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 must have health insurance in France in accordance with the law. 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 Allianz Care 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 does the state healthcare insurance in France cover?
- 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
Allianz Care provides International Health Insurance for you and your family. They have modular plans to suit your needs and budget while providing access to quality healthcare worldwide. They provide ‘always on’ services through a 24/7 multilingual helpline and convenient MyHealth digital services.
In January 2016, the Protection Maladie Universelle (PUMA) replaced the old French health insurance scheme Couverture Maladie Universelle (CMU), and now grants all residents of France easier access to health services in France.
Under PUMA, permanent residents receive state health insurance if they’ve lived in France for three consecutive months. This healthcare reform simplified the requirements for workers and residents in France; unlimited healthcare access is now a right of all residents. This applies regardless of age, medical history, and record of social security contributions (cotisations sociales).
Previously, French health insurance for foreigners was only offered if a number of conditions were met. If their living or employment situation changed, they had to re-apply for coverage under a different category. This sometimes left gaps in healthcare coverage. The new PUMA scheme guarantees that legal residents keep their health insurance despite changes in circumstances. This also means that those who received health insurance through CMU no longer need to re-apply annually.
PUMA equalizes the rights of European Union and non-EU citizens for getting a carte vitale (health insurance card); everyone receives French health insurance after three months of residency. Non-EU citizens already enjoyed this right before 2016, while EU citizens had to wait five years before applying.
The CMU–complémentaire (CMU-C), a program that provides free health insurance in France for low-income or unemployed persons, also continues to complement PUMA. Find out whether you’re eligible for the CMU-C.
The healthcare reform mostly affects residents not previously covered by employment or business-based health insurance in France, current recipients who changed their employment circumstances, and new residents of 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 living in France can apply to receive state health insurance in France under the new PUMA program. The PUMA program is for those with less than five years of French residency, are unemployed, are younger than 65, and don’t receive a pension from a 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 employees paying into the French social security system are eligible for state medical insurance. There are, however, some exceptions depending on your situation. Find out below whether you can access public health insurance in France.
Residents in France
All residents who prove stable and regular residency in France for at least three consecutive months per year can register for 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.
Jobless or low-income legal residents are also eligible for French health insurance and can get subsidies through the CMU-C.
Employees working in France are eligible for healthcare insurance through their cotisations sociales (social contributions) towards French social security.
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). National health departments issue this form; they confirm 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 recognized 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 recipient
- A student with plans to study in France for less than three months
- Non-EEA citizens older than 28 years and have no job. In this case, they are eligible for health insurance in France under the PUMA scheme.
Students who live in France for less than 183 days per year are generally ineligible for public healthcare. Those ineligible for state healthcare insurance in France will find a range of affordable options for private insurance.
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 social security system or visit your local CPAM (Caisse Primaire d’Assurance Maladie). Employers typically register their employees with social security and arrange their healthcare formalities. However, it’s your responsibility to check this has been done. Self-employed workers apply via the Régime Social des Indépendants (RSI).
If you qualify under PUMA, visit your local CPAM or send your application by post. CPAM assesses your rights, but the social security authority (URSSAF) determines if you contribute towards your healthcare costs. If you earn below a certain threshold, you qualify for free healthcare (under CMU-C).
You’re typically asked to present a CERFA form, proof of identity and residence, translated birth and marriage certificates, proof of three-months’ residence in France, banking details, evidence of income, and your declaration de medecin traitant (doctor registration). During registration, you can add beneficiaries or dependents. After registering, CPAM will ask for proof of income to determine your contribution amount. For more information, you can call CPAM’s English-speaking helpline at 3646 (from France) or +33 811 70 3646 (from abroad).
After activating your health insurance in France, you may need to formally request your carte vitale; it isn’t always issued automatically, unfortunately. The card includes information necessary for making claims but doesn’t store medical information. Ask for an attestation de couverture sociale or a temporary French health insurance card; issuing a carte vitale can sometimes take a long time.
You’ll need to present your carte vitale at every health appointment. Reimbursements typically arrive in your bank account within a week. You can update your carte vitale annually by inserting it in the green box at CPAM offices, 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; 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 government amends the percentage of cotisations sociales deductions 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 total earnings during the prior 12 months before you apply for CMU-C. Expats must also first activate PUMA before qualifying for CMU-C. After approval, the state health insurance covers all medical and dental costs. You won’t be asked for upfront payments after 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. Anyone 16 years or younger can visit 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 patient covers the rest of the medical fees.
Carte vitale holders don’t need to make upfront payments; patients without a card must pay the appropriate medical fees at the point of service. You’ll receive reimbursements in your bank account between five and 10 business days later.
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 specialized care. However, your reimbursement for advanced procedures will be typically less due to the higher cost.
Many French residents top up their coverage with a private health insurance policy, known as a mutuelle. There are many mutuelles to choose from, some of which cater to specific professions while others are aimed at English speakers. Employers often offer a place in a mutuelle as part of your benefits package. Meanwhile, students can either choose for coverage from their parents’ mutuelle or select their own.
Most French insurance companies reimburse the remaining 30% of your general healthcare costs, including emergency hospital treatment. Private care costs depend on the type of cover required and factors such as the age of the applicant; however, few mutuelles ask for your health details prior to approval. Basic packages focus on hospital care and medicine, but may include limited dental coverage. Private insurance doesn’t guarantee faster treatment, however.
State insurance typically doesn’t cover consultations with psychologists, osteopaths, chiropractors and certain specialists. If you require any specialist treatment, private insurance offers the same treatment as you’d get at home. Research and compare plans before moving in order to obtain the best insurance coverage for your situation.
Many specialists are independent but receive public health funds from the state. The state sets the price of services. However, some carry a surplus charge that the individual must pay if their mutuelle doesn’t cover it.
Thus, some policies that refer to 100% coverage can appear misleading. Reimbursements only refer to state-fixed tariffs, such as the standard charge for a consultation with a doctor. Surplus amounts aren’t 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, private insurance may offer partial or total refunds.
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).