NEW (SEPTEMBRE 2017)!
This policy change equalises rights for EU citizens with non-EU citizens, who already had the right to apply for their Carte Vitale after three months’ permanent residence in France, whilst EU residents were obliged to wait five years.
This reform, effectively abolishing the ‘CMU de base’ and replacing with a new system called the ‘Protection Universelle Maladie’, simplifies what some have seen as unfair legislation for EU citizens and their supposed free movement within the European Union.
Simplified Health Insurance for Foreigners in France
If you have no professional activity, regardless of your age, the protection universelle maladie guarantees a right to the reimbursement of most of your health costs (70% on average) and the application system is now much simplified. Individuals need to complete the correct form from l’Assurance Maladie and send it back with the requested supporting documents to your local CPAM (Caisse Primaire d’Assurance Maladie) office.* Top-up or complementary insurance (une mutuelle) can be taken for full reimbursement of most medical costs.
Documents Required to Apply for Health Insurance in France.
• Photocopy of your official birth certificate – the jury is still out at the moment as to whether you need to supply a certified translation (traduction assermentée) as there are more reforms happening in order to dispense with the necessity to provide these within Europe. However, until these reforms become official and until that news reaches the desk-workers in the CPAM offices, we recommend that you add a certified translation into your application file.
• Photocopy of your passport
• Proof of your permanent residence in France for more than three months – this can be a copy of your lease, your title or deed (Acte de Vente or Acte Finale), gas, electricity or fixed-line phone bills.
• A RIB
• If you have dependent children at home with you, you need to complete an additional form from l’Assurance Maladie.
Submitting Your French Health Insurance Application
Once you have everything together and have filled in the forms, you can hand it in to your local CPAM office or send it via post. They will study your situation and your rights. If necessary (ie., if you are non-working but under state retirement age), they will then write and ask you to send proof of income so they can calculate your contributions. You will then receive a temporary Social Security number, followed by a request for a photograph for your Carte Vitale, which you should receive next. Note that timescales may not shorten with this reform, but as soon as you have your temporary number (between 4-6 weeks), you can start claiming your costs back.*
Complementary CMU (CMU complémentaire) is still in place.
The basic CMU, which has been replaced with the protection universelle maladie, should not be confused with the complementary CMU (CMU complémentaire). CMU complémentaire is the French state’s free top-up health insurance for those living here in a stable and regular manner and on low incomes — it complements the new protection universelle maladie. CMU complémentaire is means-tested and only available to those below a certain income threshold. The new legislation therefore doesn’t change the CMU complémentaire in principle nor its attribution rules.
We at Renestance are thrilled to hear about these changes, making it easier for Francophiles across Europe to make the move to France and benefit from the world-class healthcare.
* For more information in French, please visit l’Assurance Maladie.
If you do not read French and need assistance filling out this form, please contact our Administrative Assistance team here at Renestance. You can also hand the whole procedure over to Renestance and we’ll do everything for you!
UPDATE APRIL ’17
Note: If you are an inactive (not working) EU national and have been told that you must reside 5 years in France before you’re eligible for a Carte Vitale by your local CPAM or by the Anglo Améli phone line, we have a possible solution! As with most things bureaucratic, the success of your task often depends on the individual person you are dealing with, but it always helps to have some form of official, written back-up.
Click on this link to the Améli website itself, where they state that, as well as having to have the legal right to live in France, you need only to have been a stable resident for three months or more to qualify to apply for PUMa. Print it out to take with you to CPAM with your application pack, or use it to quote to the Améli team: www.ameli.fr/assures/soins-et-remboursements/cmu-et-complementaires-sante/la-cmu-de-base-n-existe-plus/l-affiliation-sur-critere-de-residence_rhone.php
We have been informed that it works!
NEW (SEPTEMBRE 2017)!
Nicole is a bilingual Brit from Cambridge who has been living in the Languedoc since 2002 and is one of the first Renestance's Consultants. She knows how to get things done and can find the key contacts, having worked in real estate, managed two businesses of her own, and started a large social group for English-speakers in the area.
All articles by: Nicole Hammond
Richardon 2016-01-16 at 15:46
a bit confused.
Is Protection Universelle Maladie state provided?
When you say Health Insurance – do you mean private health insurance not top-up (I.e mutuelle)?
The article is a bit ambiguous, can you clarify please.
Dennelle Taylor Nizouxon 2016-01-19 at 10:12
Apologies for the ambiguity, Richard – yes, Protection Universelle Maladie is the French state health insurance which provides you with a Carte Vitale and reimburses about 70% of your medical costs. For private top-up insurance, you would make the request directly to the private insurer, la mutuelle, not the CPAM.
Carinon 2017-11-08 at 22:34
I bought the whole set of books you have published on healthcare and found it to be super helpful! Thank you for that!
I am a US citizen and I am moving my fiscal residence to France next year. I will be working for a EURL as gérant and I will be paying into the French Social security system. I will also be eligible in 5 years for a french citizenship if I stay, and I plan to get the french passport. I wanted to know, how many years do I have to pay into the french system to not have to pay for healthcare at retirement? I am 44 years old now. Is there a minimum of 10 years? or do we have to pay also when retired? Since in the US we have medicare and are covered and do not have to pay for healthcare at retirement age, since we already payed our medicare taxes for many years. I am starting late in the french system and wanted to know how long it will take so I do not have to pay as much when i am older and probably not making much. Or will I have to pay also like the other expats do in France. I was worried because I am freelance and my work sometimes is less and I was concerned that I payed long enough and enough into the system.
Nicole Hammondon 2017-11-09 at 14:30
Hi Carin – There is a minimum number of quarters of social charges that need to be paid to qualify for ‘free’ healthcare, a French pension etc in France. You can find out how many, what the minimum amount to pay etc is online through your ‘caisse’ (probably RSI) when you are here and registered and working, and have your personal space set up online. Alternatively, you could ask a French accountant to calculate this for you within a hypothetical situation. You could also look into whether it’s possible to import your US pension to France – known as ‘totalisation’. I hope this helps! Best, Nicole
carinon 2017-11-12 at 14:02
I am starting to work on Jan 1 2018 for a EURL (i am a us citizen) and my boyfriend (he is italian) also is moving his residence to France Jan 1. He is working under the Maison des artistes so will he not be able to get his rights for health cover until the end of the year? Is this correct? Do I also have to have private health insurance at the beginning and wait to start paying taxes to be eligible to get the State health care? (carte vital)
Should I keep my private health insurance for another year? (I am supposed to renew now) or I was wondering if I should cancel it? And my boyfriend should keep his italian rights before he moves everything to France at the AIRE (italian consulate)?
Thanks for your advice…
Romke Soldaaton 2016-01-17 at 07:16
I’ve had the Carte Vitale for many (over 12) years. However, since most of my retirement income comes from Holland, it’s the Dutch authorities who pay my health costs, and I’m charged a considerable sum (nearly 300 euros p/m) for that “privilege” since I’m 65. Do these new rules mean that I can now re-apply for full French cover and pay my dues in France? It’s an important issue since my income is low enough to not pay income tax in France. In my pre-65 years the CMU was free for me and I’d love to go back to that situation!
Dennelle Taylor Nizouxon 2016-01-22 at 22:34
Romke, your story threw me for a bit of a loop, to be honest. I am not familiar with the way the Netherlands handles the pensions/healthcare of their retired citizens living in France. But as residents of France are entitled to PUM, and normally EU citizens of state retirement age do not need to pay contributions, you might as well apply again. If you have been a stable and regular resident for at least three months, it couldn’t hurt to try! Good luck 🙂
Joanneon 2016-01-17 at 08:58
What is a RIB?
Dennelle Taylor Nizouxon 2016-01-19 at 10:03
Joanne, it’s nothing anatomical 😉 It’s a Relevé d’Identité Bancaire – it has all of your French bank account information so that institutions can wire sums directly to your account. It can be found at the back of your check-book or you can request it from your bank.
Patricia Howellon 2016-01-17 at 15:49
Your article states that “ANYONE who has moved to France and been living in the country as a permanent resident can apply for French health care coverage.” Is this applicable to U.S. citizens as well?
Dennelle Taylor Nizouxon 2016-01-19 at 09:54
Yes, Patricia, in fact Americans and citizens of other non-EU countries have been able to apply for a Carte Vitale after three months of residency since well before this change. What is new is that non-working EU citizens under retirement age can apply after three months of stable residency as well, rather than wait five years as was previously the case.
Yateson 2016-01-18 at 08:44
I also believe that you have to prove you’ve had/ got full health insurance cover for the three months prior to application. Is this correct? Presumably if Britain does leave the EU then things would change? Thanks for your site…just discovered it.
Dennelle Taylor Nizouxon 2016-01-22 at 22:21
You are correct, Liz, that every legal resident of France must have health insurance…but the CPAM does not require this information for the application. And since the PUM is now open to all legal residents of France, if Britain were to leave the EU, then Britons would simply have to obtain stay visas like those residents currently coming from outside the EU. 🙂
Annon 2016-01-18 at 17:55
Thanks to your info I was able to challenge CPAM’s refusal to take me on. I was in the process of appealing, but just went back and said that i wasentitled and they agreed. They aren’t however able to tell me how much it will cost. Do you have any idea of the percentage of my income that I will need to pay?
Dennelle Taylor Nizouxon 2016-01-19 at 09:42
Excellent news, Ann! The contributions are calculated as 8% of your income over the 9611€ threshold, based on your last two year’s tax statements.
Ericaon 2016-11-19 at 02:06
Hello, is this divided into parts (spouse/dependants) and then calculated, like income tax is? Also, we have been in France for a year, but have private insurance and did not sign up for Carte Vitale, do we still pay the 8% when we file our first taxes in May 2017?
Ericaon 2016-11-19 at 02:32
Sorry, I just read through most of this thread and found the answers to my questions. I’m still iffy on the second, is the 8% charge the same as the CSG/CRDS social charges in France, or is it another charge for having the Carte Vitale? Extremely informative website! Thank you!
Dennelle Taylor Nizouxon 2016-11-21 at 11:40
Hi Erica, the 8% is a social charge paid to URSSAF, as opposed to income tax, which is calculated very differently and paid to the Trésor Public. If you aren’t working in France, you would only pay CSG/CRDS (usually around 15.5%) on applicable passive income, but yes, this is separate from the 8% contributions you would pay for the PUMa/Carte Vitale health coverage. Hope this helps.
Graham McAdamon 2016-01-19 at 15:48
My wife found the link to your website via the expat ladies’ site ‘LIFT’.
Our circumstances are that we took early retirement both aged 58 when we moved to France in Dept 16. We are now both 61. The UK Form S1, granted to us for a period of 18 months, entitled us to a Carte Vitale. Upon expiry of Form S1, we were asked by CPAM to apply for CMU in April 2015, which we did without any hassle. And of course, we have to contribute 8% of our total household income (above the 9611 Euro threshold).
So, my question is what exactly has changed? Was I just lucky in my dealings with CPAM who gave me the advice to ‘convert’ to the CPU scheme?
Finally, as far as you are aware, will the UK still allow us to benefit from Form S! again, when we attain UK State Retirement Age (66 in our case)?
Dennelle Taylor Nizouxon 2016-01-22 at 22:10
Your experience is a bit unclear to me, Graham, because the Carte Vitale is just the instrument by which you use your CMU coverage, so I don’t understand why you would have had a Carte Vitale with the S1 and then be asked to apply for CMU again. In any case, I think you were lucky, as others in your situation had been told to wait for five years of residency before applying for CMU/Carte Vitale.
Once you reach state retirement age, you will no longer have to pay the contributions for the CMU, but your coverage will continue…so if you intend to stay in France, you won’t need an S1 again.
Hope this helps.
jill robertson 2016-01-22 at 14:56
What is the form needed please.
Dennelle Taylor Nizouxon 2016-01-22 at 22:00
There is a hyperlink to it in the fourth paragraph “correct form”, but here is the URL https://www.ameli.fr/sites/default/files/formualires/168/736.cnamts.pdf
jill robertson 2016-01-23 at 17:22
Many thanks for your reply and the information on your site is very helpful.
Dennelle Taylor Nizouxon 2016-01-24 at 18:24
You’re very welcome, Jill 🙂
Elizabethon 2016-01-24 at 14:56
Please clarify the phrase “after 3 months residency.”. I have a carte sejour temporaire (renewable annually) since 2013. Do I qualify?
Dennelle Taylor Nizouxon 2016-01-25 at 20:50
At least three months of stable and regular residency in France can be proven with electricity or fixed line phone bills, “quittances de loyer” or rental receipts from a landlord, or a property deed, for example. And yes Elizabeth, if you have a carte de séjour, it should be valid for at least 3 months.
Angeline Hargreaveson 2022-03-22 at 13:42
Hi, I hope I’m in the right place ,apologies if I’m not! I have a care de sejour and have been living here for two and half years I have a temporary healthcare no. but cannot get my proper card or no. because my passport doesn’t match my birth certificate, a middle name was entered as a child and they can’t get their heads round it ! How do I get over this hurdle should I just get my middle name legalised ? Hoping for some assistance. Please Angeline
Ann-Liion 2022-03-24 at 15:19
Thank you for reaching out to us! Could you please fill in the contact form, you find it when following this link. https://www.renestance.com/contact/
We will get back to you as soon as possible.
Thank you in advancea nd I hope to see your form in my mailbox soon:)
In these cases, the easiest thing to do is to contact your nearest embassy (specific to your nationality) and they can issue you with a Déclaration d’Identité. Note that you will need to attend in person (if it’s a bit far from you, you can make a trip of it!) and you’ll need to take all the papers you have that may help your situation (passport, birth certificate, even marriage certificate – originals and I’d take copies too). It’s definitely not an insurmountable situation, but it is one that may involve a little time dedicated to it. Good luck! Best, Nicole
John Bon 2016-01-27 at 21:36
We are retired US citizens and are retiring to France in August, 2016 from the US for at least a year. It sounds like we need health insurance for at least 3 months in France. We are planning on that, but it sounds like after that we might not need the insurance unless we want to TOP UP. Did I understand correctly? Is there a difference if we are retired?
