ALD allowance: amount, request, for whom?

L’allocation ALD allows total coverage by the Health Insurance of care given to a person suffering from a chronic disease recognized as a long-term condition. You must be over 20 to qualify. What are the other terms? How to apply?

Definition: what is the ALD allowance?

AllowanceLong Lasting Affection (ALD) is intended for all people suffering froma chronic and/or serious illness. The costs of health care inherent in this disease are then covered 100% by the Health Insurance. On the other hand, the care necessary for other possible illnesses is not not 100% covered.

What are ALDs?

The list includes 30 diseases :

• Disabling stroke.
• Bone marrow aplasia and other chronic cytopenias.
• Chronic arteriopathies with ischemic manifestations.
• Complicated bilharziasis.
• Severe heart failure, severe valvular heart disease, severe arrhythmias, severe congenital heart disease.
• Active chronic liver diseases and cirrhosis.
• Severe primary immune deficiency requiring prolonged treatment, human immunodeficiency virus (HIV) infection.
• Type 1 diabetes and type 2 diabetes.
• Severe forms of neurological and muscular disorders (including myopathy), severe epilepsy.
• Hemoglobinopathies, hemolysis, chronic constitutional and severe acquired.
• Hemophilias and severe constitutional disorders of hemostasis.
• Coronary infarction.
• Severe chronic respiratory failure.
• Alzheimer’s disease and other dementias.
• Parkinson disease.
• Hereditary metabolic diseases requiring prolonged specialized treatment.
• Cystic fibrosis.
• Severe chronic nephropathy and primary nephrotic syndrome.
• Paraplegia.
• Periarthritis nodosa, acute systemic lupus erythematosus, progressive generalized scleroderma.
• Severe progressive rheumatoid arthritis.
• Long-term psychiatric disorders.
• Progressive ulcerative colitis and Crohn’s disease.
• Multiple sclerosis.
• Progressive structural scoliosis (with an angle equal to or greater than 25 degrees) until spinal maturation.
• Severe ankylosing spondylitis.
• Organ transplant aftermath.
• Active tuberculosis, leprosy.
• Malignant tumor, malignant disease of lymphatic or hematopoietic tissue.

Added to this list are: severe forms of a disease not appearing on the ALD 30 list, but which require prolonged treatment of a foreseeable duration of more than 6 months and particularly costly therapy. This list is called ALD 31 and includes in particular cases of congenital malformation of the limbs, repeated episodes of pulmonary embolism, Paget’s disease, age-related macular degeneration (AMD), asthma, etc. Several conditions causing a disabling medical condition requiring continuous care for a foreseeable duration of more than six months. They are part of a ALD list 32. This applies to people with “polypathologies”, that is to say suffering from several conditions causing a disabling pathological state: for example, a person suffering from blindness who also suffers from the after-effects of a hip fracture limiting his movements, a person suffering from polyarthrosis and urinary incontinence …

What are the conditions to benefit from it?

The criteria are:

• To be suffering from a disease listed on the ALD 30, ALD 31 or ALD 32 lists
• To be old more than 20 years

What is the amount of the ALD allowances?

The CPAM reimburses medical expenses up to 100% of the Social Security reimbursement base.

An ALD allocation opens right to exemption from co-payments. It means that the patient benefits from 100% coverage by health insurance. Concretely: the CPAM reimburses medical expenses up to 100% of the Social Security reimbursement base. For all sector 1 doctor consultations, no fees are payable

First of all, it is necessary to contact the attending physician who will declare the disease as chronic and/or serious. It is he who will take care ofsend the request for coverage to the insured’s health insurance fund. A document is sent to the patient to inform him of the obtaining of the allowance. He must then update his vital card and present the document received to the doctors that he has to consult within the framework of his ALD.

Sources: Health insurance / APAMAD