France’s healthcare system provides some of the best public healthcare in the world, although private health insurance is necessary for certain circumstances.
All legal residents in France are obliged by law to have health insurance in France. Many expats are now eligible to apply for state French health insurance (l’assurance maladie) in order to access France’s world-renowned healthcare system now that the French government has instated a new universal healthcare insurance system known as the Protection Maladie Universelle (PUMA) in January 2016. Individuals who are not covered by the PUMA or might want to increase their health coverage must apply private health insurance while living in France.
International health insurance provider Aetna International explains who is eligible for public medical insurance in France and whether they need to avail of private French health insurance for foreigners.
This guide covers the following topics:
- Changes to health insurance in France
- Am I eligible for state French health insurance?
- Student health insurance France
- How to apply for French health insurance
- Rates of contributions to the state healthcare insurance scheme
- What is covered under state healthcare insurance in France
- Health insurance in France for low-income and unemployed residents
- Private health insurance in France
- Choosing a French health insurance company
- Healthcare vocabulary in France
Aetna International is one of the largest international health benefits providers. By delivering comprehensive health benefits and population health management solutions worldwide, they are committed to helping create a stronger, healthier global community. Their award-winning expatriate business provides health benefits to more than 800,000 members worldwide.
On 1 January 2016 the Protection Maladie Universelle (PUMA) replaced the old French health insurance scheme Couverture Maladie Universelle (CMU), and now grants all residents in France – including foreigners – easier access to health services in France.
Under PUMA, legal permanent residents in France are entitled to state health insurance in France if they have lived in the country for three consecutive months on a ‘stable and regular basis’. This healthcare reform has simplified the requirements for workers and residents in France to qualify, as unlimited healthcare access will now be an automatic and continuous right of all residents regardless of age, prior medical history and record of paying French social security contributions (cotisations sociales).
Previously, France health insurance for foreigners was only offered if a number of living or employment conditions were met. If their living or employment situation changed, they were urged to apply for state health coverage under a different and more suitable category, sometimes leaving periods when they were not covered by any health insurance in France.
The new PUMA scheme guarantees that any legal resident in France will be able to stay with their French health insurance plan despite changes in their personal circumstances or loss of employment/business. This also means that those who received French health insurance through the old CMU system will no longer have to apply yearly to renew their coverage – effectively reducing the administrative burden on state insurance recepients.
PUMA also equalises the rights of European Union (EU) and non-EU citizens to apply for their carte vitale (health insurance card) and receive French health insurance after three months of residency in France. Non-EU citizens already enjoyed this right prior to 2016, while EU citizens had to wait five years before they could apply for health insurance in France – a law that was largely criticised for undermining the latter’s free movement within the European Union.
The CMU–complémentaire (CMU-C), a program that provides free health insurance in France for low income or unemployed persons, will also continue to be in place to complement the PUMA. Read below whether you are eligible for the CMU-C.
The healthcare reform will mostly affect residents who were previously not covered by employment or business-based health insurance in France, current recipients who have had changes in their personal or employment circumstance and new residents in France. It has no practical implications to those who are currently employed, self-employed or retired EU expats with a valid S1 form.
Who can apply for the new French health insurance scheme?
Expats who are living in France can apply to receive state health insurance in France under the new PUMA program if they have lived in France for less than five years, do not have paid employment, are under the national retirement age of 65 years and do not receive a pension from an European country. Non-European students who are older than 28 years with no salaries and British early retirees are also eligible if they receive no salary.
You can apply for health insurance in France as soon as you have completed three months of consecutive residency. If approved, the government will assess whether you need to pay contributions towards the Unions de Recouvrement des Cotisations de Sécurité Sociale et d’Allocations Familiales (URSSAF). You would have to find private health insurance in France if your application is rejected.
As a general rule, all individuals – including foreigners – who plan to live long-term in France must have French health insurance. All legal residents in France and salaried employees who pay into the French social security system will be eligible for state medical insurance in France, although there are some exceptions depending on your situation. Find out below whether you can access public health insurance in France.
Residents in France
Following the health regime change to the new PUMA scheme, all residents who have proof of stable and regular residency in France for at least three consecutive months per year are entitled to health insurance in France. ‘Stable and regular’ residency means your family or principal home is in France, where you must have initially lived for three continuous months and will do so for at least six months (183 days) yearly thereafter.
Unemployed or low-income legal residents are also entitled to French health insurance and can get subsidies through the CMU-C.