Dennelle Taylor Nizouxon 2016-01-28 at 14:37
If you will be applying for a one year long-stay visitor visa, you will need to show private health insurance for France in your application, John. This will cover you for the first three months and until you receive your French national health insurance, at which point you could downgrade your private insurance to just supplemental or top-up. Your eligibility for the French national health insurance is dependent upon your stable residency in France and your inactive working status, not your age. If you were working in France, and not retired, then you would automatically be in the French social security system because you would be paying contributions through your employer. Hope this answers your question.
Katherineon 2016-01-28 at 13:18
Just as a point of interest, I am a non-EU ( American) married to a Brit and was told upon our arrival here in 2012 that I was NOT entitled to a Carte Vitale after 3 months, nor was my husband as he hadn’t quite reached retirement age. We used every resource imaginable and visited and wrote to CPAM many times (my husband is fluent in French) but the outcome was we had to spend €3000 which we could ill afford on a year’s worth of private health coverage until my husband received his S1. It then took us a year and a half (from submitting all the correct documents) to finally have our cartes bestowed upon us. I have not been able to start my planned business because I am worried that should I leave the umbrella of my husband’s S1 I would not be able to go back to being his dependent on the S1 should my business fail or close. This has caused us no small amount of difficulty and stress and taken unspeakable amounts of our precious time in the nearly 4 years we’ve lived here.
Had we known about you at the time we might not have had these difficulties! I’ve commented not to frighten people but to make newcomers aware that even with good French your outcome will not always be what it should be and hiring a service like yours may well be the best idea.
Dennelle Taylor Nizouxon 2016-01-28 at 14:25
Thanks for sharing your experience, Katherine. It’s true that even French nationals struggle with the bureaucracy at times! The trouble seems to stem from the nearly constant changes to the laws and procedures without systematic dissemination to the people “on the ground” who are facing the public. I hope you have been able to resolve the matter and get your Carte Vitale.
Nickon 2016-01-30 at 21:32
Thank you for a most informative site. We have two questions. One is about double taxation, and the second is about the minimum earning limit. One of us has a Police Pension payable and taxed in the UK. Would you know at what rate, above the minimum income, this would be charged at? With regard to the minimum earning limit, we are both dependent on this one income. Are the minimum amounts added together eg €9611 x 2, or does the minimum amount of income only apply to one person? We are both below state retirement age if it helps. We already have temporary social security numbers, but after nearly two years, the S1 has just run out. We are in the process of sorting out private hospital insurance. The Fonctionerres have not managed to issue us Carte Vitales as yet.
Dennelle Taylor Nizouxon 2016-01-31 at 13:35
Thanks for the comment, Nick. Minimum earning limits are per household, so not cumulated. If you’ve been residing in France for more than three months in a stable manner, I would suggest you apply again for the Carte Vitale. I’m confused by the fact that you already have temporary numbers…seems your case would need a specific follow-up to understand the status. For your specific tax question, I’m afraid I’m not qualified to respond, but I know that existing tax treaties eliminate double-taxation in general. I would suggest consulting with a tax accountant on that one, though.
Joyon 2016-02-03 at 12:35
I could do with a little clarification if possible. My husband and I arrived permanently in France in July last year, we visited our local CPAM office to register for health care (Carte Vitale).
We have both just turned 60, early retirees, therefore do not qualify for a S1.
Not fully understanding, we supplied all info and documents requested and in December had a letter accepting us for CMU (base) at an astronomical cost, calculated on our income in 2013 when we were both in full time employment. Since June 2015 we have no income, only our savings to live on and cannot afford these charges.
Question: will the new system (PUM rather than CMU base) be any more affordable if, as I read it, we will still be charged 8% of our income earned in 2014 (again we were both fully employed during that year) ???
Dennelle Taylor Nizouxon 2016-02-03 at 14:18
Unfortunately, Joy, you are in the rock-and-a-hard-place situation. In 2016, they will most likely apply the 8% (after the 9611€ threshold) on your 2014 income. Although it is very difficult to get information on how the URSSAF calculates the contributions, it seems they do not take into account the latest income levels for those who’ve recently left employment, nor do they even average the previous two years. People in your case must decide between comprehensive private health insurance or the sometimes equally costly PUMa until the income from the reference year reflects your current income. You are not alone, but I do wish I had better news for you…
Joyon 2016-02-03 at 16:02
Yvonneon 2016-02-06 at 10:18
Hi, I am not sure if we are in a similar situation as Joy, but we have recently moved to France on a 3 year break before moving back to the UK. We are currently earning no income but living on what we have managed to save up the past few years. I guess we are currently classed as early retirees. When we submit our forms and they ask us to provide details on our income, will they be calculating our 8% contributions based on money earned in 2014?
Dennelle Taylor Nizouxon 2016-02-06 at 11:04
Yes, Yvonne, it sounds like you are in the same case. They will surely calculate your contributions based on your income in 2014. When comparing the costs of your different health insurance options, make sure to take into account the cost of top-up insurance in addition to the contributions you would pay for the French Assurance Maladie, which only covers about 70% of medical costs, on average. Sometimes comprehensive private insurance will end up being less costly than the contributions plus top-up insurance.
Nickon 2016-02-16 at 17:59
Sorry for two further questions. We are still deciding whether it is cheaper to have private insurance or PUMA. The first question is about the definition of income in 2014. Does this mean proof of income as shown in my P60 from 1 April 2014 to 31 March 2015, or am I supposed to declare my income from 1 January to 31 December 2014? As I went onto retirement pay in April 2014, there will be a marked difference! The second question is in regard to the exchange rate used. Do I declare in sterling and let Les Fonctionaires work it out, or should I use the current exchange rate, or even the available rate back in April 2014 which went as low as 1.187 euros to the pound?
Dennelle Taylor Nizouxon 2016-02-26 at 11:17
As far as we can tell, Nick, the URSSAF will calculate your contributions based on your P60 plus your income tax returns going back two years before the application date. In your case, if you apply 1 April 2016, then you would supply your P60 plus your tax return or proof of income for 2015. The exchange rate question is a good one, and we were unable to find the answer, so I would assume that you furnish the official income documents (in GBP) and URSSAF applies the relevant exchange rates.
NIckon 2016-10-18 at 19:50
This is sort of an update, and sort of a further question. Just before the arrival of PUMA, we moved from the Herault ( 34), to the Aude (11). The S1 ran out on 02/01/2016, so we applied for PUMA in the Herault, with all documentation, checked and passed at the local CPAM office. Couple of months later, the letter arrived, saying that as we had moved, Herault had nothing to do with us, and we should submit new documentation to the Aude. Did this, and after more months, now have the letters from the Aude, giving us the same temporary numbers as we had two years ago in the Herault!. After over two years, we still have no Carte Vitale. Hoping, but at at this rate, how much would it cost us for your assistance.
Having read the comments since our last efforts, we understand that you are recommending that we register for french tax. No problems, but just want to understand what problems we might have. We arrived in March 2014, and this is the first we have seen of this, bearing in n mind that we pay all taxes back in the UK, as government pension.
Regards, and many thanks in advance.
Nicole Hammondon 2016-10-28 at 15:23
Hi Nick – First of all, when you file your taxes in France, which is a legal requirement as a full time resident, you will be able to note whether any income is taxed at source. You will not be taxed twice on the same income, under the terms of the Double Taxation Treaty. Regarding how much you’ll pay, it seems that the URSSAF are calculating payments on your tax reference number, generated from your French tax returns, which is why it is important to get these in. If you declare in May 2017, you’ll have a statement by October 2017, and this will be based on your income from 2016 so should be quite fair as it will be based on your current pension income. On a positive note, you have temporary numbers, so you are in the system and can claim your costs back using the brown treatment forms. Time from temporary number to actual Carte Vitale? This seems to vary enormously and I think, as long as you are not out of pocket, I would just sit tight. It will happen! And of course, you can apply for a mutuelle as long as you have your temporary number. Best, Nicole
Chris easdonon 2016-02-25 at 17:18
Hi, we are in cmu and this will probably mean we are transferred to puma. My wife has to have a series of operations . Is there are proceedure to follow with cpam to have the operation costs approved, same as you would do with a private healthcare policy or do you just go ahead? Neither my wife or i have a carte vitale yet and only have a temporary social security number.
Dennelle Taylor Nizouxon 2016-02-26 at 11:10
Hi Chris, yes you should be automatically transferred to PUMa. And yes, normally your doctor would fill out a form called “demande d’accord préalable” and give it to you to complete and send to your CPAM to the attention of “M. le Médecin Conseil.” If the doctor has not given you this form, there may be no need to get the pre-approval for those operations…but you would probably want to check with the doctor to make sure.
Chris easdonon 2016-02-28 at 09:55
Thank you for your advice dennelle. The other thing we are trying to determine is to find a surgeon to carry out the operations that does not charge debatements ( the practice of doubling the normal rate of the operations by medical practitioners- I’m not sure of the exact word ) my wife had breast cancer a while back and had one breast removed and had reconstructive surgery including an implant. This implant has now ruptured which you can see on the irm and the series of operations are for its safe removal and replacement. It has come to our attention that cmu de base will only pay for the basic operation not any debatements the surgeon decides to add on. Our top up insurance will only pay 100% of the basic tarif so it would mean we have to pay the rest. The surgeon has flatly refused to tell us if he charges debatements.
Is there any way of finding a surgeon who will not make these charges. The doctor has suggested we use the hospital and not a clinic, but I have been told we may encounter there charges there as well. Could cpam help us search in their database for a hospital and a suitable surgeon to avoid this problem?
Dennelle Taylor Nizouxon 2016-03-03 at 13:04
I am fairly sure that doctors are legally obliged to not only notify their patients if they charge “dépassement d’honoraires” but even to post the notice in their office. The practice of charging these extra fees is quite common, especially if you are looking to have surgery in a private clinic, but you might be able to find a surgeon in a public hospital who does not (chances are better outside of Paris, probably). To find a doctor “au tarif Sécu” try this site http://annuairesante.ameli.fr/ …be careful to choose one who is “conventionné” however, otherwise it won’t be covered by CPAM (or your top-up). The other possible option you have is increasing your top-up insurance coverage level.
João Henriqueon 2016-03-07 at 15:05
I’m from Brazil. In September, I’ll begin a MSc Economics in France. Since I’m over 28, I’m not entitled to a student healthcare.
My wife will come along, although she won’t be studying. My Brazilian employee will continue to pay my salary during my studies, and I will continue to pay the income tax and social security in Brazil.
My question is: when the CPAM calculates my contribution, will it consider 8% of my total pre-tax income in excess of 9600 eur? If so, I will be paying in both countries, and I wonder if it is worth the cost.
Dennelle Taylor Nizouxon 2016-03-08 at 12:53
Hi João, the 8% calculation is for those with an inactive status in France. If you are coming over with a student visa, you should enter the student social security system upon enrolment at the university. Have they told you that you cannot subscribe to the “mutuelles étudiantes,” which are the top-up insurance plans? Your coverage and cost depend upon your age, your salaried activity, your family situation, etc. but your university should be the ones to explain it to you, as they should be more familiar with cases like yours. Here’s a page with some explanation (en français) and helpful links https://www.ameli.fr/assure/adresses-et-contacts Hope this helps, and enjoy your time in France.
João Henriqueon 2016-03-09 at 15:44
Hi Denelle, thank you very much for your time.
Unfortunately, the student social security, including the mutuelles, only apply to those less than 28. If I want a top-up I must subscribe to the CMU-C (either before or after jan/2016).
What I could grasp from the sparse official information:
1) Before PUMa, students over 28 needed to apply to the CMU, and the 8% contribution was calculated by their fiscal declaration of the previous year. This would be a real burden to my budget.
2) After PUMa, the CMU no longer exists and everyone is entitled to the same system. I’m not sure how much will be my “cotization”. I read on ameli.fr that revenues from capital over 9611 eur are subject to a cotization, but my earnings will be on form of a salary in Brazil. In that case, I will be unemployed in France, without capital earnings. So, I believe I wont have to pay. Please, see this page: https://www.ameli.fr/assure/droits-demarches/difficultes-acces-droits-soins/complementaire-sante/complementaire-sante-solidaire-qui-peut-en-beneficier-et-comment
What do you think?
Nicole Hammondon 2016-03-11 at 10:55
I’ve looked into your situation and it seems to me that you would indeed be liable to pay your social charges at home and in France too. But, being such a different situation, to be absolutely sure, I would recommend a call to Améli on the English-speaking line if you’re happier there – +33 (0)811 36 36 46. Should you require any help in applying for your Carte Vitale, we can propose our Standard Carte Vitale Service to ensure that you hand in a full and complete application package. Please feel free to email me at firstname.lastname@example.org for more information.
Nicole Hammondon 2016-03-23 at 09:30
It has come to our attention that there is currently a Carte Vitale scam finding its way into peoples’ email inboxes. Be vigilant! The Améli (the body that deals with Carte Vitale application) will NEVER ask you for your private details online. Here is a link to more information: https://anglophone-direct.com/carte-vitale-scam/
Paula Bucklandon 2016-03-25 at 11:04
Hi – I think that we are in a similar situation to Joy – we visited our CPAM office the other day with copies of all the forms required to make our application for a carte vitale and the lady there was very quick to tell me that the protection universelle maladie had finished and I was to contact Newcastle for an S1 – I’m in my 50s so assume not eligible. I have been living in France since January 2015 my EHIC is invalid and I have a need for regular medication. My husband works in the UK and has an EHIC but has just suffered a heart attack due to a collapsed stent whilst here in France and we were looking for some kind of insurance cover going forward. Whilst looking on line for a private healthcare provider, one stated that private healthcare insurance cannot replace the CMU. We noted your advice to someone above ref private insurance as possibly a cheaper option than contributions + top up. Would you be able to advise please. Many thanks.
Chris easdonon 2016-03-30 at 10:09
Hi, are the cotisations to puma, charged at the same 8%.rate as with CMU for non active early retirees? I have heard stories of considerable hikes in contributions. These may be miscalculations by Urssaf, but I would like to be sure as we have not received our demand for 2016.
Lakulon 2016-04-26 at 09:27
If only they wanted those few documents. We have been asked for a lot more than that, payslips, savings documents, etc etc. Proof of income for 2015 than asked for 2014 as well.
