French healthcare for foreigners under the PUMA system
By law all residents in France must have some form of health insurance, whether private or a state French health insurance scheme.
In order to be eligible for coverage under the state French health care system (PUMA), you need to be either employed or living in France on a stable and an ongoing basis for more than three months with the intention to spend more than 183 days a year in France.
You will typically need to pay cotisations sociales (social contributions) to cover your healthcare in France, although some categories are excluded, for example, if you earn below a certain threshold.
If your household income falls below a certain threshold (which depends on number of people in the household), you may also be eligible for free supplementary health insurance coverage (CMU-C) or for help in taking out a supplementary private heath insurance (Aide pour une Complémentaire Santé or ACS).
If you are financially dependent, the system of ‘ayant droits‘ was abolished with PUMA and instead all eligible persons are granted their own right to healthcare, significantly improving the situation for economically inactive spouses.
If you’re not eligible for PUMA, you may have to take out private health insurance. You can take this out on a temporary basis to give you time to register with the social security as under the PUMA sytem you have to wait 3 months before you can start your registration.
If you have lived in France longer than three months (and applying under PUMA), you can register for French healthcare via your local CPAM (Caisse Primaire Assurance Maladie) office. You can find your local CPAM office via the Ameli website.
If you are employed, your employer will first register you with French social security after which you can register for French healthcare. Your employer may arrange your healthcare registration but it’s not a legal requirement, so make sure you chase the paperwork and check CPAM has been contacted. If you’re self-employed, you need to contact the Regime Social des Indépendants (RSI) instead.
You’ll need to show certain documents, which can include your passport or national ID card, proof of your long-term residence, marriage or birth certificates if family are to be included, evidence of income and proof of your address in France. You’ll also need to choose a primary and submit a declaration (Declaration de Médecin Traitant) to your insurer before accessing healthcare in France.
The CPAM office will handle your reimbursements, although it is the URSSAF which will handle your ‘cotisations’ (contributions) for access. You will typically need to pay around 8 percent of your income if you earn above a certain threshold (EUR 9,654 in 2016), otherwise it will be free under the CMU-C scheme.
CPAM has an English speaking helpline. They cannot answer your queries straight away but they will make enquiries and get back to you. You can call them on