French Health Insurance & Social Security in France

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French Health Insurance & Social Security in France

French health insurance (sécurité sociale) has traditionally been available to everyone resident in France: French national or foreigner, whether salaried, working as an independent artisan or professional, unemployed or retired. 

The system is complex with allowances varying, depending on a person's status. The information below provides an introduction and general guidelines on eligibility, including registration with CPAM and how to join the social security system, the Carte Vitale and Top-up Insurance (mutuelle).

Social Security (Health Insurance) 

All residents in France are obliged by law to have health insurance. Most qualify for the state health insurance (sécurité sociale); in local terms, this means affiliating to the CPAM or Caisse Primaire d'Assurance Maladie.

• CPAM French Health Insurance Advice Line (English-speaking) open Monday to Friday 09:00-18:00: Tel: 0811 363 646
• Comprehensive information from CLEISS (Centre des Liasons Européennes et Internationales de Sécurité Sociale) in English: Click here
• Ameli (Assurance Maladie en Ligne) has further information in English: Click here 
• Information on the French health care system and how it applies to British citizens: Click here (PDF in English)

The Basic System of Social Security 

Like other countries, France uses taxation to fund health care for residents but unlike Britain for example, France operates an insurance system. This is a mixed system with the bulk of cover coming from State assurance, and top-up cover coming from mutuelles or private health care insurance companies. All medical facilities are part of the State system but the patient is free to choose their own doctors, specialists, medical facility or hospital. 

What Social Security Provides 

The Social Security decrees that on average 70 percent of the cost of medical treatment will be reimbursed but the exact figure received depends on:

• the treatment needed and its costs
• and the income of the patient

It is the interaction of these two factors that determines the specific level of CPAM repayment:

1. The agreed price of the treatment is set by the Ministry of Health and known as Tarif de Convention. Repayments range from below 60 percent of this amount to full repayment of 100 percent. This is the level for:

• major surgery
• major diseases such as cancer
• disability and other long term care

2. The income levels of a person and their family. There are taxable income levels below which 100 percent of the Tarif de Convention is reimbursed, based on the status as a single person/couple/couple with dependants. Tariffs for these categories can be supplied by the CPAM offices.  

• For a table summarising the schedule of family benefits: Click here (from CLEISS, Centre des Liasons Européennes et Internationales de Sécurité Sociale)

Note: In Alsace and Moselle the percentage level of reimbursement for medical care is higher than in the rest of France. However, salary contributions are higher for the employee. Employers do not make greater contributions.

Social Security for Employed People

No payments are due from low-income singles, couples or families (tariffs available from CPAM). Low-income families are entitled to a free top-up policy. 

For people above the minimum income levels, the contribution (cotisation) is eight percent of the difference between the appropriate family threshold level and taxable income - marked on the French income tax return in the row with two asterisks as relevant fiscale de revenu. CPAM makes these calculations.

Expatriates who have come to live in France need to prove their income to CPAM. This is most easily done with a French tax return. However these tax returns are submitted one year in arrears, in February each year, so those who have not declared themselves as tax residents need to show evidence of income. This can be another country's tax return, or evidence of income such as payslips, pension statements, or earnings from capital such as bank deposits, coupons from government bond holdings or share dividends.

Employed person

On starting a work contract, the employer declares the new employee to URSSAF (Union de Recouvrement des Cotisations de Sécurité Sociale et d'Allocations Familiales). The employee must register with their local CPAM office. 

Take the following (and photocopies):

• Proof of legal residence in France (EU-member passport or Carte de Séjour) 
• Birth certificate showing parents names (a birth certificate for each family member partner, children)
• Marriage certificate (if relevant)
• Bank or postal account number certificate (RIB)
• Three months' pay slips or the work contract or an employment certificate

The employee and their family will be entitled to health cover for illness, pregnancy, work accidents and death. A green health card (Carte Vitale) will be supplied for each family member over 16 years.

Self-employed person

A self-employed person should contact the relevant local authority.

• Professionals: contact URSSAF (Union de Recouvrement des cotisations de Sécurité Sociale et d'Allocations Familiales) or the Chamber of Commerce (Chambre de Commerce et d'Industrie/CCI)
• Artisans (craftsperson, tradesperson): contact the Caisse Régionale des Artisans et Commerçants
• Farmers: contact the Mutualité Sociale Agricole/MSA

Social Security for Retired and "inactif" People

Changes to the law in 2007 affected "inactif" people from EU Member States who are about to become resident in France. An inactif person is one who is not engaged in economic activity on an employed or self-employed basis in France. They are classed as inactif regardless of whether they receive income from inside or outside France (from a pension, investments or other source).

• Information is available on the French Social Security website: Click here (in French)

Retired EU Citizens (European Conventions and Forms E121 and E106)

EU expatriates resident in France qualify for retirement when they reach the retirement age as established in their home country (not at the retirement age set in France). Retired people receive benefits and pay nothing provided that they have a Form E121. This puts an expatriate in France onto exactly the same legal basis as a French national. E121 should be obtained from the former country of residence. 