Dennelle Taylor Nizouxon 2016-05-06 at 16:24
Yes, it is frustrating when they move the goal posts! And we’ve found that they are asking for different items now than just a couple months back when we wrote this article, probably because the CPAMs are incorporating the new rules (which is a good sign). Hang in there and look at the bright side, at least you know they’re working on your case and it isn’t lost in a pile somewhere!
Gailon 2016-05-12 at 15:17
Hi Dennelle. I’m here living of my husbands pension, while he’s working in UK. I was not looking at applying for my Cover until Hubby comes over maybe in a couple of years. I’ve not worked in UK for a couple of years… [edited to protect the privacy of the commenter].
Dennelle Taylor Nizouxon 2016-05-13 at 12:17
Hi Gail, thanks for commenting on the blog. We tried to respond privately to your comment with a direct message to your email address, but it bounced back. If you could please send us an email at email@example.com, Nicole will personally answer your questions.
Lynn Prestonon 2016-05-19 at 16:16
After trawling through loads of forums about the French health system I have found this to be the most informative read and was getting really encouraged. I almost sorted our documents out for a visit to our local CPAM until……. I came across the fact that proof of income would be taken on previous tax year. We have been in France now for three months and living on a reasonable private pension but nothing like our income of 2015-2016 in fact a quarter of it. I don’t understand why if the income is not relevant anymore, why is it accountable?
I feel our only resolution would be to have a private health insurance which I am in the process of application. I suppose my question would be, can we apply next year based on 2016-2017 tax year
Dennelle Taylor Nizouxon 2016-05-19 at 17:07
Hi Lynn, thanks for the comment. I’m so pleased that you’ve found the information helpful! You’ve touched on the major downside of the application process, and in fact the URSSAF says it takes into account the previous TWO years of income (based on your tax filings). If you are under state pension age, it is possible that private insurance will be the least costly option until your previous years revenues match your current ones.
Jacquion 2016-05-19 at 20:09
Hi, Your information is really interesting, but none of it seems to apply to my situation and I wondered if you might be able to clarify.
I am in my early fifties and I moved to France 3 years ago after being made redundant. I’m not employed or claiming any benefits from either country.
I came with an S1 from the UK, with which I was able to successfully obtain a Carte Vitale, valid until January of this year. I have just received correspondence from L’Assurance Maladie asking me to fill in new paperwork – Form S3710b (Couverture Maladie Universelle, protection du base), a questionnaire ‘européen inactif’, a request for a new S1 from England or a letter of refusal of a new S1, and a mountain of justicatif proof.
Having read an article back in January, I was pretty certain that the CMU was obsolete and I should now transfer to the PUMA. I found the article and downloaded the form today, then phoned the 3646 helpline number to check. The guy confirmed this was the right form, and I was all set to put it in the post tomorrow, when I saw another article stating that I should have top up insurance – which I can’t afford to pay for.
Can you clarify whether this is right? Thanks.
Dennelle Taylor Nizouxon 2016-05-20 at 09:11
Hi Jacqui, thank you for commenting on the blog. You do not need to have top-up insurance to apply for the Carte Vitale – it is optional. And yes, you’re correct that the name has changed to PUMA. Hope that helps.
Laura Heywardon 2016-05-20 at 07:55
My husband and I had a top-up health insurance for a few years but were both healthy so didn’t use it and had to cancel as it went up every year and we were living on just my pension and savings. However my husband died last October and I now have arthritis in my hip which needs replacing. I have a carte vitale but hear conflicting advice about whether I need to get a top up insurance again. Some say that they had it done with just a carte vitale and it only cost them 600 euros which I am happy to do but others say it would still cost thousands even with a carte vitale. I really don’t know what to do. I still only have my pension . Please can you advise me which way to go.
Dennelle Taylor Nizouxon 2016-05-20 at 09:26
Hi Laura, I’m very sorry to hear about the loss of your husband. I’m sure you’ve had mountains of paperwork to deal with since October, and now you need to figure out the best way to handle medical costs. My advice would be to do a cost comparison of a few different top-up plans (mutuelles), because their cost will depend entirely on your personal situation. There are online cost comparison websites and brokers who can do a lot of that work for you and make sure you’re comparing “apples to apples.” Many people erroneously think that the Carte Vitale will cover 70% of all your expenses, but 1) the coverage level depends on the type of expense, and 2) that coverage level only applies to the amount that the CPAM thinks it should cost (see this table) For example, if you need to have a crown, and your dentist charges 500€, the CPAM will only reimburse 75.25 of that, and your mutuelle would pay the remaining 425€. The mutuelle “tops-up” whatever the CPAM doesn’t cover, provided it covers at least something (eg. your mutuelle will not cover cosmetic surgery if it’s not covered by CPAM). Best of luck and kind regards.
John Stotton 2016-05-24 at 12:12
We are 16 year residents of France with health cover under the S1. I understand that should Britain be silly enough to pull out of the EU I would still have the right to remain in the French health system but have to pay. At the moment I get a EHIC through the UK . If we join the French system do we then get a EHIC from them to cover us on trips to the UK and Spain. I know it’s a cheek all us Brits asking on an American site but thanks.
Dennelle Taylor Nizouxon 2016-05-24 at 13:48
Hi John, thanks for your comment. First of all, this is by no means an “American site.” Renestance exists to help all English-speakers realize their dream of living happily ever after in France. Yes, I did spell “realize” with a Z, because I am American, but we do have British (and French) people on the team and will even answer questions coming from Kiwis, South Africans and Scandinavians! 🙂 To answer your question about the EHIC, yes, those in the French system with a Carte Vitale get the French equivalent CEAM to cover their healthcare while traveling elsewhere in Europe. I am not about to guess what impact a Brexit will have on the healthcare coverage of UK citizens with S1s living in the EU…
John Stotton 2016-05-24 at 20:53
Danelle, thanks for your reply. I am in the French system with a Carte Vitale but I don’t qualify for a French issued EHIC. My European health cover comes from an EHIC issued by the UK. I suppose my question should have been;- Do people from non EU countries affiliated to the French health system and with a Carte Vitale get an EHIC issued by France?
Dennelle Taylor Nizouxon 2016-05-25 at 10:26
John, apologies for not being clear – just because you have a Carte Vitale does not mean that your medical costs are being paid by the French Assurance Maladie. The S1 is the mechanism by which the EU country administering your healthcare is reimbursed by the country who received your contributions. As long as your coverage is provided by the S1, your EHIC will be issued by the UK, or whichever country’s health system you have paid into and is now paying your medical costs (by reimbursing your host country). French CEAM cards, or EHIC equivalents, are issued to people paying into and getting coverage from the French Assurance Maladie. Does that answer your question?
John Stotton 2016-05-25 at 12:36
It nearly answers my question. Let me have one last try. If Marie who asked a question after me were to pay her 8% and join the French system completely, would she be entitled to a French issued EHIC and consequently be able to travel the EU and be medically covered in the other EU countries?
I’m sorry to keep on but the thought of being left high and dry medically by my own country frightens the **** out of me.
Marieon 2016-05-25 at 01:11
My husband and I are from New York, but intend to move to Paris permanently. We both are over 65, just retired and only receive social security. But our income from the last 2 years on our tax return is very high. Is the income from the last 2 years also taken into account when you are 65 and apply for health care after 3 month of permanent residency? Thanks a lot.
Dennelle Taylor Nizouxon 2016-05-25 at 10:44
Hi Marie, thanks for your question. Unless you are EU nationals, it doesn’t matter whether you have reached state retirement age, because you have not paid into an EU country’s health system. Unfortunately, the Medicare that you likely paid into will not cover you outside of the US. You will therefore find yourself in the same boat as early retirees from the EU, who are asked to pay contributions roughly equivalent to 8% of their past two years income. I recommend comparing quotes for comprehensive private health insurance in France, as it may cost less than the 8% (over the 9611€ threshold), and is probably lower than you’d expect. Many retired Americans on Medicare are surprised to see how much their health insurance actually costs them out-of-pocket once supplemental premiums, copays, deductibles, and all the rest is taken into account. So your least cost option may be to keep the private insurance that you are required to have for your entry visa until your prior two years of income reflects your current run-rate. Nothing is preventing you from applying for the French healthcare after three months of residency, however – if the contributions are too high, you can cancel the application.
Marieon 2016-05-25 at 15:47
Thank you so much Denelle. I have 3 follow-up questions on this matter.
1. After 2 years, when only our social security income is taken into account, do we still have to pay the 8%
contributions on our social security income that is higher than 9611€?
2. We intend after 5 years to take the French citizenship? Do we still have to pay the 8%?
3. I am actually born in Germany and I paid there into the system for 15 years, but I lost my citizenship when I took
the American citizenship. But that was a long time ago before the EU. My guess is, it does not count because I am
not a citizen anymore, even so I will receive a small pension from Germany.
Dennelle Taylor Nizouxon 2016-05-26 at 11:16
You’re welcome, Marie. My response may answer all three of your questions 🙂 The French social security system is not based on citizenship but on contributions to the coffers, so since you won’t be working in France and paying the social taxes, nor have you paid into an EU country’s health system coffers (your German contributions notwithstanding) in the past, you will have to pay 8% of your income to benefit from French social security and healthcare, regardless of your level of income. Note: You are only required to pay these contributions if you wish to benefit from the system – you are perfectly free to “stay off the grid” and insure yourself privately. If you did become French citizens, and your income fell below the poverty threshold, you would be eligible for state aid, subsidies, free healthcare, etc. and would not be required to pay the contributions…but I certainly would not wish that outcome on you!
Marieon 2016-05-28 at 05:04
Thanks again. Another question just came up. Do my husband and I have to pay taxes in France on our Social Security income from the USA? Thank you so much for answering my questions.
Dennelle Taylor Nizouxon 2016-06-06 at 17:25
If you are a fiscal resident of France (see our article on paying taxes in France), you will need to declare your global income on your French return. That does not necessarily mean that you will owe tax on it in France, however, as there are bilateral agreements in place to ensure people aren’t being taxed twice on the same income.
emily laughlandon 2016-06-09 at 09:31
Good morning, Denelle,
Thank you for this very informative article on French healthcare. I am planning to bring my 83 year old mother to live in France from Britain and am confused about her medical rights. Does this new legislation on the Carte Vitale render the UK’s “S1” form invalid? Do you know if she could be simply added to my husband’s Carte Vitale (as I and my children have been?) Finally – do you know if there is a specific office of the Sécurite Sociale that EU residents coming to France can contact for information??
Dennelle Taylor Nizouxon 2016-06-10 at 07:41
Hi Emily, thanks for the question. The European S1s are still valid, and that is how your mother would get her own social security number and Carte Vitale. There is a lot of information online, and we have found that the Ameli phone line is quite helpful as well. But you and I have already spoken on the phone and we are more than happy to assist with your mother’s CV application. Speak soon!
Janiceon 2016-06-13 at 15:09
First, thank you for a very informative site! I’d been struggling with Googling many sites regarding healthcare eligibility in France, and much of the info is wrong, incomplete or out of date. .
However, I’m a bit confused reading through these many posts – some apply strictly to UK individuals, some to Americans, so I’d just appreciate a bit of clarification.
I’m from the USA & obtained my 1 year long-stay visa. I’ve just reached my 3-month stay in France and requested and received a letter from Securité Social with a list of what documents they need from me to apply for health insurance. (By the way, they indeed want an apostille for my birth certificate, which I found out I must obtain in the USA from the Secretary of State in the State where I was born, but what the heck is “mentions marginales”?)
“D’une copie intégrale de votre acte de naissance avec mentions marginales…”
I “retired” from work in the USA in December 2015 and do not earn any “salary” income and the pension that I will receive will not start until four more years in 2020 when I’m 62. (58 now). I’m living off my savings until then.
Am I considered “retired” – or “early retirement”? (Or did I read correctly –in your response to Marie – that as I am NOT an EU citizen – that distinction/designation doesn’t apply to Americans?)
Do I need to pay the 8% based on what I earned in 2015 (and 2014?) – or is there no charge in my case?
I don’t have any French or UK forms that are referenced on your site – S1, P60, but do have US tax returns, obviously. Do they calculate this 8% based on “gross income”, net income or ? (Is it strictly based on “salary” – or income from other sources (i.e. interest, dividend or other types of income?). Do I understand correctly that they ADD both years (not average) – and then deduct 2x 9611Euro threshold?
Example: if 2015 (net or gross?) income = 50,000, Plus 2014 (net or gross?) income = 40,000
The calculation is as follows: ?
$50,000 + $40,000 = $90,000
(roughly adjusted to Euros) = 80,100Euro – (2 x 9611) = 60,878 x .08 = 4870Euro
Thanks a million (dollars or Euros) for your help 🙂 !
Nicole Hammondon 2016-06-13 at 15:24
Hi Janice – Thank you for your comment and queries. I shall dive in and answer your questions in Dennelle’s absence today. Firstly, the ‘mentions marginales’ or ‘filiales’ mean that they require your birth certificate in its ‘long form’, ie showing both of your parents’ names. Your income is based on revenue, and in the case of savings, will be based on interest generated by those savings. Your US tax forms will be used as a base for calculating your contributions. In order to secure your entry visa, you would have had to prove you were self-sufficient financially, so you can use the same evidence again. You will be liable to pay the 8%, if you could not afford to pay it, the clever authorities would not have given you an entry visa! Your example calculations seem correct. Remember that this is for the basic healthcare and you may like to also purchase top-up health insurance (a ‘mutuelle’) to cover the remaining average 30%. Hope that helps! Of course, we are here to answer further questions if you’d like to email us directly – I am on firstname.lastname@example.org.
Kevinon 2016-06-17 at 17:15
I like many are very grateful for your information supplied in these post, and I have been waiting patiently hoping that someone in similar circumstances to me would ask the questions that I would ask and have those important questions answered. That has not happened as yet so I thought I would put finger to tablet and ask myself. Here are our personal circumstances.
Married… Both under 60… Both have government pensions only taxable in UK. Both early retirees.
French house owner for 6 years. Resident in France since last August. Seeking best options for health care.
Having read everything everywhere on the subject, I feel I am left with the following options for health care.
1 Full Private Health Insurance for Husband and Wife.
2 Register as Micro Entrepreneur ..registering my wife as ayant droit.
3 Apply for Protection Universelle Maladie.
4 Do nothing, return to UK if I get ill and stay with family.
Options 1 and 4 are out of the question, and we want health care, so its choosing the most financially viable between 2 and 3.
