party 18 €
...................... ....... 100% ....... .......100% ....... ....... 100% .......
STUDENTS WITH JOBS
Daily allowance (4)
............................................................................. ...................... .......15 €/DAY....... .......15 €/DAY
....... .......15 €/DAY.......
...
...
...
Mutuelle
Sur-Mesure
at smerep.fr
PREVENTION FEE
Plaque removal (2 sessions / university year)
.................................................
Hepatitis B screening
.................................................................................
Vaccination fees (not reimbursed by social security) (5) (7) ......................
(6)
Prevention consultation...........................................................................
Hearing prosthesis fee (7)..........................................................................
Birth fee (8)
.....................................................................................
Quit smoking treatment fee (7) (9)
....................................................
Eye care fee: frames, correcting lenses, contact lenses (7) .......................
Fee for correcting myopia on both eyes (7) (12)
.............................................
Dental fee: prostheses (2) (7) ...................................................................
Sports consultation (7)...............................................................................
......................
......................
......................
......................
......................
......................
......................
......................
......................
......................
......................
....... 100%.........
....... 100%.........
..........................
......... 50 € ........
.........................
.........................
.........................
.........................
.........................
.........................
.........................
........ 100% ........
........ 100% ........
......... 90 €.........
.......... 50 € ........
.......... 45 €.........
.......... 45 €.........
.......... 30 €.........
......... 50 €.........
..........................
..........................
...........10 €.........
........ 100%........
........ 100%........
........150 €.........
.......... 50 €........
....... 200
..
€.........
........150 €.........
.......... 30 €.........
........150 €........
........150 €........
.......
200 €........
........... 15 €.........
'WELL-BEING' SCHEME
(12)
..............................................
...................... ......................... ..........60 € ....... .......... 80 € ......
'Alternative healthcare' treatment basket (11)
(dietary, acupuncture, osteopathy and naturopathy)
'ENJOYING LIFE' SCHEME
Latest generation contraceptive pill fee (7)
.......................................
Morning after pill fee (7)
......................................................................
Pregnancy test fee (7)
.........................................................................
Condom fee (7)
...................................................................................
SMEREP PACK:
......................
......................
......................
......................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
.........................
......... 80
..........10
..........10
..........10
€
€
€
€
......
......
......
......
includes compulsory civil liability for students
Civil liability , Medical Civil Liability (13), Individual Accident (14), 'Travel,
........................ INCLUDED
Actual costs*
Individual Journeys, Repatriation' Assistance (13), Hospitalisation for Accidents
(13)
INCLUDED
INCLUDED
Actual costs*
Actual costs*
INCLUDED
INCLUDED
SOLIDARITY FUND
Solidarity fund (15)..................................................................................... ......................
INCLUDED
Excess fees or fee increases due to non-compliance with the treatment programme are not covered, and neither is the supplementary fixed charge payable by the patient. Excess fees which specialist doctors may charge are payable by the patient up to the
limit (8 € as of 30 April 2006) fixed by the national accord(s) agreed within the framework of Article L.162-5 of the Social Security Code. The fee contribution of 1 € and non-refundable charges, which are compulsory, remain at the charge of the affiliate
where they are applicable.
If you register for SMEREP health insurance on a pro rata basis (9, 6 and 3 months), the tariffs are also charged on a pro rata basis
(A) The social security reimbursement rates in force on the date of the SMEREP General Assembly of 30 March 2016.
continuous subscription to the same scheme.
They include social security reimbursements, excluding fixed contributions and non-refundable fees where applicable,
(9) As a complement to the social security reimbursement of 50 € / year, SMEREP contribution of 30 €.