Employees who work in France are entitled to French healthcare insurance through the cotisations sociales (social contributions) they pay to the French social security system.
Self-employed freelancers and business owners
Freelance micro-entrepreneurs (sole traders) and Société à Responsibilité Limitée (SARL) or private limited liability corporate entity business owners can access medical insurance in France through the Régime Social des Indépendants (RSI).
EU, EEA and Swiss citizens
Citizens from the European Union (EU), European Economic Area (EEA – EU plus Iceland, Liechtenstein and Norway) and Switzerland and their families who are staying temporarily (and not working) in France can typically use their European Union Health Insurance Card (EHIC). However, French health insurance is applicable once you become a resident or stay long-term in France.
EEA and British retirees
Retirees from the UK and the EEA who are receiving pensions from their home countries and have their principal residence in France can apply to French health insurance if they have a valid S1 form (formerly E121 and E106). This form is usually issued by respective national health departments and confirms the holder’s long-term commitment to living in France.
Children aged 16 years and under
Anyone who is 16 years old and under is automatically eligible for healthcare insurance in France regardless of their nationality.
Foreign students aren’t typically recognised as ‘French residents’, meaning most students must acquire the required Students’ Social Security (Sécurité Sociale Etudiante), which covers health expenses while in France, unless they fall within the following categories:
- EU or EEA citizens with a valid EHIC
- A resident of Quebec with social security coverage
- A French government scholarship recepient
- A student with plans to study in France for less than three months
- Non-EEA citizens who are older than 28 years and have no salaried employment (in which case, they can apply for health insurance in France under the PUMA scheme.)
Students who live in France for less than six months per year (183 days) will not generally be eligible for public healthcare. Those who are not eligible for state healthcare insurance in France will find a range of affordable options for private health insurance in France.
Visit the French government’s health insurance department L’Assurance Maladie‘s (AMELI) website to read more about France’s health insurance for foreigners.
The first step to acquiring health insurance in France is to either join the French social security system or visit your local CPAM (Caisse Primaire d’Assurance Maladie). If you’re employed, your employer will typically register you with social security and then arrange your healthcare formalities, although it is your responsibility to check this has been done. Self-employed workers apply via the Régime Social des Indépendants (RSI).
If you qualify under PUMA, you can visit your local CPAM (Caisse Primaire d’Assurance Maladie) or send your application by post. The CPAM will assess your health rights but it is the social security authority URSSAF that will determine if you need to pay contributions towards your healthcare costs; if you earn below a certain threshold, you will qualify for free healthcare (under CMU-C).
You will typically be asked to present a CERFA form, proof of identity and legal residence (passport and visa), translated birth and marriage certificates, proof of three-months’ residence in France (utility bills, rental agreement), bank details (RIB) and evidence of income and your declaration de medecin traitant (doctor registration). During registration, you can also add beneficiaries or dependents (ie. husband, wife, legal partner or children) to your health insurance in France. After you have registered, the CPAM will ask you to send proof of income to determine your contribution amount, if necessary. For more information you can call the CPAM’s English-speaking helpline at 3646 (from France) or +33 811 70 3646 (from abroad); fees apply.
Once you have been approved and activated your health insurance in France, you may need to make a formal request for your carte vitale (green card), the national insurance card in France, as it is not always automatically issued. The card includes information necessary for making healthcare claims but does not store medical information. It is recommended to ask for an attestation de couverture sociale or a temporary French health insurance card as a carte vitale can sometimes take long to process.
You will need to present your carte vitale at every health appointment (doctor, hospital, pharmacy) and will generally receive reimbursement directly into your bank account within a week. You can update your carte vitale annually by inserting it in the green box that can be found at CPAM offices and some hospitals and pharmacies.
Anyone working in France will have social contributions (cotisations sociales) automatically deducted from their salaries to cover their state healthcare insurance in France. Costs vary according to a number of factors, including your income and household, but it averages around 8% of your net income above a minimum threshold set by the state; retirees and non-resident taxpayers typically pay less. Visit CLEISS (Centre des liaisons Européennes et internationales de sécurité sociale) for the full list of French health insurance contribution rates as of 1 January 2016. The percentage of cotisations sociales deductions are amended by the government yearly.