Protection Universelle Maladie. From what I have read and understood, this is a straightforward process, but effectively the French authority’s take 8% of your complete unearned income from all your declarations as a contribution to the heath system. Say for example, I have a £24000 yearly income net of UK tax a year giving me a bank payment of £2000 per month, Is it safe to say I would pay the French government 8% of that being £160 per month? Or do they calculate the contribution on your gross UK income before UK tax? Is there a tax allowance threshold similar to the UK of £9800 before they start taxing you, thereby only taking the 8% after that threshold, example 24000 – 9800 = £14200. Therefore only taking 8% of the remainder, being £1136 a year or £95 month. If my wife had her own UK pension is that added to the total family income and calculated as a whole sum, mine and hers combined? And again if there is a tax allowance as discussed, does she get this individually or do we only get the one allowance set against the whole income sum?
Where only one party is receiving an income, say me only and my wife doesn’t have an income, does my income only count as the whole and my wife will be included and given her own carte vitale as an individual?
As you can see, I have some concerns financially over going along this route, paying nearly £200 or 260 euros a month without a top up policy.
Register as Micro Entrepreneur. This may be a better option but not as simple or as straightforward as the PUM above. If I registered as a ME, I would be paying monthly sums of 22% on my income from work here in France. I would keep that to about 50 euros a month. Yes there is some additional costs, trade insurance, and more administration cost, etc. However I would effectively control the monthly contribution and keep this reasonable. However I have heard of problems registering ones spouse as ayant droit.
Also one question concerns me, if once registered as ME and paying monthly tax and contributions, would I also receive a yearly French tax return? Or because I am paying monthly, are these contributions and monthly invoices sent to the correct department all they require? Again as I understand things, as I have a UK Gov pension, this can only be taxed in the UK…but as ME, do the French also take additional contributions cotisations when examining my tax return, even though all my tax is paid in the UK?
I’m sorry if I have gone a little into too much detail, however I am sure by answering this question, you may also be helping a number of others who has similar concerns.
Kind regards. Kevin
Dennelle Taylor Nizouxon 2016-06-23 at 09:20
Hi Kevin, thanks for following the blog and we’re happy that you’ve found some helpful information on our site. Your comment actually contains nine different questions in total, so I will do my best to answer the CV-related ones, but you should probably consult a tax expert for the others. First off I’ll say that your option 4 is “out of the question” because you are obliged to have health coverage while residing in France, but option 1 should not necessarily be out of the question. The cost of a comprehensive private insurance policy (100% reimbursement) is not ALWAYS higher than the cost of PUMA plus top-up insurance. You should contact a few companies for estimates based on your personal situation.
As far as the contributions calculation goes, it is 8% of your global household taxable income (including pensions, earned and unearned income) over 9,611€/yr, so assuming you file your taxes as a married couple, and you are both applying for a Carte Vitale, that would be 4% of the total for each of you. We have asked the URSSAF detailed questions about how the 8% is calculated (and about the minimum revenue thresholds), but they are not at all transparent. We have no solid information on whether they apply a standard deduction or allowance, or if the taxable income amount is before or after tax, unfortunately. If only one person is receiving an unearned income in the couple (a pension or other non-salary income), I believe the income will be seen as belonging to the household. In any case where neither of you is working, you would have to submit separate applications (even if they have the same household income amounts) and would be attributed separate Carte Vitales with different social security numbers.
If one of you is earning a salary and paying social charges in France, as you would if you registered a Micro-entreprise, the non-working spouse is considered a dependent and would be covered as an “ayant droit.” This part of the system is undergoing changes, but normally the dependent spouse would show up on the employed spouse’s “attestation” as a dependent, and both would use the same social security number.
I hope you’ll forgive my not addressing all your questions about the tax treatment for Micro-entreprises in France and UK pensions. I’d be more than happy to refer you to an English-speaking accountant who could advise you, however.
daveon 2016-06-27 at 10:50
hello, not sure if this thread is still open, but I’ll give it a try; I’m 63 and my wife is 53 and we are considering moving to France; my wife’s earnings in the previous two years are around £XXX and mine are around £YYY; so, in round figures, would my wife be charged 8% of £XXX-9611 euro, and would I be charged 8% of £YYY – 9611euro for the Cartes Vitale? In two years time, as we’re from the UK and I’d be eligible for my state pension, would the charge for the Carte Vitale be reduced to zero?
Dennelle Taylor Nizouxon 2016-06-28 at 00:13
Hi Dave, I edited your post because I don’t like to see people put a lot of personal information on our public website- hope that’s OK. To answer your question, while your wife and you will submit separate applications for the Carte Vitale (and will have different social security numbers), your income will be evaluated at the household level. The threshold of 9611€ is also per household. As we’ve stated elsewhere on here, the URSSAF does not share their actual formula for calculating the contributions, but we believe they would send you a joint bill for 8% of (£YYY+XXX)-9611. Your second question has become more complicated since last week, but currently EU citizens who have reached the state retirement age of their home country (or are receiving a state pension) are issued an S1 form. This form effectively transfers the cost of your contributions to the fund you paid into (the UK for you). Whether the UK will still be in the EU in two year’s time, and still be party to the reciprocal benefits system in place for EU citizens, is anyone’s guess now…
dave hamshawon 2016-06-28 at 13:25
hello Dennelle, thanks for the reply; yes isn’t democracy a wonderful thing! re my second query, for non EU citizens, is the annual charge for the cart vitale recalculated each year to be based on the previous two years income?
Dennelle Taylor Nizouxon 2016-06-30 at 13:59
Again, I cannot officially confirm the URSSAF methods of contribution calculation, unfortunately, but if they work like many other French agencies, they will likely ask you for an updated/recent tax return (avis d’impots) after the first year.
Katieon 2016-06-27 at 17:20
Thank you for such an informative site and for answering people’s questions. It is often hard to find accurate, up-to-date information on these matters so your site is a real service.
I have a few questions for you if you would be kind enough to answer:
1) I am a UK citizen and have paid into the British social security system the last 9 years. I am now interested in registering at my local CPAM in France, but I do not yet have a job here. I am debating whether or not I should wait until I have a job to register at CPAM, as I am concerned about being required to pay contributions into the French healthcare system (which I cannot afford right now, as I am without a job!), being required to buy private medical care, or perhaps being required to register as unemployed (which I also do not want to do, for the sake of minimising bureaucracy). Do you have any advice on this matter?
2) My motivation for registering at my CPAM is to start my French “residency clock”, given what has happened with Brexit. Do you have any resources or information about how the beginning of the 5-year residency window for EU nationals is established in France? I have read much conflicting information online (some say CPAM registration, some say get a titre de séjour, some say register at La Marie). Is there official guidance about how to start the residency clock that you could direct me to?
Many thanks for your guidance. This is a very confusing time for all of us British EU-based expats; it means a lot to have people help.
Dennelle Taylor Nizouxon 2016-06-27 at 23:57
Hi Katie, yes we have just been thrust into a very confusing and concerning time, indeed! I don’t know how long you’ve been a resident in France (?), but if you’re still in the first three months, your EHIC card from the UK will cover your expenses. 1) The simplest way to get French social security coverage is through employment, as you rightfully suspect. If you’ve been looking for a job for a while and are nervous about being hit with medical expenses, then you could go ahead and apply for the Carte Vitale at your local CPAM, but consider that: a) they may ask to see your current coverage, b) they will base your contributions on your past two years of income (not your current, lower income), and c) there’s a good chance you’ll still be waiting for your Carte Vitale by the time you’ve landed a job. 2) The best way to establish yourself as a French resident is to do a tax declaration. They will likely use EDF bills or other ways to confirm your permanent residency at the beginning of your five years, but an Avis d’Imposition is highly appreciated by the French Administration! Once you spend over 183 days in a calendar year in France, you are considered a fiscal resident anyway, so you might as well get a jump start. That document will make nearly every French bureaucratic procedure go more smoothly. Hope that helps and best of luck!
Katieon 2016-07-11 at 16:10
Many thanks for your prompt and informative response! I have a few follow-up questions if that’s okay:
1) To ensure I’ve understood correctly: if I am employed, they will base my contributions on my current income, even if I literally just started the job?
2) To qualify for a Carte Vitale through employment, do you know if I need a CDI? (or is a CDD sufficient?)
3) To qualify for a Carte Vitale through employment, do I need to be working full-time, or can I qualify through part-time work? (I have seen a few mentions on blogs about needing to work X number of hours before being eligible, but I’m unclear how reliable that guidance is.)
4) Once I am employed and have registered with CPAM, do you know what happens if my employment situation changes (e.g. I switch to part-time, or stop working)? Would I still be covered? If I needed to make contributions, what income would they base it off of? (the most recent job, even if I only worked there for a few months, or the past 2 years’ income?) (Many of the jobs I am finding are temporary, thus the concerns.)
5) Lastly, in terms of registering – given that the earliest I could file a French tax return is 2017, do you have any other suggestions for registering my residency?
Thank you again for all your help – it is very much appreciated.
Dennelle Taylor Nizouxon 2016-07-15 at 13:39
Hi Katie, my answers to your first four questions come from my personal experience as an employee and an employer in France, as opposed to any official CPAM/URSSAF knowledge. Any legal, declared employment in France would qualify you for a social security number and a Carte Vitale, regardless of whether it’s a CDI, CDD, part-time or full-time. You will need to work a certain amount of time to qualify for certain benefits, like unemployment or paid maternity leave, but I believe the health coverage is immediate (or the time it takes the administration to register you and attribute you a number). Again, this is just my understanding, only official sources can confirm the accuracy for sure. The contributions or “charges sociales” are based on your earnings, usually from 21-23% of your brut pay (and your employer pays a higher percentage to URSSAF on your behalf), and starting with your first pay slip. PUMA was created primarily to make health coverage seamless for people whose employment status changes, so you should keep your coverage even if you become unemployed. In terms of “registering your residency” in some official way, the only thing I can suggest is applying for a Carte de Séjour. As a UK citizen, you currently have the right to live in France with just your passport, so this is entirely optional, but it couldn’t hurt.
Carolyn Humeon 2016-06-30 at 13:27
I’d like to echo other contributions on this thread that, after so much time spent googling and researching, that this site is a breath of fresh air – providing clear and up to date information on the complexities of applying for a carte vitale.
My partner and I moved to France at the beginning of April this year so will have been in France for 3 months in early July. I intend to register and start up as a micro-entrepreneur and pay my cotisations this way. So, a couple of questions:
1: we are currently renting a property whilst the purchase of our permanent residence goes through. So we only have a letter from our landlord confirming our residence here. We don’t have any direct utility bills in our name here so is this likely to cause a problem?
2. We are due to sign the Compromis de Vente at the end of next week so would it help to ask the Notaire for an attenstation?
3. currently we are not married – although because of French inheritance laws we will be getting married next year. Would my partner still be treated as an ayant droit beforehand? (I use the term partner in no legal sense – he and I have been together for many years but never got around to marrying!)
Nicole Hammondon 2016-07-01 at 14:21
Thank you for your compliment! To answer your questions:
If you intend to start up as a micro-entrepreneur, you will have the immediate right to apply for your Carte Vitale.
Should you apply outside of the starting a business route, and regarding justifying your address here, do you have a lease with your landlord? If so, this will have dates on it and could well suffice. Also, do you have a fixed line phone bill? Bank statements? Not as ‘solid’ as an electricity bill, but if they show your address, they can be used. If you do not have a lease, nor phone bills or bank statements, is your letter from your landlord an ‘Attestation d’hébergement’ or similar? The French authorities like this type of sworn statement (attestation sur honneur). You will need to show strong evidence of your presence in the country for the last few months, to satisfy the ‘stable’ part of the pre-requisite criteria of ‘stable and regular’.
Your partner can be added to your Carte Vitale as your ‘conjoint’. The CPAM have apparently phased out the ‘ayant droit’ with the new laws introduced in January, but as I pointed out to them, how can, for example, a home-maker apply for the Carte Vitale independently, if he or she has no income? So they admitted that there are still cases for a ‘rattachement’ – a linking of two people to one card.
Hope this helps!
Andrew Mackieon 2016-07-14 at 10:03
My wife and I have lived permanently in France for 3 years. I am an early retiree with no UK state pension and I’m the dependent of my wife who has her own Carte Vitale and a UK state pension. Please may I ask … Should I apply for my own Carte Vitale now that the ‘ayant droit’ system is no more under PUMA or should I let sleeping dogs lie?
Dennelle Taylor Nizouxon 2016-07-15 at 13:42
Hi Andrew, unless you are notified of a requirement to obtain your own Carte Vitale, let that pooch snooze… 🙂
Martin Racheron 2016-07-17 at 12:45
I have only recently discovered this site but wish had done so much earlier! The content is easy to follow and highly informative unlike some others could mention!
My wife and are planning to move to France in the next few months once our house sale in England has gone through. The referendum result somewhat took us by surprise and we now plan to rent a property rather than buy whilst events unfold. We are both in our mid fifties and do not plan to work in France. I took redundancy in 2014 with a substantial payment but have no income until my company pension becomes payable in 7 years time. My wife has a reasonable private pension that she is currently drawing and this will remain our only income (apart from a small amount of bank interest on savings) until my pension is payable. This is not a problem as we have capital to draw upon which will bridge the gap. I have a couple of questions about applying to join CPAM.
1. I had significant earnings in the UK tax year 2014/2015 because of my redundancy payment and clearly would not want to be assessed for cotisations based upon this figure so want to get my timing right. Are the previous 2 years income that you talk about for calculations calendar years i.e 2015 and 2016 or UK tax years which run until April? I am happy to delay applying until this has passed if necessary.
2. We will need to have private medical cover in place for the period until we entered in to the French ‘system’ and wondered if this should be taken out in the UK before we leave or taken out with a French company?