It proves that:

• appropriate social security taxes have been paid in that country
• the person has reached the official retirement age
• they are receiving a State pension. 

In France, husbands and wives - or acknowledged partners - are treated as one taxable unit. So if there is a significant difference in age between partners, then birth and marriage certificates are needed to bring both partners under Social Security.

EU expatriates below these age groups, or those who do not meet the qualifications described above, may be entitled to a Form E106. This may give full State cover, depending on the individual circumstances, but probably not for more than one to two years. After that, all entitlement to any State medical cover is lost until the qualifications above are met (official retirement date and receipt of a State pension). 

Couverture Maladie Universelle (CMU)

Couverture Maladie Universelle, CMU (universal illness cover) provides two slightly different state insurances: 

• CMU de base (basic cover) 
• CMU complémentaire (complimentary top-up cover)

Basic CMU is allocated for those with little or no income (there is a fixed ceiling). Basic CMU refunds care and drugs at much the same rates as other state insurance with between 35 and 65 percent refund on medication and 60 to 100 percent for medical services and operations.

CMU complémentaire is complementary protection (comparable with a mutual insurance) granted based on the insured person's financial resources. It has all the advantages of a complementary protection and provides 100 percent cover and exemption from any payments.

Application for CMU must be made to the local sickness insurance office (CPAM). 

The following must be provided:

• Proof of identity, passport
• Birth certificate showing parents names (a birth certificate for each family member partner, children)
• Marriage certificate, or a certificate of cohabitation
• Declaration on wages for the last 12 months (income tax declaration)
• Salary earned by anyone under 25
• Proof of residence in France for more than three months (lease agreement, rent receipts, electricity bills)

A green health card (Carte Vitale) will be supplied for each family member over 16 years.

CMU benefits for inactif EU Citizens 

The European directive 2004/38 was entered into French law with the Decree 2007-371 of 21 March 2007. This specifically concerns those EU citizens resident newly moving to a member state or resident for less than five years. 

Any citizen of an EU member state has the right of residence provided they:

• Have health insurance (either private or are eligible for state insurance)
• Have sufficient financial means not to put a drain on the state 

In the light of this, recent legislation has been clarified with regards to EU (including UK) nationals taking up residence in France. The points are as follows:

1. Any EU citizen who is entitled to a Form E106 or Form E121 continues to receive benefits as long as the documents are valid. They should register or be registered with their local CPAM office.
2. Inactif people moving to France who are not eligible for forms E106 or E121 must take out private health insurance before the move. CPAM will not be able to grant CMU benefits.
3. Inactif people who are not covered by health insurance from another member state must take out private health insurance before or on arrival in France.

EU citizens gain the right of permanent residence in France after a five years of uninterrupted legal residence (and this applies to non-EU family members who have lived with them for that period. A "family member" is the spouse or partner and any dependant child under 21 years). The right of permanent residence is lost if the EU national was living away from from France for more than two successive years.

EU citizens and family members with the right of residence are entitled to equal treatment with French nationals. However, until the right of permanent residence has been acquired, France is not obliged to provide social security to anyone other than employed or self-employed workers and members of their direct family.

EU Citizens living in France by 23 November 2007

All inactif EU citizens who were resident in France before 23 November 2007 have access to French health benefits if:

1. They were registered with CPAM and granted basic CMU benefits.
2. They held a valid Form E106 at that time.

Therefore anyone who was resident in France and qualified for state health care on 23 November 2007 remains eligible; they do not need to take out private health insurance. Be aware that as these regulations are recently instated, not all health offices (CPAM) have up-to-date information. For further information contact the CPAM English-speaking helpline:

• Tel: + 33 (0)8 20 90 42 12 or CLEISS
• Tel: + 33 (0)1 45 26 33 41
• For further information from the French Social Security website: Click here (in French)
• For a PDF of the government circular describing the changes in detail (N°DSS/DACI/2007/418) Click here (in French)
• For a PDF version of European directive 2004/38: Click here
• Comprehensive questions and answers from French Social Security: Click here (in French)

(Note: In September 2007 it was stated that inactif people who have been receiving CMU benefits had six months from 1 October 2007 to take out private health insurance, during which period they would continue to be covered by CMU. This is no longer the case; the above change was announced on 14 December. Time line on website French Health Issues) 

  (14 December 2007 + 24 January 2008)

How to Join Social Security 

Visit a local CPAM office - or arrange a meeting with a Social Security officer making a regular visit to the local Mairie - and ask for affiliation. Affiliation should then take place that day either as attestation provisiore if not all the documents are available, or as attestation d'affiliation. 

Claims from that day forward are covered by CPAM to the percentage appropriate to the applicants status. 

The following may be needed when completing the form (declaration en vue de l'immatriculation d'un pensionné, ou de sa veuve, ou d'un orphelin):

• Proof of identity: passport or Titre de Séjour
• Details of place of birth (and for partner and children)
• Proof of address in France with proof of ownership (deeds) or rental agreement
• Date of permanent arrival in the departément
• Proof of having lived in France for at least three months (three months' utility bills, rent statements, or mortgage payments or a notarised statement of home purchase)
• Marriage and birth certificates, if partners are to be included
• A RIB (Relevé d'Identité Bancaire) provided by the bank
• Evidence of income for at least the previous 12 months, whether in France or elsewhere or an avis d'imposition or latest French tax bill.