If you are unemployed or your annual income sits under the government thresholds, and you do not have private health insurance in France, you are eligible for free complementary state-funded healthcare, known as CMU–complémentaire (CMU-C). The current income thresholds per household for 2016 are as follows:
- Single-person household: €8,653
- Two-person household: €12,980
- Three-person household: €15,576
- Four-person household: €18,129
- Each additional person in a household with more than four people: €3,461 each.
Income is determined by your household’s combined earnings during the prior 12 months before you apply for CMU-C. Expats must also first activate PUMA before qualifying for CMU-C. Once you have been deemed eligible, all medical and dental costs will be fully covered and you will not be asked for upfront payments after healthcare services have been rendered. You can apply for the CMU-C by filling in this form and submitting it to your local CPAM (Caisse Primaire d’Assurance Maladie).
Adult patients older than 16 years old and covered by the state medical insurance in France are required to register with a family doctor (médecin traitant) to access the full reimbursement of their medical costs. Failure to do so will lead to penalties of higher medical fees and lower reimbursement rates. Those who are 16 years of age and younger are able to go to any GP without fear of financial penalty. You will receive a Declaration de Médecin Traitant after registration. Read Expatica’s guide of how to register with French doctors.
The majority of your medicals costs will be reimbursed through state health insurance in France, usually in the region of 70% for visiting a doctor, dentist or specialist, around 80% of French hospital costs, and up to 100% of prescribed medications. The rest of the medical fees have to be covered by the patient.
Carte vitale holders are not required to make upfront payments, while patients without a card must pay the appropriate medical fees at the point of service. French healthcare insurance reimbursements are then sent directly to your bank account and usually take five to 10 business days.
Dental care under French health insurance
Dental care is covered under the state-run French healthcare insurance, but comes with its own tariffs and reimbursement rates. General dental treatments are reimbursed in the same way as other care that falls under the specialist category, but your reimbursement for advanced procedures will be typically less due to the higher cost.
To make up the difference of what French health insurance does not cover, many French residents subscribe to a private health insurance policy, known as a mutuelle. There are many mutuelles to choose from, some of which are catered to specific professions while others are aimed at English speakers. If you’re an employee of a company, you will most likely be able to join the company’s policy as part of your benefits package. Meanwhile, students can either choose to be covered by their parents’ mutuelle or select their own private health insurance in France.
Most of these French insurance companies will reimburse the remaining 30 percent of your general healthcare costs, including emergency hospital treatment. The cost of private care depends on the type of cover required and factors such as the age of the applicant, although few mutuelles ask for your health details prior to approval. Basic packages tend to focus on hospital care and medicine, but may include limited cover for dental treatment.
Unlike health insurance in some other European countries, however, private health insurance in France does not guarantee faster treatment nor is it associated with private practitioners. It simply acts as a way of bridging the 30% gap left by the national French healthcare insurance coverage.
State insurance typically also does not cover consultations with psychologists, osteopaths, chiropractors and certain specialists. If you require any specialist treatments, particularly for those with pre-existing illness or chronic condition, private medical insurance in France can greater ensure you receive the same treatment as you would at home. It’s therefore important to start researching and comparing plans before moving, in order to obtain the best private health insurance cover for your situation.
Many specialist practitioners are independent or private, but are paid from public health funds. The price of their services are fixed by the state, but some carry a surplus charge which must be paid by the individual if their mutuelle doesn’t cover it.
Thus some policies which refer to 100% cover can at first glance appear misleading. Reimbursements only refer to state-fixed tariffs, such as the standard charge for a consultation with a French doctor. Any surplus charged will not be covered by the mutuelle, and is therefore payable by the individual. It may seem complicated at first, so don’t be afraid to ask for advice. For prescriptions, your private health insurance in France may also offer partial or total refunds depending upon your policy.
It is therefore important to ascertain which French insurance company offers the the best private health insurance in France to cover your healthcare needs.
Some of the largest French health insurance companies, or mutuelles, include:
Below are some medical terms in French to help you with setting up your health insurance in France and visiting a French doctor or hospital in France. You can find more in our guide to medical terms in French, while this voice prounciation guide online can help with your French pronunciation.
- Insurance in French: assurance, une assurance médicale (medical insurance)
- Healthcare in French: services de santé, soins de santé, soins médicaux (medical care)
- Health in French: santé
- Doctor in French: médécin
- Hospital in French: hôpital
- Ill in French: malade
- Fever in French: la fièvre
- I am cold in French: J’ai froid
- Ambulance in French: une ambulance; J’ai besoin d’une ambulance (I need an ambulance).
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