Many thanks in anticipation of your help,
Dennelle Taylor Nizouxon 2016-07-18 at 11:05
Hi Martin, you should apply for an EHIC while in the UK, as this will cover your medical expenses at the same reimbursement rate as the NHS for three months in France. Whether it makes more financial sense to take out a private, comprehensive health insurance policy or pay the contributions for the French PUMA depends entirely on your personal circumstances (health, age, income, etc.) It is best to request a few quotes and do the cost comparison. If you do decide to take out private insurance, it doesn’t matter whether it’s a UK or French company…there are loads of international insurers who offer these policies. Since there is so little transparency about how the URSSAF calculates the contributions, I might suggest that you take out a private policy to begin after your EHIC becomes invalid and still apply for a Carte Vitale/PUMA coverage to see the actual cost of the contributions. There is no obligation to take the PUMA coverage if your private policy is less expensive, but if PUMA is less costly, you could switch to that and downgrade your private comprehensive policy to just a top-up insurance (or mutuelle).
Ross Cameronon 2016-07-18 at 08:59
Hi, thanks for your brilliant blog(s) which I’ve just discovered! I have some questions regarding accessing French Healthcare: my wife and I bought a house in Languedoc in 2012, and have since then renovated the house and both of us have retired, and now that I’m 65 and in receipt of UK pension with an S1 for both of us, we want to now live here permanently. In collating the required documents we have a problem: my wife was born in Canada, became a naturalised US citizen, and recently became a naturalised UK citizen, but she has no birth certificate (records destroyed in a fire some 40 years ago!). Would her certificate of UK naturalisation stand as a substitute for birth certificate? With respect to establishing permanent and stable residency, we arrived in France in May of this year with a view to becoming resident here: the local Mairie is puzzled (reluctant/uncertain?) to register us as we’re EU citizens, and our utility bills/bank statements and so on have our UK address(es) on them (although they note the French address). Should I insist that the Mairie give us an “attestation d’enregistrement” or try the sous-prefecture for a titre/carte de sejour…or something else?
Nicole Hammondon 2016-07-18 at 14:21
Thank you for your compliment and for your questions. Regarding your wife’s birth certificate, you should be able to order a replacement from the records office in Canada without any problem. You can probably do this online and have it sent out to you, for a small fee. It is definitely worth doing this as birth certificates are required for many administrative tasks here in France, and should you decide to apply for the Carte de Séjour/Résident at any point, then you will not only need your own, but your parents’ too! As you will be asking for a Canadian birth certificate, you may like to ask for a dual-language version in both French and English, which would actually save you money on translation fees.
Next, yes, your Mairie should be aware that they can give you an ‘attestation d’enregistrement’, and you are still within the three months date limit of your permanent arrival, so there should be no problem. I would insist. Lastly, I would arrange to change your addresses on your bill to just your French one as soon as possible. You can apply for your Carte Vitales very easily as you both have S1s and do not need to wait for the usual 3 month residency criteria to pass as you will be applying for reciprocal healthcare (ie through the UK) – you can apply straight away. Do drop me a line if you’d like us to handle this for you. And, of course, the best of luck with everything! Enjoy France!
Patrick Samuelon 2016-07-26 at 19:55
Hi, I am in the process of buying a property in France and would like to relocate there in a few months time. Can I use the EHIC for health cover in the firt 3 months before applying for the PROTECTION UNIVERSELLE MALADIE (PUMA) or am I required to take out a health cover for that period ?
Nicole Hammondon 2016-07-27 at 11:51
Thank you for your message. You certainly can use your EHIC for your first three months’ health cover, then at that point apply for your Carte Vitale (PUMa). By the letter of the law, you are obliged to have health cover when applying for the PUMa, but it is understood for Europeans that they arrive with the EHIC, which lasts for three months of stable living in one country, at which point they can apply for the PUMa on the basis of having been here for three months stable living. So the system here does not expect you to take out private insurance for the application period, don’t worry. (Note that non-EU citizens DO need to prove they have private health cover before applying.) If you need any help applying, we can get you through the system quicker than if you apply on your own as we know exactly what they ask you for every step of the way and pre-empt the process! Best, Nicole
Patrick Samuelon 2016-07-27 at 21:56
Thank you for your reply, that is reassuring as I was told by a Health care Insurance that I had to have Private Health Insurance because the EHIC would mean I remain ”habitually resident “ in the UK !
Yes I would be grateful for your help at some point in applying for PUMa . Can I just contact you when I need to apply ?
Nicole Hammondon 2016-07-28 at 13:45
Hi Patrick – glad to have been of assistance! I’ll send you the basic details now so that you have my email address in your system and you can get in touch as and when you need us. Look forward to hearing from you…Best regards, Nicole
Patrick Samuelon 2016-07-29 at 08:54
Sorry to trouble you but did you send the details as I don’t seem to have received them .
Robin Bromageon 2016-08-09 at 18:19
Like so many others – I’m really grateful to find this site and your most helpful information. From the various questions posed I think I know the answers, but I would like just a couple of points of clarification if you don’t mind?
1. Is the 8% cost of PUMA based on the previous 2 years taxable income? So for 2016 this would be average of 2014 and 2015. this means then that for many like me, the initial cost will be high as I was in full employment until mid 2016 and have just moved to France.
2. I’m guessing that PUMA is optional, right? i.e. if I take out a private insurance I don’t have to join the French system and don’t have to pay the 8%? From my enquiries on private policies, this could mean that for me having private insurance for the first two years might make sense, moving on to PUMA when two years are based only on my retirement income, i.e. around 2018/2019. Obviously depends on my specific financial circumstances, but have I got the principle right?
Dennelle Taylor Nizouxon 2016-08-09 at 18:48
Hi Robin, thanks for posting. Yes, both of your points are correct in principle – good job! As mentioned previously, the contribution calculation is anything but transparent, but the only official information we’ve had says it’s based on revenues from previous two years. Best regards, Dennelle
Nicole Hammondon 2016-08-19 at 11:54
Hi Robin – In fact, although you need to give details of your last two years’ income when applying for the PUMA, your actual payments of the 8% of household income over the allowance of 9,611€ is calculated on your French tax returns, which will reflect your current ‘true’ income. So we always recommend getting into the French tax system as soon as you arrive here. If you arrive just after the annual period for declaring French tax (May), you will need to wait until the following May to declare, then you will receive your tax statement in October and start paying your PUMA costs in November. So you get quite a long period of ‘free’ time. Your costs will always apply retrospectively. If you arrive in France after May, you can declare the following May and receive your tax statement in October, for payments to start in November. So you’ll be paying slightly quicker. At the end of the day, you will always be paying for the time you are here in France, in the PUMA system, so it’s not worth calculating the best month to arrive! 😀 Note that if you don’t enter the French tax system, you could be in a really tricky position when it comes to your healthcare if you can’t provide a tax statement for them to calculate your payments on. Hope this helps!
Jackieon 2016-08-16 at 11:56
Just found your blog whilst searching for some help and like so many others find it superbly informative and helpful.
This is our current situation which I’m hoping you may be able to advise us about.
We are both retired and have been living in France from 1st Aug 2015. We took private health insurance for one year as my husband wasn’t due to receive his S1 until 20th April 2016.
When this arrived, with the co-dependent form for me (his wife) we went to local CPAM in May with all relevant docs which they duly copied and said registration would take a month (…).
Received a letter requesting further copies of our passports, which have been sent to them.
Have had nothing since so I rang the advisory line and was told it would be another month to wait.
Expressed concern as our private health expires this week and was told not to worry, our registration would be dated from our application, presumably May?
But we have nothing to confirm this. Would you know if this is correct and can we rely on it as we don’t want to be up the creek without any paddles so to speak !
We do want to take out Assurance Mutuelle but cannot as we don’t have any social security numbers as yet.
And we don’t want to have to take out private health again as we are both eligible for the French system… any advice would be very gratefully received, thank you!
Nicole Hammondon 2016-08-19 at 11:42
Hi Jackie – your S1 is valid from the date written on it, so regardless of when you receive any notification back from the CPAM, you should continue paying your healthcare costs yourself, making sure that you keep your brown treatment forms, so that, when you receive your temporary, and then your permanent, Social Security numbers, you can make claims for repayment. Note that you will only be covered for up to about 70% (average – sometimes less, sometimes more) of your healthcare costs; you may like to take out top-up insurance for the rest.
KATZon 2016-08-23 at 15:44
I seem to be in an obscure & unique position, my husband works in the Uk and visits for short breaks, I remain resident inactif in France and have been here since jun 2009, my husband maintains myself by transferring monies to a french account from which I pay he normal bills and our daughter aged 18 is here living with me & who is in a French School & he pays uk tax. I was under the impression I had to wait the 5 years of residency before I could apply for my health card, now it seems I can apply after 3 months, I do not work here although I had a temporary job in France for a few months in 2010, normal deductions were taken from my salary. So after reading all the above I am still confused. Both my daughter and I have an EHIC card & have so far either paid for medical needs or in the case of my daughter she had emergency surgery and they insisted we supplied her EHIC and were sent minimal bills which we paid. Do I need to apply for residency now and show my husbands earnings, if so from which tax years please or do I wait till June 2017 and use the 2015 & 2016 P60’s of my husbands.
Nicole Hammondon 2016-08-23 at 16:33
Hi there Katz – I read your post with interest. Actually, if your husband works in the UK and pays his National Insurance contributions there, you are, and have been since either you moved here or your husband started work in the UK with you living here, entitled to claim your healthcare costs back using the S1 form. You need to call +44 191 218 7777 and explain your situation and ask them to send you one. They may ask you to complete an online form to request this. Under a European reciprocal arrangement, this S1 form allows pensioners and those whose spouses work in the UK (and pay NI there) to have their healthcare costs covered by their home country. It also covers children in full-time education. It surprises me that you have been able to use your EHIC card for so long, as they are only valid while you are NOT considered a resident in the country you require healthcare in (ie you are holidaying or travelling), therefore after your first three months here, you would have been considered a resident here and your EHIC should have been deemed invalid. I do know that some people risk it and continue to use their EHIC cards, but I also know of others who it’s caught up with! Once you have your S form, you can apply for the Carte Vitale using that. If you need any help with the process, just ask us! We can help you through all the paperwork, and our process actually speeds up the application as we know exactly which information will be asked for in subsequent sages of the application, so we simply ensure we send it all off at once! 🙂
KATZon 2016-08-23 at 17:15
Thank you for your prompt response, i did not expect to use the EHIC either but the hospital insisted we gave it to them ! I will discuss with my husband & follow your advice, thank you;
Nicole Hammondon 2016-08-23 at 17:51
Wendyon 2016-09-02 at 03:41
Hi I have been reading all the above with interest and am wondering if you can help me please. I came to France to work for a UK co last April for a 6 month contract, intending to return home in the October. However I met someone over here and started staying with him and his family when my contract ended. I stayed registered in the UK and travelled back and forth as my son is still at home in the UK (he’s 26 so I haven’t just left him !). I then took another 6 month contract over here this April which is due to finish soon. My partner has proposed and we are getting married in January 2017. What is my status now and what will it be after we are married ? My husband to be works for himself over here and has his own carte vitale. He has been here over 5 years now and has 2 children in the French school system. I have had to use my EHIC card a few times as I had a kidney infection earlier in the year and was hospitalised for a week, and I have had to see the GP who has now diagnosed me with carpal tunnel syndrome. I am about to send my brown forms to the local CPAM office to claim back the 70%, is this correct ? AT what point can I apply for a carte vitale myself ? I wont be working after my contract ends until I can learn sufficient French. (I will be working but not being paid as i will be assisting my husband to be initially). Many thanks for any help you can give me !
Nicole Hammondon 2016-09-02 at 15:55
Hi Wendy – thank you for your message about the Carte Vitale and congratulations on your engagement! The good news is, as you have worked in France for more than one hour on a contract here (yes, one hour! Great minimum!), you can apply for your own carte vitale right away. You just need to check to which organisation you have been paying your social security cotisations (charges), and apply to them with the same paperwork as for a regular application, but including your first and most recent payslips. It does not matter that your employment is coming to an end shortly. If you would like us to help you through the application process, informing you which paperwork you need and the best way of presenting this, as well as information about how to speed up the application process, let us know. You can email me direct at email@example.com. The cost for our Standard Carte Vitale Service is 105€ TTC (we also offer a VIP service for clients local to us in the Languedoc Roussillon area, which includes face-to-face meetings). If you decide to use our services, we can be with you every step of the way, right through to receipt of your card. Whatever you decide to do, we hope this information helps and best of luck with your forthcoming nuptials! 🙂 Nicole
christine marshallon 2016-09-06 at 09:42
at the moment we live in Spain,we are English
We are moving to France very soon
we have health cover here in Spain can we use this until we get our french healthcare sorted
where do you go to get your carte vitale
Dennelle Taylor Nizouxon 2016-09-06 at 12:49
Hi Chris, thanks for your comment. The French organisation that would handle your healthcare coverage is called the CPAM – Caisse Primaire Assurance Maladie. Go to this website https://www.ameli.fr/assure/adresses-et-contacts and type in your postal code for the office nearest to you. If you would like assistance in applying for the French coverage, please send us an email at firstname.lastname@example.org. Happy moving and welcome to France! 🙂
Bill Clarkeon 2016-09-06 at 11:54
I have just discovered your excellent site this morning. At the age of 79 as a UK national I have been living in France for the past 9 years. I am married to a German lady who holds dual French, German Nationality. I have a green health card and a “carte de sejour” valid for the next eight years. I am obviously concerned over retaining my present healthcare provision when Brexit kicks in ( assuming I will still be around then!). Would I still keep the green card automatically, being married to a French passport holder or will I still be at risk of losing it depending on the negotiations? If so the obvious thing for me would be to try and get French Nationality, a bit strange at my advanced age but perhaps necessary.
Best wishes Bill Clarke
Dennelle Taylor Nizouxon 2016-09-06 at 12:55
Hi Bill, thanks for the message and the compliment on our site! The good news is, you can relax. Even if your wife only held German nationality, her EU-citizenship would cover you for the reciprocal health benefits as well as for residency should your UK-based rights run out. If she is a French national, even better! You will keep your lovely green Carte Vitale. 🙂
Edieon 2016-09-07 at 14:53
My husband and I are both 75 and have lived in France permanently for 12 years and have our CVs and top up insurance so have no problems. I understand that the UK government pays France every month for our basic health care but cannot find any info about this. I was explaining this to someone and want to let her know the facts (France isn’t footing the whole bill as she thought). Do you know how much per month is paid to France, or can you tell me where to look please?