Changing address or bank

• When communicating with the CPAM always have the relevant social security number handy
• After a change of address or status always update the Carte Vitale by inserting it into a Carte Vitale terminal (green box in pharmacies, CPAM offices and some Mairies)

When changing address within the same département, notify the existing CPAM of the new address; it will say to which office registration should be moved. The file will be transferred and a new entitlement certificate issued. Then update the Carte Vitale at a Carte Vitale terminal.

When changing address to a different département, complete and return Form S1104, the déclaration de changement de situation form available from CPAM.

• To download the form: Click here (PDF in French)

Send details of the new bank and a RIB (Relevé d’Identité Bancaire) (or RIP) to CPAM, quoting social security number. 

Using the Carte Vitale

The Carte Vitale (green card) is the national insurance card issued to anyone eligible aged 16 and over. It gives evidence of membership and rights to French health insurance - an affiliation to CPAM. It is issued on application to CPAM.

It contains all the administrative information necessary for the refund of care:

• Social security number
• Details of health insurance scheme and top-up insurance
• Details of the relevant health insurance office
• Full name and date of birth of the card holder and their dependants
• Details of any exemption or reduction that apples to payments or entitlement to supplementary universal cover

The Carte Vitale does not carry personal medical information.

The Carte Vitale should be handed over at every health appointment (doctor, clinic, hospital, pharmacy) that is equipped with a computer able to read it. The patient will generally receive reimbursement for treatment or medicines directly into their bank account within five days. Reimbursement is made according to income level and the Tarif de Convention (or "approved treatment cost") currently in force.

A person with a Carte Blanche or top-up insurance card (private complimentary insurance) will have the treatment recorded and appropriate balance reimbursed by their mutuelle.

A Carte Vitale has no expiry date but must be updated annually inserting it in the green box at town halls and some hospitals and pharmacies.

A person without a Carte Vitale eligible for state health insurance will receive a feuille de soins (a brown receipt form) from the doctor, pharmacist or hospital staff. This is recognised by CPAM as a legitimate medical payment. It should be posted to CPAM for reimbursement.

The "nouvelle Carte Vitale" is an new, upgraded version that is being issued to card holders across France. A form will be sent, to which a recent identity (ID) photograph must be added, the form signed and returned in the envelope provided, along with a copy of ID (resident's card or passport).

Top-Up Insurance (Mutuelle) for Social Security 

CPAM repays only a percentage of medical costs and also excludes ambulance costs, the cost of a stay in hospital, and the use of a private room. In addition modern dental and optical treatments are often very much higher than the Tarif de Convention.

Private health insurance (santé complémentaire) is available from any medical insurer. Rates vary depending on the degree of cover required and status of the applicant. Policies may range from 100 to 200 percent of the Tarif de Convention.

Note: Not all mutuelles offer cover people to over 70 and some have an earlier cut-off date of 65.

Cancelling Top-Up insurance

A contract can not be cancelled "midstream". There are therefore two cancellation options: 

1. At least three months before the policy renewal date, notice of cancellation must be given by registered letter. 
2. Alternatively, the insured has up to 20 days after receipt of the renewal notice in which to cancel by registered letter with recorded delivery (Lettre Recommandée AR). It is the stamp on the envelope which is the final proof of the correct notice period. The envelope should be kept as it protects the consumer - the insurance continues until registered cancellation is received. To find out how to send a registered letter (Lettre Recommandée AR) see AngloINFO INFOrmation Page Post in France: Codes, Addresses and Mailing a Letter.

A policy is automatically ended by the death of the insured.

Note: The Loi Chatel of August 2005 does not apply in this instance, neither does it apply on any "life" policies or professional policies. 

Contacts

• Information from the French Government Web site (in French)
• AMELI Assurance Maladie en Ligne  
• CNAM French Health Service English-language service
  Tel: 08 20 90 42 12
• CLEISS Helpdesk for international mobility and social security
  At: 11 rue de la tour des Dames, 75436 Paris cedex 09
  Tel: 01 45 26 33 41 
  Website
• Information from the Haute-Vienne CPAM (Caisse Primaire d'Assurance Maladie) in English 

Contacts for UK Citizens

• Information in English from the French Embassy in the UK: Click here
• UK Citizens: DWP Overseas Medical Benefits helpline International Pension Centre
  At: Room Tc001, Tyneview Park, Whitley Road, Newcastle upon Tyne, NE98 1BA
  Tel: +44 (0) 191 218 1999 (Monday to Friday 8am - 5pm)
  Website

Further Information

• See AngloINFO INFOrmation Page French Medical Terminology
• See AngloINFO INFOrmation Page Attending Doctor in France
• See AngloINFO INFOrmation Page Social Security in France: Terminology
• See AngloINFO INFOrmation Page Social Security Organisations in France

Updated 24/01/08