In France, a list of 30 diseases recognized as “long-term illnesses” or ALD can be covered 100% by health insurance because they require prolonged and costly treatment. There is also an ALD 31 and ALD 32 list.
Several categories of diseases can be 100% covered by the Caisse Primaire d’Assurance Maladie (CPAM). These are conditions that involve prolonged treatment and particularly expensive therapy. These diseases are listed on a list of 30 long-term conditions (ALD 30)established by decree in the Official Journal of January 21, 2011. A person suffering from a disease registered on the ALD 30 list can benefit from the ALD allowance, ie exemption from the co-payment. There is also a list of ALD 31 and ALD 32.
What is the list of 30 long-term conditions (ALD 30)?
- disabling stroke;
- long-term psychiatric conditions including recurrent depression, bipolar disorder;
- progressive ulcerative colitis and Crohn’s disease;
- chronic arteriopathy with ischemic manifestations;
- type 1 diabetes and type 2 diabetes in adults or children;
- complicated schistosomiasis;
- severe primary immune deficiency requiring prolonged treatment, human immunodeficiency virus (HIV) infection;
- severe forms of neurological and muscular disorders (including myopathy), severe epilepsy;
- severe constitutional and acquired haemoglobinopathies, haemolysis;
- hemophilias and severe constitutional disorders of hemostasis;
- severe heart failure, severe arrhythmias, severe valvular heart disease, severe congenital heart disease;
- bone marrow failure and other chronic cytopenias;
- severe chronic respiratory failure: COPD, severe asthma;
- Alzheimer’s disease and other dementias;
- chronic active liver diseases (hepatitis B or C) and cirrhosis;
- coronary disease: myocardial infarction;
- hereditary metabolic diseases requiring prolonged specialized treatment;
- cystic fibrosis;
- Parkinson disease ;
- severe chronic kidney disease and primary nephrotic syndrome (kidney failure);
- paraplegia;
- active rheumatoid arthritis;
- aftermath of organ transplantation;
- multiple sclerosis;
- progressive structural idiopathic scoliosis;
- severe spondyloarthritis;
- active tuberculosis, leprosy;
- malignant tumour, malignant disease of the lymphatic or hematopoietic tissue including:
- colorectal cancer ;
- skin cancer ;
- Prostate cancer ;
- thyroid cancer;
- bladder cancer;
- cancer of the upper aero-digestive tract;
- Cervical cancer ;
- lung cancer ;
- breast cancer ;
- lymphoma.
29. vasculitis,
30. systemic lupus erythematosus, systemic sclerosis.
NB: Severe arterial hypertension is no longer part of the ALDs since the decree of June 24, 2011. This deletion is based on the opinions issued by the High Authority for Health (HAS), emphasizing that isolated arterial hypertension is a factor of risk and not a proven pathology. Hypertensive treatments prescribed for another long-term condition such as diabetes or a cardiovascular condition remain covered like any treatment prescribed under these exempting ALDs.
What is the list of 31 long-term conditions (off-list or ALD 31)?
Off-list conditions, known as “ALD 31”, are severe pathologies of progressive or disabling form, which are not included on the list of ALD 30, but which involve prolonged treatment of a foreseeable duration of more than 6 months and therapeutic particularly expensive. This is, for example,congenital malformation of the limbs, recurrent episodes of pulmonary embolism, Paget’s disease, age-related macular degeneration (AMD), asthma….
For care to be accepted in off-list ALD, the treatment must include drug treatment or equipment.
2 of the following 4 criteria are also mandatory:
- future hospitalization;
- repeated medical technical procedures;
- repeated biological acts;
- frequent and regular paramedical care.
What is ALD 32?
ALD 32 concerns people with “polypathologies”, that is to say several characterized conditions which lead to a debilitating pathological state and which require treatment for a period of more than 6 months. This is, for example, a person suffering from blindness who also suffers from the after-effects of a hip fracture limiting her in her movements.
What is the list of long-term psychiatric conditions?
Three medical criteria must be met to open the right to exemption from the co-payment under ALD 23 called “Long-term psychiatric disorders”: the diagnosis of the condition, its seniority and its functional consequences in life daily in direct relation to the affection. The initial exemption is granted for a period of 5 years, renewable. The pathologies selected must be more than one year old at the time of the request (the attending physician must provide chronological markers on the history of the condition):
- Psychoses such as schizophrenia and persistent delusional disorder;
- Recurrent or persistent mood disorders (bipolar disorder or depressive disorder);
- Intellectual disabilities and serious developmental disorders during childhood (mental retardation, childhood psychoses, autism, PDD, etc.);
- Severe neurotic disorders and serious personality and behavioral disorders (serious anxiety disorders, phobias, OCDs, borderline states, profound personality disorders, etc.);
- Eating disorders (anorexia nervosa).
On the other hand, acute and transient psychotic disorders (isolated delirious outbursts), isolated depressive episode, or acute reaction to a stress factor do not come under the exemption from the co-payment.
Is a rare disease an ALD?
A rare or orphan disease is considered as such when it is chronic, progressive, life-threatening and can lead to different types of disabilities. Even if there is no specific ALD for each of them, the majority of these diseases are directly or indirectly part of the 30 long-term conditions or they can be considered under ALD 31 or 32.
If you think you could benefit from an ALD, check with your attending physician. If this is the case, you must imperatively respect the course of coordinated care in order to obtain optimal reimbursement of the health costs inherent to your condition.