Nicole Hammondon 2016-09-13 at 14:22
Hi Edie – I think the confusion here lies in the fact that the UK does not pay a set sum each month to France. The S1 Form that you are eligible to when you reach state pensionable age allows a reciprocity of care between EU nations. So France covers the bills for UK S1 holders in France, and the UK covers the bills for French S1 holders in the UK. A sort of ‘entente cordiale’ if you will. As you rightly note, the state healthcare service in France only covers part of your overheads (on average 70% for regular care, less for dentistry, ophthalmology etc), so most people purchase a top-up insurance to cover the rest. Hope this helps your friend! Best, Nicole
Mary Smithon 2016-09-07 at 19:11
I am a retired US citizen and have just successfully applied to renew my title de Sejour after living one year in France. I want go apply for PUMA but after reading your comments, I’m afraid I may have two problems. First, I do not have a French bank account, but plan to open one soon. Second, I had private health insurance when I arrived in France last December but cancelled the policy as it did not cover pre existing conditions and I was uncertain that I would stay in France. I have now obtained a new policy but it has only been in effect for two weeks. What would you suggest?
Nicole Hammondon 2016-09-13 at 14:24
Hi Mary – I was about to reply to you when you called us at the office! Looking forward to helping you. Best, Nicole
Davidon 2016-09-12 at 03:29
Thank you so much for your site. I will be 74 years old next year in August 2017 and I am moving to Paris from New York in 2017 to live there permanently. I understand that after 3 month of continued residency I will be able to apply for PUMA. I also understand that I need Mutuelle insurance to cover the 20% to 30% that is not covered by PUMA.
I am in excellent health but I have problems finding a Mutuelle insurance that covers seniors at my age and of course I would like to know how much it might cost.
Anything you offer might help. Thanks a lot.
Nicole Hammondon 2016-09-13 at 16:54
Hi David – I’ve had a recent recommendation for SOFICAS for the over 70’s- who also have an English-speaking dept. http://www.soficas.fr/home/default.aspx. Also, we often recommend AXA, who also have an English-speaking dept. Another route to explore is to ask your bank. They are often very competitive for insurance policies. Do let us know how you get on so we can all share the information! Best, Nicole
Henryon 2016-09-12 at 14:29
I am a U.S. expat who worked in France for more than 10 years. Recently, I retired in France but am considering moving back to the United States.
My question is this: Do I lose all my French health benefit if I repatriate to the U.S.? I do not have French citizenship, but do have a 10-year carte de sejour.
I had hoped that, should I become ill or require hospitalization while in the U.S. I could return to France for treatment.
Is that possible?
Thanks in advance for your help. This site is fantastic!
Nicole Hammondon 2016-09-13 at 14:04
Hi Henry – unfortunately, once you live in a country for three months or more, you are considered ordinarily resident there and subject to that country’s rules regarding health, taxes etc. So if you moved back to the States, unless you fell ill and came back to France for health treatment within three months, you would lose your rights here in France. Sorry not to have better news for you! Best, Nicole
Karen Johnstonon 2016-09-12 at 17:22
What a wonderful website ! Having searched all over the internet re PUMA and found many conflicting stories I have found one I understand !
Please could you answer a couple of questions for me ?
Both my husband and I are early retired’s, my husband is 53 and I am 52, we both have long term health problems which require daily medication, I also wear a prothesis. We moved to France in March 2016 but I suffered a relapse in my health after several weeks of being here. I did not know how to claim money back from my EHIC and just paid for treatment and doctors visits.
We are about to go to our CPAM office this week to apply for PUMA but now find that our contribution will be calculated on our last 2 years income!. Help w only live on my small NHS pension, my husband has no income at all (he stopped claiming DLA when we left the UK).
Should we apply for PUMA or private health cover?
Nicole Hammondon 2016-09-13 at 14:12
Hi Karen – in our opinion, there is never any harm in applying for the Carte Vitale (PUMA). The minimum income levels the CPAM seem to require in order to grant a Carte Vitale are extremely difficult to nail down, but roughly equal to the SMIC (minimum wage). If you are living satisfactorily off of your pension, both of you, then there is every chance that you will be passed. As in every case, we do recommend that you join the tax system here in France as soon as possible (so you will declare next May) as your eventual contributions will be based upon your tax declarations. You will not start paying contributions until you have a tax reference number, generated from your first declaration (received in the October following first declaration in May). I hope this helps and of course, please do contact us if you’d like us to help you through the application process. Best, Nicole
Claire Hugheson 2016-09-14 at 17:11
Hi, hoping you can help me! If my husband opts for PUMA, will I be able to be added to his “policy”? I am already an AE with a CV but we’d prefer the simplification! Thank you
Nicole Hammondon 2016-09-22 at 14:11
Hi Claire – since the first January this year, each person is attached to the PUMa in their own right, so you are obliged to keep your own card and therefore separate ‘health account’. Best, Nicole
rosieon 2016-09-18 at 15:47
Hey thank you for writing such a up to date article, i have recently moved to france with my partner and my 2 year old son, i do not work as i look after my son full time, but my partner travels back and forth from the uk to work, I want me and my son to be on the french health system but because i do not work is this possible? i have proof i have been here 3 months plus etc
any help would be great
Nicole Hammondon 2016-09-22 at 14:08
Hi Rosie – If your partner pays his national insurance contributions in the UK, then he can apply for a family A1 form from the UK authorities (https://www.gov.uk/government/organisations/hm-revenue-customs). You would hand this form into your nearest CPAM office, along with some other personal documentation, and this would be your application to join PUMa and eventually receive a Carte Vitale which would cover the whole family. Best, Nicole
Marie Edwardson 2016-09-22 at 02:12
Thank you so much for your very informative and clarifying website. I am moving permanently in 2017 from Manhattan/New York to Paris. After 3 months I will immediately apply for PUMA.
The long stay visa application requires to take out private health insurance for my stay in France.
For how long would you recommend taking out private insurance? Just for 3 months? Or 4 months? Or more?
How long will it take approximately to receive confirmation from PUMA that I am in the system?
Thank you so much for your help.
Nicole Hammondon 2016-09-22 at 13:59
Hello Marie – yes, that’s right, you do need to have a private health insurance policy, valid for your whole stay, in order to secure your visa in France. Then, after 3 months’ permanent residency, you can apply for the PUMa. This can take a few months, although it is often quicker for non-European applicants who have been pre-qualified financially. As I presume you are coming to France on an entry visa that you will convert to a stay visa, probably of one year, you should take out one year’s health insurance. Remember that you can cancel this as soon as you are covered by the PUMa. If you can pay by monthly instalments, it will save you paying a lump sum up front and claiming it back later on. Remember, if you need any help with your visa conversion or the Carte Vitale application once you are here, please don’t hesitate to contact us. Hope this helps you! Nicole
Marie Edwardson 2016-09-22 at 16:28
Thank you so much for clarifying this, Nicole.
I will come on a Long stay visitor’s visa (Visa de long Sejour) for more than 90 days.
If I understand it correctly, I have to file immediately for the “carte de sejour” in Paris.
And I should as soon as possible file my tax return.
Is there anything else what I have to do, besides “small things” like bank account, TV/Internet, phone, gas, water?
And yes, I might very well contact you for help, when I am in Paris.
Nicole Hammondon 2016-09-22 at 16:43
You will also need to undertake a medical at your local OFII office, as part of your visa conversion to VLS. You could even open an English-language bank account in France before you move with, for example, AXA International http://www.axa-in-france.fr/banking-savings/ or Crédit Agricole’s Key Finance team (https://www.credit-agricole.com/en/), simply changing your address when you arrive. We’d be happy to help you with your move! Nicole 🙂
Marie Edwardson 2016-09-22 at 23:13
Thanks again. I am not sure about AXA, because I have heard horrible stories about the company, but Crédit Agricole’s Key Finance team might work.
Michaelon 2016-09-23 at 11:27
First of all thank you for your brilliant web site, I wish I had found it sooner. It is refreshing to be able to get up to date information.
Can I ask for your assistance please?
Briefly, I bought a house and moved to France at the beginning of this month. The house has a Gite which I could rent out and therefore start a small business.
I am 61 years old and retired due to injury from the Police in the UK a few years ago. I receive an ill health pension, an injury award and industrial injury benefit. My injury award and INB are not taxable in the UK and my ill health pension is below the tax threshold therefore I do not pay tax in the UK since ceasing my self employment in May 2015.
Because I have ongoing health issues and require daily medication I am trying to find out the best way forward as far as healthcare is concerned. Your advise on this matter would be very much appreciated.
Should I go down the micro-entrepreneur route, private insurance or other?
I cannot obtain an S1 (apparently) because I do not receive an age related pension.
Will I still have to pay the 8% contribution even though my pensions are not taxable in the UK?
I believe if I do the ME, I would pay 20% tax, would that be just on the income from the gite or would it include my pensions as well.
Many thanks indeed,
Nicole Hammondon 2016-09-28 at 14:21
Hi Mike – You could apply for the PUMa without working as an inactive pre-retired EU citizen. You would pay 8% of your global income, after the allowance of 9,611€. You would need to be declaring your income in France in order for the CPAM to calculate your contributions as this is applied from your tax declaration. You would need to speak to an accountant to find out whether your pensions, award and benefit would be taxable in France. Then you could calculate your anticipated contributions if you took this route. You could also make enquiries to insurance companies to get some quotes for private insurance to compare. If you start up as an ME, you would pay total contributions, including social security contributions, of approximately 25/26% of your income on your gîte earnings, but you would still need to declare all your earnings on a French tax declaration. Again, I would consult an accountant in France to discuss this. Hope this helps! Best, Nicole
Jamimaon 2016-09-25 at 19:03
Thank you so much for this very informative site.
We are retired and I am moving with my husband to France to live there and we do not intend to come back to the US. My question is not related to private health insurance for the long stay visa, but to the following:
“In order to secure your entry visa, you have to prove that you are self-sufficient financially.”
I searched and have difficulties finding the income threshold or the minimum amount for 2 people.
Could you help?
Dennelle Taylor Nizouxon 2016-09-26 at 09:32
Thanks for your comment, Jamima! As it’s not related to the subject of this particular article (health insurance in France), we’ll take it offline and answer you directly via email. I hope that’s OK. Kind regards, Dennelle
Marieon 2016-09-27 at 01:05
Thank you so much for answering my questions above. It has been all very helpful. But I have problems finding a health insurance company for the first year in Paris before we can join PUMa. The prices for my husband and me, ages 64 and 74, both in outstanding health, are between $3,000 and $4,000 per month for 2 people. Is this the normal price? I have written here from the USA to at least twelve health insurance companies for quotes like: Travel Safe, Seven Corners, Medex, AXA, IMG (Insubuy), Allianz, Wallach, International Corporate Benefits, Globality Health, Soficas, Health Europe Assistance etc..
For our long-stay visa the application requires the following:
“Please provide a letter from an insurance company stating that you will be covered, for a minimum of 45,000 Dollars (it might be more in 2017) for the duration of your stay in the Schengen states, for medical, hospitalization and repatriation expenses (these three words must appear in the letter).”
No insurance company even acknowledged the required letter.
Can you recommend a company?
Nicole Hammondon 2016-09-27 at 13:51
Hi Marie – I am going to reply to you by email as I think this would be better at this point. Watch your inbox! Best, Nicole
Maria Straubon 2016-10-03 at 23:03
Mary, try Geoblue Travel Insurance. They do have a plan called the Explorer Essential for expats and they were always very good about reimbursements etc…I believe they have what you need for your letter.
keli martindaleon 2016-09-29 at 13:46
Great and informative!! Finally, the answers to some of these most confusing health care questions 🙂
Just wanted to ask something a ‘little’ different… Husband is UK citizen, I am USA citizen and he works and I do not. We live in France and I have carte de sejour – going on 4 years. Once I have lived here 5 years, I think I am eligible to apply for the 10 yr. ‘residency’ card. In that case, would I automatically get the health insurance (free??) or is it always based on contributing 8% off global/family income (if you are not working in France)?
2nd question: if Brexit does happen and I have become a ‘permanent resident’ of France (i.e… a resident of the EU), will my husband be able to stay w/o a visa on ‘my’ residence status?
Thanks for your time,
Dennelle Taylor Nizouxon 2016-09-30 at 11:29
Hi Keli – thanks! As they say, “there is no such thing as a free lunch,” and French healthcare isn’t free for anyone (exceptions exist for some low-income situations). Whether you pay your contributions as social charges based on your salary or business revenues or as the roughly 8% of your income as an “inactive resident,” you must contribute something to pay for the medical coverage. Sorry 😉 As for whether your carte résident non-EU (beware, the carte résident permanent is not the same thing) would allow your future non-EU husband to legally reside and work in France – that is not certain. Maybe he should apply for a carte résident of his own after five years when you do. Best, Dennelle
Remcoon 2017-05-22 at 13:13
Does this mean since I am paying CSG on my foreign income, this would already go towards the Carte Vitale? Besides this, they would then calculate a fee my other earnins i.e investiment dividends and french rental income?
I will not need to pay another 8% on top the CSG already?
Marieon 2016-11-09 at 13:26
I have been reading your very interesting and informative blog.
Both myself and my husband have applied to join the PUM.
We are both non-active and well under retirement age, living off our investments and the sale of a UK business 2 years ago. We submitted our first French tax return in May this year.
We have just been asked for a lot of extra details about our finances and, like many on the blog, that would mean our costs would be much higher than the private hospital plan that we currently have.
I wonder whether it would be better for me to set up as a ME? I am a Maths teacher and can offer private lessons. I know I can earn money at this as my son is in the local international school and a lot of parents have expressed an interest.
Would my son and non-working husband automatically be accepted too or would my husband have to do a separate application. Is it difficult to register?
Nicole Hammondon 2016-11-09 at 15:58
Hi Marie – yes, there is definitely a cut-off point for some who have a higher income where private insurance would be a more economic option. I wonder though, DO you have ‘real’ income or just savings’ interest? Your social security contributions should be based on your income, not savings, and the all important figure is your Numéro Fiscal de Réference on your tax statement. If this is not unreasonably high, your charges may actually be more affordable than you think. To answer your question about becoming and ME (AE), yes, your husband and son would also be attached to your Carte Vitale if you took this route. We are now providing an ME/AE Set-up Service, so feel free to email us if you choose this route and would like any help: email@example.com. Good luck with everything! Best regards, Nicole
Robon 2016-11-12 at 20:45
Hi Dennelle and Nicole,
I congratulate you on the valuable information you make available on this site, and I hope you are able to help me with my upcoming situation.