within the framework of the coordinated programme of treatment.
(10) Fee applying to frames and lenses reimbursed by social security and to contact lenses, whether or not reimbursed
(B) Refer to the SMEREP Health Insurance Terms and Conditions to find out the date when the schemes take effect, the
by social security.
details of the services, the conditions for their payment and the exemptions.
(11) Cover of 20 €, limited to 3 consultations for the Médiane scheme and to 4 consultations for the Totale scheme.
(1) Reimbursement of psychiatric or neuro-psychiatric visits or consultations limited to 100% for the Médiane and Totale
(12) Reimbursements on presentation of a paid invoice bearing the complete stamp and the identity n° of the health
schemes.
professional, who must be certified..
(2) With the agreement of social security.
(13) Risk covered by the ACE Europe insurance company..
(14) Insurance cover of 80% guaranteed by the ACE Europe insurance company.
(15) On presentation of the dossier. The allocation of solidarity funds is at the discretion of SMEREP (decision of the
President or his/her delegate on the recommendation of the solidarity fund commission), according to the personal
circumstances of the affiliate and within the limits of the funds at the disposal of SMEREP.
(3) Daily hospital fee limited to 30 days for the Indispensable, limited to 45 days for the Médiane, limited to 60 days for the
Totale and psychiatric and neuropsychiatriic care limited to 20 days / university year.
(4) Daily fees paid from 4th day of stopping work until the 8th day inclusive per university year.
(5) Vaccinations, including anti-flu vaccinations, and boosters, which are not covered by Social Security and which are
authorised for commercialisation on the date of treatment.
(6) One consultation per university year, entirely covered by SMEREP.
4
(7) Annual fee paid per university year on presentation of corresponding invoices.
* See conditions set out in the Health Insurance Terms and Condition and the Information Notices with the reference
(8) A single payment per child paid to the affiliate at the time of birth or adoption, on condition of at least ten months'
SMEREP 2016
SMEREP'S COMPLEMENTARY INSURANCE COVER IS AVAILABLE TO ALL STUDENTS
SMEREP's complementary insurance cover enables all students, regardless of their social security scheme, to
benefit from optimised health cover.
Social security only reimburses one part of your healthcare fees; SMEREP's complementary insurance will reimburse all or part of your fees.
SMEREP, a specialist in managing student healthcare, offers you a range of complementary insurance cover tailored to your needs and your
budget.
smerep.fr
@
TOTALE
INDISPENSABLE
8,25 €/month (99 €/year)
49 €/ month (588 €/year)
MÉDIANE
27.50 €/ month (330 €/year)
Perfect for optimal protection
+ max. of fixed fees covered
Practical cover in every
domain + fixed fees covered
General practitioners
and specialists: 200%
For you to design at smerep.fr
On sale exclusively at smerep.fr
and at SMEREP
reception centres
General practitioners
and specialists: 150%
Pharmacy: 100%
Pharmacy: 100%
Radiology: 200%
Hospitalisation: 100%
Eye care: 500% + fees up to 150 €
Radiology and analyses: 100%
Dental: 200% + fees up to 200 €
(except for pharmacy at 15%)
Eye care: 200% + fees up to 50 €
Hospitalisation: 100%
Dental: 100%
'Enjoying Life' scheme includes:
the pill, condoms,...
A very affordable price for
protection against unforeseen
health problems
General practitioners
and specialists: 100%
Pharmacy: 100%
SUR
MESURE
Hospitalisation: 100%
From 'basic' to 'top-end' cover,
the choice of reimbursement
scheme is yours.
The 'Sur-Mesure' cover offers you
exceptional reimbursements: up
to 400% for eye care and 300%
for dental care...
Compulsory civil liability
Compulsory civil liability
Compulsory civil liability
Compulsory civil liability
included in the SMEREP PACK
included in the SMEREP PACK
included in the SMEREP PACK
included in the SMEREP PACK
Date your SMEREP complementary health insurance takes effect
If you register before 31/12/2016:
Your health insurance takes effect on 01/10/2016 or, at the earliest, on the first official
day of term at the establishment where you are enrolled (on presentation of proof).
If you register from 01/01/2017:
Visit smerep.fr / 'Our health insurance and complementary insurance' to find out the
tariffs and dates the insurance takes effect.
In all cases, your health insurance will be valid until 30/09/2017 and
automatically extended.
Each affiliate will receive their insurance card together with the Heath Insurance
Terms and Conditions and Information Notices with the reference SMEREP 2016.
ARE YOU A GRANT HOLDER * ?
The Regional Council of the Ile-de-France offers you
assistance of up to 100 € for your complementary health insurance.
Your Indispensable SMEREP health insurance will cost you
0 € and will involved no advancing of fees if you present
your grant certificate for the year 2016/2017.
