Health Insurance Option for Craftsmen: Ends with Professional Activity

Imagine: you are a craftsman in Bagnols-sur-Cèze, you have contributed for years to the general health insurance scheme in addition to your compulsory scheme. One day, you retire, and you discover that you lose the benefit of the scheme you had chosen. This is exactly what happened to an Alsatian craftsman, and the Cour de cassation ruled. The option right (the possibility to choose your health insurance scheme) ends with the professional activity that justified it. Analysis of this 1985 decision, still relevant today.

What happens when you cease your activity? The health insurance scheme you are affiliated with may change, regardless of your will. The commented decision concerns a craftsman who, after ceasing his activity, was automatically re-affiliated to the non-salaried workers' scheme, even though he had opted for the general scheme. A situation that may seem unfair, but is based on logic: the option right is linked to the exercise of the activity. Without it, no option.

This decision, although old, remains a reference for all self-employed workers, craftsmen, traders or liberal professions who plan to cease their activity. It establishes a simple rule, but with serious consequences: if you change your status or retire, your health coverage may be modified. So, how to anticipate? Follow the guide.

The Facts: A Story Like Many Others

Mr. X, a hairdresser craftsman in Strasbourg, obtained in 1972 from the Regional Old-Age Insurance Fund for Salaried Workers the benefit of the general health insurance scheme. He then ceased his craft activity on April 1, 1975. Problem: the Craft Old-Age Insurance Fund of Strasbourg considered that he should be affiliated to the non-salaried workers' scheme from that date. The craftsman contested: he had opted for the general scheme and believed that this choice should continue even after cessation of his activity.

The case was brought before the Colmar Court of Appeal, which ruled in favor of the craftsman. The judges considered that the option right, once exercised, was final. But the Craft Fund appealed to the Cour de cassation. The Cour de cassation, in its judgment of March 6, 1985, quashed the appeal judgment and referred the case to another court of appeal.

The twist? The High Court held that the option right provided for by Article 4 paragraph III of the Law of July 12, 1966 (a text that allowed certain craftsmen to choose their health insurance scheme) ended with the professional activity. In other words, as soon as the craftsman ceases his activity, the option right expires, and he is automatically affiliated to the non-salaried workers' scheme corresponding to his former activity.

The Reasoning of the Court — Explained

The Cour de cassation based its decision on a strict interpretation of Article 4 of the Law of July 12, 1966. This text, in its version prior to the Law of December 28, 1979, opened an option right to craftsmen who were covered both by the general scheme (for a previous salaried activity) and by the non-salaried workers' scheme (for their craft activity). But this right was linked to the exercise of the professional activity: it does not survive its cessation.

The judges found that the Court of Appeal had misapplied the law. Indeed, the option right is a temporary advantage, attached to the status of a craftsman in activity. Once the craftsman ceases his activity, he loses this status, and therefore the option right. The rule is simple, but it has important consequences: automatic re-affiliation to the non-salaried workers' scheme, even if the craftsman had contributed longer to the general scheme.

The Court also specified that the affiliation is made to the scheme covering the craft activity, not to the scheme to which the craftsman had paid the most contributions. Thus, even if the craftsman had contributed for 20 years to the general scheme as a salaried worker, and only 5 years as a craftsman, it is the non-salaried workers' scheme that applies after cessation of activity. A solution that may seem unfair, but is based on the principle of specialty: each activity has its own scheme.

What It Changes for You — Concretely

For craftsmen and self-employed workers, this decision means that the choice of health insurance scheme is not final. If you cease your activity (retirement, sale of the business, etc.), you will be affiliated to the non-salaried workers' scheme, regardless of your previous choice.

Take an example: a plumber craftsman in Vauvert, aged 62, worked for 30 years as a salaried employee before becoming self-employed for 10 years. He opted for the general scheme. Upon retirement, he will be automatically affiliated to the non-salaried workers' scheme (SSI, formerly RSI). Consequence: his health insurance contributions will be calculated on his craft income, not on his retirement pensions. If he has high property income or pensions, he may pay more.

For landlord owners, this decision has no direct impact, but it illustrates an important principle: social status is linked to the activity carried out. If you are a craftsman and you rent out properties, your health insurance scheme depends on your main activity. In case of cessation, your coverage may change.

If you are in this situation, you must anticipate. Contact your health insurance fund before cessation of activity to find out the affiliation procedures. You may also take out a complementary health insurance adapted to your new situation.

Four Tips to Avoid This Type of Dispute

• Anticipate your cessation of activity: Ask your health insurance fund at least six months before the planned cessation date. Request a simulation of your future affiliation and contributions.
• Keep all your contribution records: Keep the contribution statements from the different schemes to which you have been affiliated. This will allow you to prove your initial option right if necessary.
• Do not rely on a final option right: As this judgment shows, the option right is temporary. If you plan to cease your activity, prepare for a change of scheme.
• Consult a lawyer specialised in social security law: If you have any doubt about your situation, a consultation can save you costly mistakes. Maître Zakine can advise you on possible options.

Further Reading: Related Case Law and Developments

This decision of the Cour de cassation is part of a consistent line of case law. It has been confirmed by subsequent judgments, notably by the Cour de cassation itself in similar cases. For example, a judgment of July 12, 1990 reiterated the same principle for a trader. The trend is clear: the option right is linked to the activity.

Since the Law of December 28, 1979, the rules have evolved. The option right was abolished for new craftsmen, but pre-existing rights remain subject to earlier case law. Thus, this 1985 decision remains relevant for craftsmen who opted before 1979.

For the future, the merger of social schemes (CPSTI, formerly RSI) has simplified things, but the principle remains: a change of activity or cessation entails a change of scheme. Courts continue to apply this logic, meaning you must remain vigilant.

Key Points to Remember

• The option right for the general scheme ends with the craft activity: as soon as you cease your activity, you are re-affiliated to the non-salaried workers' scheme.
• Affiliation is made to the scheme of your craft activity: regardless of whether you contributed longer to the general scheme.
• Anticipate changes: inform your fund before cessation to avoid unpleasant surprises.
• This decision is still relevant: even though the texts have evolved, the principle applies to rights acquired before 1979.

Are you in a similar situation? A first 30-minute consultation with Maître Zakine (€45) can save you months of proceedings — and often much more. Book an appointment →