We are UK citizens and have lived permanently in France for 12 years; originally living off savings, with a Carte Vitale obtained via the old CMU system with CPAM.
Since 2008 my wife and I have had a small business, and have been paying RSI RAM cotisations, but now at the age of 58 and 50 at the end of this year, we are taking early retirement, and will be living off a UK private pension, which is just enough to cover our needs.
We have a Mutuelle, but we need to know … a) do we qualify for the new CMU, and b) would we have to pay the 8% contribution based on our last 2 years incomes?
I am hoping that our RSI RAM contributions would already cover this.
Also, neither of us have a “Carte Residence”, as we have never needed one, so far…but do we need one now?
Your help would be much appreciated.
Nicole Hammondon 2016-11-18 at 14:43
Hi Rob – I am afraid that if you decide to stop working and take early retirement now, you will be treated like any other French person, or indeed European person, who decides to leave the workforce before their state pension kicks in. This means that you will indeed have to pay for the privilege of benefiting from the French health service. On the plus side, you probably already have a social security number, so the situational transition should be relatively easy, especially if you have a Carte Vitale and social security number each. Regarding your status here in France, I would sit tight for now. Several interesting ideas are being vaunted, including giving European ex-pats (and even those still living in the UK) the right to become European citizens, which sounds very interesting. Hope this helps! If you need any help with your paperwork transition from working to pre-retiree status, please feel free to ask. Best, Nicole
Philip Ogleyon 2016-11-14 at 13:03
Very interesting. I have a question though. I’m a professional housesitter. I look after people’s houses in France and have been for nearly four years. I’m currently in a house-sit until mid May. How do i prove i’ve been here for three months so that i’m eligible for Carte Vitale. As of now i’ve had no health problems and so never needed treatment. In fact, i’ve simply been living here under the radar as it were. Not illegally i hasten to add as i’m a UK citizen – just not on the system. However, because of Brexit, i’m thinking longer term. Can I get the owner of the property to fill in un Attestation de Herbagement? Any thoughts?
Regards, Philip Ogley
Nicole Hammondon 2016-11-15 at 11:01
Hello Philip – Hmmm. You are right – it’s a tricky situation if you don’t have some sort of ‘base’. Do you have a French bank account? What is the address they have for you? If you are living in France, and earning in money in France, you should be filing an annual tax declaration too. I think you may find it rather difficult to get ‘in the system’ without a permanent address. It seems, however, that your house-sitting contracts can run to several months, so you may have some leverage, as you say, by using an Attestation d’Hébergement. You’ll still need a RIB though, with an address on it. You could also use your house-sitting contract(s) (in French) as extra evidence of your legitimate existence here in France. If you use an Att d’Hébergement, you’ll need to also include a copy of that person’s ID and a proof of address. Lots to consider! You know where we are if you’d like us to look at this more closely. Best, Nicole
Philip Ogleyon 2016-11-15 at 13:11
Hi Thanks for the reply. I have a bank account, yes. My situation is tricky and one. I’ve been in France five years but any work i’ve done is through English system. I work as English teacher and holiday rep for UK based companies. Therefore i’m sort of in limbo. I think the best thing is to try the Att D’Hebergement option as the house owner can provide her details. They might not buy it, but worth a try. Failing that i’ll simply get a job through French employer. I’ll consider you if i need more help. Thank you.
Nicole Hammondon 2016-11-15 at 13:48
You’re welcome! Good luck!
Philip Ogleyon 2016-11-15 at 16:44
The other option might be to get the housesit changed into a standard rental and send off a quittance de loyer instead.
Nicole Hammondon 2016-11-16 at 09:23
If you are able to do that with the property’s owners, then that’s not a bad idea at all. You’d more than likely be asked to provide a lease (bail) too. Sounds like I’m playing devil’s advocate, I know, but they don’t like to make this process easy! 🙂
Teresa Sorokinon 2016-11-27 at 17:54
Just found your site through a LIFT thread, perhaps you may be able to clarify: I’ve lived here since 2003, from 2004 to 2015 I was under the Micro enterprise regine and paying social charges but no tax as I was well under the threshold. I am now retired and currently I’m living off capital gained after I sold my last property and downsized, my UK state pension is being paid into my UK bank as the sterling rate is so low and I don’t actually need the money right now. Eventually my only income will be aprox XXXXX. I own my home here outright and have no ties in the UK, but on that income level would I be allowed to continue living in France as a UK citizen? Also, I’ve had a CV for a number of years and until the sale of my property in 2015, I qualified for CMUC but now have a Mutuelle through my bank – would I have been automatically transferred to PUMA now or do I have to re-apply? As interest rates are so very low, I am still on a very small yearly income but would the capital be taken into consideration and included as income?
Thank you, I’d really appreciate any insights you may have to offer.
Nicole Hammondon 2016-12-13 at 11:49
Hi Teresa – I think your main question here is whether you have been automatically transferred to the PUMa system and the answer to that is yes (you do not have to reapply since the changes). Have you recently updated your CV in one of the bornes? Do you know if you have your CV as a French pensioner (due to your work here) or did you hand in an S1 from the UK (due to any work you completed previously in the UK) to get your CV? Your income should not come into the CV equation at all as a pensioner, as you do not pay for it. You seem to be set up correctly, with your CV plus mutuelle (from previous CMUC, due to new capital). If I have not understood or answered your query or queries, please feel free to email me directly at firstname.lastname@example.org. Best, Nicole
Julienon 2016-11-29 at 00:46
Hello to the Renestance team!
I have to say that, as a French, this is pretty funny that I found the best info on our health care system on this website.
My question is the following: my wife is American and we had been living in Italy for some years where I was working, and we relocated to France a month ago since my contract ended. We are both looking for jobs now. So, I was able to renew my Carte Vitale recently, but I am not sure how: I had the S1 form from Italy, but I am not sure that is what they used to renew my rights in the end…
The problem we have is the three month period you mention for foreigners. As I was not aware of the PUMA reform and still thought the old ‘ayant-droits’ system was working I didn’t take an S1 for my wife in Italy, and when I went to renew my CV at the CPAM, I was told ‘yes, she has to wait for 3 months to get it, so pray that she doesn’t get sick, or you could resort to full private insurances…’
But now, after reading the comments, it seems that 1) if my wife had her own S1, she could have a CV now (and so coverage), is it true and if yes is it possible to get an S1 after leaving Italy? and 2) I could add her now as a dependant on my S1 and she could get the CV that way? Is this also true?
I am becoming a little desperate because my wife is actually pregnant, and after researching private health insurance, it seems that they ALL have waiting periods of 10-12 months for maternity for instance…as a last resort if 1) and 2) are false, would you happen to know about any that don’t?
Nicole Hammondon 2016-12-13 at 11:41
Ok, so I need to ask you some questions here. I don’t understand how you got an S1 from Italy as these are now only given to retired people or seconded workers and you are, I assume, not retired (due to the pregnancy!) and you state you are looking for work. I a guessing that you were easily able to renew your Carte Vitale because you already had a social security number from the past. To answer your direct questions, you cannot add someone onto an existing S1, you have to demand a new S1 with the person(s) as dependent(s). You could try this, but as I say, I don’t understand why you’ve been given an S1 in your situation, unless Italy are still giving them out to anyone leaving their country to go to another EU country (the old rules, at least in the UK). You could also find out if she could have her own S1 if she has been working and paying into the social security system in Italy. Your best bet is to start there – to make that call and ask these two questions. Also, if you do manage to get in this way, you’d get free cover for the length of the S1 cover. If you can’t get your wife covered under an S1, you’ll have to wait out the next two months (you’ve been here one month already) and apply then, under the basis of residency. Email me directly later if you need any further advice. email@example.com. Best, Nicole
Neilon 2016-12-06 at 15:07
I’m being told by CPAM Rhone that PUM doesn’t apply to EU citizens and so my partner cannot have a carte vitale. Can anyone suggest a way to fight CPAM on this? I’m telling them one thing and they simply don’t agree.
Nicole Hammondon 2016-12-13 at 11:22
Hi Neil – If your CPAM are trying to avoid affiliating you by quoting the five year rule, note that the previous version of this (associated with the CMU) was challenged in the European Commission and consequently, in 2014, France ceased to apply this rule, however it was never publically announced. Here is the legal reference: In reference to Article 1(j) of EU Regulation No 833/2004 European citizens who are ‘habitually’ resident in another European country have an automatic right to affiliation to that country’s health system. And the link to the legal text including Article 1(j) – https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex:32004R0883R(01)
With changes and reforms taking a while to filter down to the regional CPAM offices, perseverance is key. While there is no guarantee that your application will be accepted on its first submission, keep trying. The European Commission is on your side! Let us know if this works or not. If not, we’ll just keep trying till something does work! Note that often if you talk to a different person in the office, you get a totally different response. Best, Nicole
Robinon 2016-12-27 at 12:01
Hi Nicole, Thanks so much for this super website! I’ve read through this blog, and it seems very positive in light of the possible consequences of Brexit. If possible (and given all the uncertainty – it might not be possible!) can you give any insight into our situation, which I suppose must be quite common amongst UK expats.
My partner (French) and I (British) are not married but have cohabited in UK and France for 12 years. We moved to France 3 years ago; we are both retired and both receiving UK pensions because that’s where our working lives were. We both have Cartes Vitales by virtue of S1 forms for UK pensioners and have recently taken out a mutuelle.
My partner has a French social security number because she did work for a year, maybe two, after graduation and before moving to the UK but she has never claimed a French pension which would be worth, at most a few euros per year, I suppose.
So, first question: would we be eligible for PUM now, or are we likely to have been transferred automatically?
Second question: in the worst case that after Brexit our (or specifically my) situation becomes exactly equivalent to that of any non-EU immigrant, would I be able to apply for, or transfer, my CV to a CV on the basis of PUM?
And last question (thanks for your patience!): are there any advantages/disadvantages for my partner to claim her French pension? Thanks!
Robinon 2016-12-27 at 12:02
Oh, and by the way … best wishes for 2017!
Nicole Hammondon 2016-12-28 at 10:37
Hi Robin – thank you for your questions, which are really quite simple to answer! You would have been automatically transferred to the PUMa system from the old CMU system as PUMa replaced CMU so this no longer exists. The two main advantages of PUMa over CMU are linked; each individual now has their own ‘status’ under PUMa (no more official ‘ayant droit’ status), and if your situation changes (eg from employed to unemployed or retired) it is much easier to change your ‘caisse’ (the particular health department which deals with your healthcare, eg RSI, CPAM). Going back to the fact that each person has their own status, you can see why this makes the new system more flexible; if one half of a couple retires and the other doesn’t, only the person changing their status has a change to make. Previously, both would have to wade through reams of paperwork to separate the two situations before regularising them.
Your second question is moot as you are already in the PUMa system. What you should maybe be asking is whether your S1s will be valid under the current EU reciprocal healthcare arrangement, if the UK is no longer in the EU. This is, of course, a very important question and one to which no one yet knows the answer. Best case scenario is that the UK works out a mutually beneficial arrangement with France (there are a lot of French in the UK – London being approximately the 5th or 6th largest French city!) covering healthcare, pensions and other social security benefits. Let’s hope the politicians manage to implement this!
Third question – you need to have worked for a minimum number of quarters (as in the UK) in order to claim a French pension. I’m not a pension specialist but I believe that you can approach the caisse that you paid into (RSI etc) to find out whether you are eligible for any pension. You may find that you are able to add your French quarters into your UK pension pot or vice versa – again while I would do this while the UK is still in the EU! Worth having a Google.
Hope this has helped! Happy New Year! Nicole
Robinon 2016-12-28 at 17:00
Thank you Nicola, very helpful.Happy New Year to you as well!
Kuldeep Singhon 2017-01-03 at 11:40
Hi Renestance Team,
Firstly, I would like to Thank you as this article had cleared many of my doubts regarding Carte Vitale.
I have one additional question.
By background and current situation:
I studied in France and started working since 2013. Paying my taxes. Have my carte vitale.
For my wife, dependent visa would had taken about 1 year, so she applied for student visa which was quick and joined me in France in Sep 2016. So, she is not on dependent visa. Does she need to pay some amount to get the carte viatle? (She is over 28yrs of age). We went to CPAM office last week. and they gave the appointment date to come with required docs but they did not mention anything about the fee.
Thank you in advance for your comments/suggestions.
Nicole Hammondon 2017-01-03 at 16:46
Hi Kuldeep – Happy New Year to you and thank you for your email. We are not able to advise you directly regarding the student visa system and the Carte Vitale, as there are several types of visa and a good list of other considerations to take into account. If you’d like to know the fees involved with this, I recommend calling the English-speaking Améli helpline on 0811 36 36 46, where the lovely ladies will, I am sure, be able to advise you. In the meantime, good luck with your visit and be prepared to be sent away to gather extra information and called back for another meeting later! Best, Nicole
Kuldeep Singhon 2017-01-04 at 11:36
Thank you for your reply.
We went today to CPAM office for my wife’s social security. (carte vitale)
They took the documents and told us to wait for 2 months to get the reply. (No mention of any kind of fee)
One question, If I am paying taxes then person dependent on me does not need to pay any fee for carte vitale?
If this is the case then, I think, even though my wife is on student visa, CPAM has considered her on dependent visa (by mistake i guess) as I have included “attestation d’abergiment” in docs.
Nicole Hammondon 2017-01-04 at 13:03
Hi again Kuldeep – it sounds to me likely that you will pay 8% of your household income (according to your NUméro Fiscal de Référence on your Avis d’Impôts – French tax statement) for you both to be attached to the French healthcare system. Well done for yesterday – it sounds like everything is under control! (Note that there is a strong chance you’ll be asked for more papers in the next round of CPAM-vs-you bureaucratic tennis!) Best, Nicole
Kuldeep Singhon 2017-01-04 at 11:37
AND YES! HAPPY NEW YEAR!!
Andrea Velaon 2017-01-31 at 17:25
I am a new student who just arrived to France. I have some questions regarding the proper procedure for registering or getting the insurance in france. I am 28 years old, could you provide some orientation during this whole process please.