* See the conditions for allocating this assistance at smerep.fr /
'Our health insurance and complementary insurance / Complementary
insurance'.
0 €
STUDENT INSURANCE
PACK SMEREP
STUDENT INSURANCE
INCLUDED IN ALL SMEREP COMPLEMENTARY HEALTH INSURANCE
POLICIES, it includes the essentials of STUDENT INSURANCE .
COMPULSORY Civil Liability Insurance
and Medical Civil Liability,
Individual Accident,
Travel assistance / repatriation.
COMPULSORY Civil Liability Insurance
and Medical Civil Liability,
Individual Accident,
Travel / individual journeys / repatriation,
Hospitalisation for Accidents scheme,
The special offers of the SMEREP Club: cinema
invitations, exhibitions, gifts, discounts from our partners...
Register for our Student Insurance
for 13 € /YEAR only!
The PACK SMEREP can also be subscribed to
'SOLO' for 27 € /YEAR only!
MORE RAPID
NOT INCLUDED IN THE SMEREP COMPLEMENTARY INSURANCE.
You can subscribe to our health insurance, to student insurance and to other insurance policies directly at
ns if you
Reductio
EREP
are a SM
affiliate*
smerep.fr
INSURANCE - HEALTHCARE ABROAD, ACCOMMODATION, CAR / MOTORBIKE
from
WORLD PASS INSURANCE
33€ /
MONTH**
It covers 100% of your healthcare fees abroad within the
framework of your studies, an internship or a trip. 3 € / month
supplementary discount for SMEREP affiliates.
* You are a SMEREP affiliate if you have taken out a SMEREP health insurance policy or subscribed to the SMEREP PACK
in 2016-2017.
** 2015-2016 Tariffs
ACCOMMODATION INSURANCE
from
It is compulsory. 10 € supplementary
discount for SMEREP affiliates.
24€ /
YEAR**
CAR AND MOTORCYLE INSURANCE
Tariff discounts of up to 30%.
5
@
Website: smerep.fr
CONTACT section
@
YOUR PERSONAL AND FREE SPACE
My SMEREP
Track your healthcare reimbursements
with an email notification.
Download your entitlement certificate.
EHIC request, etc.
Telephone: 01 56 54 36 34
From Monday to Saturday from 9am to 6pm
(8pm on Thursday and 5pm on Saturday)
Postal address ONLY
for the sending of all your mail:
SMEREP
16, Boulevard du Général Leclerc
92115 CLICHY CEDEX
OUR CENTRES
Open according to the university calendar, except the general centre in Saint-Michel which is open all year.
Opening times available for consultation at smerep.fr, section CONTACT
ONLY AT
SMEREP
SAINT-MICHEL RECEPTION
54, Boulevard Saint-Michel - 75006 Paris
RER
B
M 10
Luxembourg
Cluny-La Sorbonne ou
M 4
Saint-Michel
Open Monday to Saturday:
Monday to Friday from 9am to 5.30pm (8pm Thursday)
Saturday from 9.30am to 5.30pm
Open on SATURDAY,
on THURSDAY until 8pm
with MULTILINGUAL STAFF
AT YOUR SERVICE
throughout the week.
English, Spanish and Chinese
Multilingual staff at your service throughout the week.
University Evry-Val-d’Essonne
Hall du bât. Maupertuis - local BW17
Rue du Père André Jarlan
91025 Evry Cedex
RER
D Evry-Courcouronnes
Université Paris 8 Vincennes - Saint-Denis
Campus Nord
Rue Georges Guynemer
93200 Saint-Denis
M 13 Saint-Denis Université
University Cergy Pontoise
Site universitaire Les Chênes
La Tour, 1st floor, office 114
33, Boulevard du Port
95011 Cergy Pontoise
RER A
Cergy Préfecture
Université Paris-Est Créteil Val-de-Marne
(UPEC)
Niveau dalle, next to the Maison de l'étudiant 61
61, Avenue du Général de Gaulle
94000 Créteil
M 8
Créteil-Université
OUR OFFICES
Located in education establishments,
they are open to all students.
Université Paris-Est Marne-la-Vallée
(UPEMLV)
Maison de l'étudiant - 1er étage - bureau B14
5, Boulevard Descartes
77420 Champs-sur-Marne
RER A
Noisy-Champs
University Paris-Ouest Nanterre
la Défense
Maison des étudiants,
1st floor, room R101
200, Avenue de la République
92001 Nanterre Cedex
RER A
Nanterre-Université
University Paris-Sud 11 Orsay
Centre Orsay - Bât. 332 - 2nd floor
91405 Orsay Cedex
RER B
Bures-sur-Yvette
Head office
28, Rue Fortuny
75017 Paris
NEW
EVENING SERVICE ON THURSDAY EVENINGS
Opening times and contact details
available at:
@
01 56 54 36 34
or in the smerep.fr, section
CONTACT
6
Our Saint-Michel centre and
our telephone line
are open every Thursday from 9am to 8pm
p-17-0416-bro-A © SMEREP - Non-binding document (excluding the subscription form on pages 7 et 8) - La Société Mutualiste des Étudiants de la Région Parisienne (SMEREP), SIREN No. 775 684 780 is a member of the Union Mutualiste Générale de Prévoyance (UMGP), SIREN No. 316 730 662, subject to the provisions of
Book II of the Code de la Mutualité.
SMEREP LOOKS AFTER YOUR HEALTHCARE
EVERYWHERE IN FRANCE
ANNUAL MEMBERSHIP BULLETIN: 2016/2017 SMEREP COMPLEMENTARY
INSURANCE, PACK OR STUDENT INSURANCE
SMEREP
Please fill out this form using a ballpoint pen in capital letters, sign it and send it to:
SMEREP - Service Adhésions - 16 boulevard du Général Leclerc - 92115 Clichy Cedex.
You must enclose a RIB (your bank details) for the reimbursement of your treatment, regardless of the means of payment chosen, a copy
of your ID and a copy of your student card. If, in the course of the year, your details change, please let us know.
YOU:

Ms

Space reserved for SMEREP
Origin
Place
OP Code.
Agent
Subscription form valid until 31/12/2016
YOUR BENEFICIARIES:
Mr
Name: ..........................................................................................................................
Your spouse, common law partner or civil partner (if he/she is not a student, he/she
can be included as a beneficiary)
Name: ................................................................................................................................
Maiden name: ..............................................................................................................
First name(s): ...............................................................................................................
First name: ..........................................................................................................................
Social Security N°:
Address: .......................................................................................................................
.....................................................................................................................................
Postcode:
Town: .........................................................................
Tel. N°: Home:
Mobile:
Email: ........................................................................................................................
Your children
Name(s):
...............
...............
...............
...............
For your beneficiaries, remember to enclose a copy of their ID
and a copy of your family record book or certificate of marriage / cohabitation
/ civil partnership / birth.
Date of birth:
day
month
TICK THE APPROPRIATE BOX:
year
Place of birth: ............................................ County/State:
Country: ..................
Date of
Place of County/
Gender
First
Nationality
State
birth
birth
M/F
name(s)
..................... ....... ............................ ............... ...............
..................... ....... ............................ ............... ...............
..................... ....... ............................ ............... ...............
..................... ....... ............................ ............... ...............
(same scheme and services for you and the children registered on this subscription form) Nationality: .................................................................................................................
Annual tariff
adult
Services offered
SMEREP ID N°:
Annual tariff
child - 50 %
Social Security N°:
Indispensable SMEREP
 99
If you are registered with a social security centre other than Centre 617- SMEREP, do
you wish to benefit from the automatic transferral of your reimbursements from your
social security centre to your SMEREP health insurance policy?  yes  no
Remember to send us a copy of a valid entitlement certificate and, where applicable, that of
your spouse, common law partner or civil partner (PACS) if that person is your beneficiary.
Médiane SMEREP
 330
€
 165
Totale SMEREP
 588
€

Sur-Mesure SMEREP
On sale exclusively at www.smerep.fr and
at the reception centres
PACK SMEREP only
 27
€
Assurance étudiante
 13
€
YOUR HIGHER EDUCATION ESTABLISHMENT
(student insurance)
€
 49.50
€
€
294 €
Name: .......................................................................................................................
.................................................................................................................................
Reserved space
at SMEREP
Address: ..................................................................................................................
.................................................................................................................................
Are you in your last year of study?

yes

no

Date of health insurance
taking effect:
don't know
Date of PACK SMEREP or
student insurance
coming into effect:
YOUR MODE OF PAYMENT:

Cash payment:
Pay your contribution by filling in the box 'YOUR
PAYMENT'’ below.
YOUR PAYMENT:

Cash (at SMEREP reception centres only)
SMEREP signature
CONFIRMATION OF RECEIPT

Cheques payable to SMEREP

Bank Card
Pay by direct debit
(excluding the PACK SMEREP or Assurance étudiante)
Because health insurance is a substantial investment, we offer you the option of
paying in monthly instalments if you register before 31 / 12 / 2016 inclusive. You
pay an advance which includes the first two months of contributions at the
time of subscribing + your direct debit bank fees of 5 €. Then you pay via 10
automatic direct debits on the 10th of each month, starting in December 2016.
These payments can be debited from your personal account or from a nominated
account - your parent's account, for example.
Indispensable SMEREP, adult: advance of 21.50 € + 10 instalments of 8.25 €
Indispensable SMEREP, child: advance of 8.30 € + 10 instalments of 4.12 €
Médiane SMEREP, adult: advance of 60 € + 10 instalments of 27,50 €
Médiane SMEREP, child: advance of 27.50 € + 10 instalments of 13.75 €
Totale SMEREP, adult: advance of 103 € + 10 instalments of 49 €
Totale SMEREP, child: advance of 49 € + 10 instalments of 24.50 €
Bank Card N°:
month monthyear
year
Date:
2 Pay your advance by filling in the box 'YOUR PAYMENT'
Signature:
day
day

1 Details of direct debits:
Holder: ...............................................................................................................
Expiry date:
OR
month
month
year
year
opposite.
3 Complete your European (SEPA) direct debit authorisation overleaf.
7
TERMS AND CONDITIONS, VALIDATION AND SIGNATURE OF YOUR SUBSCRIPTION FORM
Non-payment: I accept that I am under the obligation to pay the full amount of my subscription to SMEREP. In the event of an incident which is the account holder's responsibility when a direct debit
becomes due, I recognise the right of SMEREP to:
• Suspend the payment of any service which is due to me until this amount is paid in full, in accordance with Article L. 221-7 of the Code de la Mutualité.
• To reimburse retroactively the services covered by the insurance scheme once the subscription payments have been made.
SMEREP processes, and is responsible for, personal data concerning you for the purposes of managing your request for affiliation, managing and tracking its relationship with its affiliates and fulfilling its
contractual obligations (particularly relating to services and the associated accounts), processing claims, organising events, selecting and prospecting, managing payment and debt recovery, managing
and monitoring liquidations, carrying out studies and surveys, managing customer satisfaction, applying internal safeguards against fraud, money laundering and the financing of terrorism, managing legal
disputes and, more generally, for the purposes of acquitting itself of its legal, regulatory and administrative obligations.
To receive useful information
on social security and on all
the advantages of the SMEREP
Club, remember to tick
THIS BOX.
All responses requested on this form are compulsory. If any are absent, your affiliation may not be approved or its processing may be delayed.
The recipients of the data are the authorised departments at SMEREP, its technical partners and the authorities who are entitled to have knowledge of this
data.
In accordance with the provisions of Law 78-17 of 6 January 1978, you have the right, on legitimate grounds, to question, access, rectify or dispute the
processing of the data which concerns you, as well as the right to preclude commercial canvassing. These rights may be exercised by sending a letter by post,
accompanied by a signed proof of identity, to SMEREP - Service Informatique et libertés – 16, bd du Général Leclerc – 92115 CLICHY CEDEX.
 I agree to receive commercial offers by post and electronically (email, text, MMS, etc.) from SMEREP and its partners.
In addition, if you do not wish to receive information emails from SMEREP or its service providers, you can, by following the link contained in each email, terminate the sending of these messages.
In signing this subscription form, you explicitly agree to personal data concerning your health and, where applicable, as the parental authority, data concerning your children as beneficiaries,
being processed within the framework of providing the services set out in the contract and for the technical operations which are required for implementing the policies and services and for
which this data must be processed, failing which these policies and services cannot be implemented.
!
The subscription is automatically renewed for 12 months from the date when your SMEREP policy takes effect (except for student insurance). You can cancel your subscription at the
end of each year, in accordance with the provisions of the 'Règlement mutualiste'.
I have read the statutes, the Health Insurance Terms and Conditions and Information Notices with the reference SMEREP 2016, which can be consulted at www.smerep.fr, are available at the SMEREP
reception centres and can be obtained by written request to: SMEREP - Service Adhésions - 16, boulevard du Général Leclerc - 92115 Clichy Cedex, and I accept the terms and conditions. In particular, I
am aware of the total subscription due, of the minimum duration of my subscription, of the content of the guarantees and exceptions, of French law pertaining to my contract, of the language in which I
conduct my dealings with SMEREP, and of the modalities for examining claims and for seeking mediation.
I request that my subscription take effect as of now, being aware of my right, in accordance with Article 6 of the 'Règlement mutualiste' (health insurance regulations), to cancel my subscription
in writing by sending a letter by registered post to SMEREP - Services Adhésions – 16, boulevard du Général Leclerc – 92115 Clichy cedex – within 30 days of the date of subscription to my
SMEREP policy (a standard cancellation letter is appended to the 'Règlement mutualiste').
Signature:
Signed at (place): ........................................................................................................... On:
day
month
year
REMEMBER TO FILL IN THE SUBSCRIPTION FORM IN FULL AND TO SIGN IT.
EUROPEAN (SEPA) DIRECT DEBIT AUTHORISATION
Reference Number of the Authorisation:
In signing this authorisation form, you authorise SMEREP to send instructions to debit your account to your bank or to the bank of your nominated
guarantor (your parents, for example) to debit their account. You also authorise your bank to debit your account (or the bank of your guarantor to
debit their account), in accordance with SMEREP's instructions.. NB: direct debits cannot be set up on savings accounts.
You have the right to be reimbursed by your bank according to the terms and conditions of the agreement which you have signed with it. A request
for reimbursement must be presented within the 8 weeks following the date on which your account is debited for an authorised instalment.
Please complete the fields marked with an asterisk*
Account holder:
Name * : ............................................................................................................................................................................................
Surname / First name of Account Holder
Your address * : ................................................................................................................................................................................
Street number and name:
Town * : ...........................................................................................................................................
Postcode * :
Country *: .........................................................................................................................................................................................
Your account details *:
IBAN (International Bank Account Number)
BIC (Bank Identifier Code)
Name of creditor : SMEREP
S.C.I : FR52ZZZ396871
SEPA CREDITOR IDENTIFIER
Address of creditor: 16, boulevard du Général Leclerc - 92115 Clichy CEDEX
Country : France
Type of payment :
Scheduled payment (corresponds to your monthly instalments)
Signed at *: .................................................................................
Place
Signature(s)* Please sign here:
Date:
day
month
Periodic payment
year
To be returned with your subscription form to:
SMEREP
16, boulevard du Général Leclerc
92115 Clichy CEDEX
Note: Your rights concerning the present authorisation are explained in a document which you can obtain from your bank.
© SMEREP - Legally binding document - La Société Mutualiste des Étudiants de La Région Parisienne (SMEREP) - 16, boulevard du Général LECLERC - 92115 Clichy CEDEX, N° SIREN 775 684 780
is affiliated to the Union Mutualiste Générale de Prévoyance (UMGP), N° SIREN 316 730 662, subject to the provisions of Book II of the Code de la Mutualité.
To be filled in only if you have opted for payment by monthly direct debit, and enclosing your RIB (bank details).