Nicole Hammondon 2017-02-01 at 16:08
Hi Andrea – unfortunately, the cut-off age for foreign students to enter the healthcare system in France on a student basis is 27. Once you are 28, you should apply in the normal manner, through your CPAM, proving that you are here on a stable and regular basis (prove that you have lived in France for 3 months or more and you have the legal right to be here – correct visa if necessary). Your income should also not be more than 720€ per month. Best, Nicole
Bhanuon 2017-02-01 at 15:39
Dear Ms Nicole,
I am from India and currently a student in France.
My Embassy issued a birth certificate ( In French) based on details in my passport, Can I put this certificate as a proof of birth to apply for a social security number.
Nicole Hammondon 2017-02-01 at 16:02
I have replied to you by email. Best, Nicole
Julieon 2017-02-16 at 11:29
Great site….we have learnt so much.
Just when you think you have things correct in your head another question pops up. Basically we have decided to go with 2 years private health cover as in 2015/16 we were lucky to earn quite well. Our plan was to apply for the CPAM after 2 years. Hubby has a tax free government pension which I understand is not taxable in a France. So…..I spoke to the NHS department and they said we should inform them of the date we move and we will receive a letter stating the UK are no longer responsible for our health care. This apparantly helps us to apply for CPAM after 3 months. I have read several times in this thread that we can use the EHIC for the 3 months but how can this be if the UK state they are no longer responsible from the day we leave the UK.
Confused of London……hope you can help.
Nicole Hammondon 2017-02-16 at 11:43
Hi Julie – this letter confirming your end of rights to UK healthcare (‘fin de droits’ in French) will be handed in as part of your CPAM application. I suggest either asking for this letter after three months’ residency in France or asking for the letter to be dated three months in advance, or the point noted, when you apply for it. You definitely have three months’ cover with your EHIC card, as, after that point you are considered to be resident in France, and no longer a tourist (which is the status the EHIC covers you for). Hope this helps! If you need our help with compiling a solid application pack when the time comes, please don’t hesitate to contact us. Best, Nicole
Hello thank you for this very helpful site.
Our situation is that my partner and I have been living in our French home since December. I am trying to work out the best way to get French health cover and we were going to set him up as an micro entrepreneur. I then found some information saying that as all of his work, self employed, is in the uk he should still pay NI and tax there and receive a form to hand to CPAM for French cover. I have tried to find an English phone number to talk to an official to verify this is the correct thing to do, but can find nothing. Do you know if this is correct or should he register as ME here. Also as his partner do I receive cover ad I know ayant droit no longer exists ( we lived her five years ago and had cover through his wrk here and Ayant droit). Secondly if he registers here is there a minimum turnover for charges and paying charges to gain entry to the health system? We had pretty good years financially for his work the last two years but this one looks pretty dire which is why I ask.
Thank you for any advice you are able to give.
Nicole Hammondon 2017-02-23 at 15:41
Hi Briony – I read a good explanation recently that said you should be registered to work where your bum is! So even though his work is in the UK, he should be set up to work here. A good accountant will be able to advise on the best way to set up his status here, and your dual adhesion to the Assurance Maladie will follow automatically (you will have rights as his partner – ‘conjoint’). If you need the name of an English-speaking accountant, email me at firstname.lastname@example.org. Do keep us posted as to how you get on. Best, Nicole
Jack Hunteron 2017-02-27 at 19:12
My journalism & government friends tell me the UK will trigger article 50 in a matter of days, probably in time for a European Summit on 9 & 10 March. I’m scrambling to put in place “comprehensive sickness insurance” before this Brexit milestone. I want to exercise my treaty rights as a ‘self sufficient’ EU (Brit) citizen and take up residence in France. Protection universelle maladie with a mutuelle policy would cover me, but the latter seems out of the picture because my tenancy agreement begins 1 March 2017 and I cannot wait 3 months. So, could anyone tell me whether any private healthcare package is usually considered as a normal substitute for the protection universelle maladie? Considered by who, you might ask. Ideally an immigration lawyer, but failing that, perhaps in the eyes of a mutuelle. Tough question, sorry! But applicable to last-minute Brefugees working remotely around Europe! Bupa tell me that none of its policies are likely to “meet visa requirements”, a phrase that seems to be the benchmark in this situation. Thanks in advance!
Nicole Hammondon 2017-02-28 at 09:38
Hi Jack – I would contact AXA Insurance in France and talk to Paulette Booth or her colleague, Donna, on +33 (0)5 61 07 16 84 or email email@example.com. They are a mine of information and have policies to cover all situations. Hope this helps! Best, Nicole
Kim Cooperon 2017-03-13 at 16:22
Hi Nicole, I am totally confused as what we need to do to obtain a carte vitale. I am 56 and my partner is 55. We both took early retirement and moved to France in August last year, so we know we are eligible to apply. Where would we find someone to translate our paperwork into French for us? Also can you claim money back after the event? I had a hip replacement in November (as NHS wouldn’t consider it) My partner and I used money from our pension lump sums and house sales to pay all the fees and aftercare. A chronic infection led to a second operation and a further three months of expensive antibiotics, dressings, blood tests and nurse fees.
Nicole Hammondon 2017-03-23 at 10:26
Hi Kim – I’m sorry to hear about your health problems. I hope you are on the mend now. We can help you put everything in place to have a solid application pack for the PUMa healthcare. Unfortunately, your French healthcare cover would not commence until your application is in and approved, so you will not be able to backdate any claims through the French Assurance Maladie. However, you may be able to use your EHIC card to do this, if you have one. This depends on how long after you arrived in France you had your operations as the EHIC card is ‘supposed’ to be valid as long as you have tourist status in another EU country (ie 3 months, as after that you are considered a resident). However, I have heard many people’s stories of EHIC claim reimbursement many months into their residence in France. It sounds like it’s worth you trying this route. Have you kept all your brown treatment forms? Reimbursements are claimed from your local CPAM office in France. You will need to provide your treatment forms (feuille de soins), copies of receipts and prescriptions, a copy of your EHIC, your address of residence and your bank details, including IBAN and BIC. For more information visit the CLEISS website or email firstname.lastname@example.org. Hope this helps and you manage to recoup some of your costs. Do feel free to email me at email@example.com if you’d like us to help you through the PUMa French healthcare application process. Best, Nicole
Fionaon 2019-06-08 at 00:12
Hi we have had a holiday house in France for 5 years and have now moved here permanently. We both took early retirement in 2016. My husband has just registered as a micro entrepreneur and so has a social security number. He’s been told his CV application will be straightforward but mine as his dependent could take 6 months. The form I’ve been given to fill in asks for a letter saying I’m not entitled to an s1. This will mean I have potentially no health cover after my EHIC runs out. Is there a way around this. The advice so far has been for me to find a job for an hour a week!
Mike Berryon 2017-03-22 at 12:51
Hi thanks for a great site.. we are totally confused. We went to our CPAM office today with complete dossiers that demonstrated we were EU nationals (British), had been resident for over 3months, and have sufficient means to avoid being a burden on the state. We are early retirees and do not have state pensions or S1 forms. We were told that as we had an income over €12,967 and we are European we will have to wait 5 years to join CMU. We called the Ameli U.K. Help line and this was confirmed. The help line suggested filing anyway, our application would be rejected and passed on for assessment to see if we were the in poor health (we are not) or too poor.. no other options seem to be available and this seems to be directly opposed to the experience of others. Were we advised correctly?
Nicole Hammondon 2017-03-23 at 10:16
Hi Mike – Firstly, here is a link to a page you can print out and take with you to prove your right to apply for PUMa on the basis of your stable and regular residence after 3 months – https://www.ameli.fr/assure/droits-demarches/difficultes-acces-droits-soins/complementaire-sante/complementaire-sante-solidaire-qui-peut-en-beneficier-et-comment. We believe that the English-speaking Améli helpline have been told to tell British applicants that they cannot apply until they have been resident for 5 years and that this is wrong. It clearly goes against European law, which states that Europeans should have access to healthcare in the country in which they are resident. Of course, if you are not paying for healthcare through employment, then it is something for which you should pay. You should definitely apply anyway. Once your local CPAM office have confirmed that your application has all the right paperwork, they will send it to the CREIC in Nîmes, who deal with international applicants. Once your applications are there, they will be handled by those who actually know the law and, although you will most likely be asked to supply further paperwork (bank statements etc), your chances of securing the PUMa health cover are fairly assured. NB the current turnover time to assess applications at CREIC is three months, so note your hand-in date at the CPAM and chase on the Améli line (unfortunately the only point of contact to chase applications) after 3-4 months. Best of luck! Nicole
Mike Berryon 2017-03-26 at 18:06
Many Thanks for the link.. We plan to follow up and submit the dossier. Yes of course we should pay, that is what we expected. The social security payments and the private healthcare payments are of a similar level. In the meantime we will probably take out a private policy for 12 months, just to be sure.
Nicole Hammondon 2017-03-27 at 13:31
Hi Mike – why don’t you think about ensuring you take out a private plan that can be either downgraded to mutuelle level or cancelled, as you wish, when you’ve got your Carte Vitale? Good luck with everything! Nicole
Mike Berryon 2017-03-27 at 14:30
Thanks yes I thinks that is a good idea, do you have any suggestions as to which company we should look at?
In the meantime we visited CPAM again this morning, with complete dossiers and a copy of the Ameli link. We saw another agent who had a very brief look at the dossiers, extracted the passport, RIB and EHIC copies, he then returned the rest of the dossiers to us. He said the next thing we would hear is a letter welcoming us to CPAM and giving us Carte Vitals that would last until the EHIC expired in 2019… I don’t hold out much hope that this will be the case, but we will see what happens.
In the meantime we will look at the private insurance..
Thanks for your help
Nicole Hammondon 2017-03-27 at 15:26
Hi Mike – We direct clients towards the English-speaking AXA agency in France – Paulette BOOTH – Agence AXA International – Senior International Client Manager – Tel : 05 61 07 16 84 – Fax : 05 61 30 39 00 – http://www.axa-in-france.fr – Email : firstname.lastname@example.org. She, or her colleagues, can find you a policy that you can downgrade or cancel before one year. French policies lock you in for a minimum one year. So pleased to hear that your applications passed the first step this time with the added Améli information back-up! It really is a case of perseverance as dealing with a different person can change everything. Fingers crossed for you! Best, Nicole
charles ethertonon 2017-03-29 at 18:42
I’m a trying to find my French security social number previously worked in France from 1978 to 1981,when the French security social system was CPCAM. I’ve got my old Attestation de travail, and my old elector’s card.
As i’m now permanently here in France again,i’m a Uk expat.
Nicole Hammondon 2017-03-30 at 12:42
Hi Charles – I would take what paperwork you have into your nearest CPAM office, plus a birth certificate, if you have one, and ask them to see if they can look you up in their system. Having a previous social security number will greatly increase your chances of passing through the application process smoothly to re-enter the system. Do let us know how you get on! Best, Nicole
charles ethertonon 2017-04-01 at 08:46
Was in Paris ,yesterday, and went to the CPAM office in the original district where i previously worked.Queued for 45 minutes, and found my old number in the space of 30 seconds at the counter.
Now all that remains is to affiliate to my regional office.
So the french bureaucracy of 40 years ago is still live and well.
Nicole Hammondon 2017-04-06 at 12:42
Thanks for letting us know – I suspected that it would be that easy! Let’s hope the affiliation goes just as smoothly! Best, Nicole
Greg & Cathy Wardon 2017-04-09 at 23:55
This appears to be the website with all the answers. But would appreciate more clarification on our particular situation. We intend to retire to France in the next five years. We know many things can change in that time but let’s assume what is in place today. First does Medicare qualifies as a health insurance policy for the 90 day timeframe before establishing residency and appling for the French national healthcare system? In case of the a worse case scenario we could always go back to the US for any serious medical issue. But if Medicare does’t qualify as the insurance requirement we understand a private plan would be required. The problem is they likely have pre-existing condition riders. Like most our age we have some medical issues. I have a benign for of cancer and our son who has already qualified for US social Security disability including Medicare has had a kidney transplant and of course on lifetime anti-rejection drugs. Hopefully we all could go three months without a serious medical condition. But if we do get private policy for the 90 day timeframe it appears we then can buy in to the French national system. From what I understand this would be based on 8% of our total household income which would be total of out US SS income plus a small private pension I have? we intend to long term rent for a yer before we decide on the location in which to buy a home.
Nicole Hammondon 2017-04-10 at 12:01
Hi Greg and Cathy – thank you for your post. Unfortunately, Medicare does not cover you outside of the US, so you would need to take out a private healthcare policy before coming. You’d also need this policy, for your Carte de Séjour applications, to cover you for the whole 12 month period that your CdS application will cover, although note that you can cancel or downgrade to a top-up policy (should your policy allow this – it’s a good idea to ask this when researching) once you have successfully entered the French healthcare system. We might be able to address all of your moving-to-France questions with the new Migration Consultation for people at the information-gathering stage. It consists of a 20 mn or so call/Skype to provide some consulting or coaching on the top 3 items of your choice. After the consultation, we will write up a Migration Plan for you with a summary of the consultation and my recommendations for next steps, along with any detailed info you need to proceed. We propose an introductory rate for this entire service of 60€, including tax. If this service interests you, please email email@example.com. We’d love to hear from you! Best, Nicole
Laurie Winterson 2017-05-05 at 08:14
What a wonderful source of good information for those of us dreaming of a move to France! I am an American, age 64, considering moving for an initial 3 months to complete a personal, WWII-family-related project, and would happily consider applying for PUMA, but will have the same issue as many of your writers: I will have worked nearly full-time in the U.S. for the previous two years, thus will need to be able to pay 8% of my income toward health insurance, plus deal with the uncovered 30% of costs. I see the need for private insurance that may actually be more reasonable in cost.
Since I would be turning 65 during the application process (just after completing the three initial month’s residence), is there any recognition or benefit to being at retirement age for France? I ask because I have read that one may apply for PUMA if one is YOUNGER THAN THE FRENCH RETIREMENT AGE OF 65. Is there any limitation in age for applying for the system? Younger or older better or no matter? Thank you so much. It’s still a point of confusion on the PUMA website.
Nicole Hammondon 2017-05-05 at 14:18
Hi Laurie – thank you for your message! To allay your fears, you can apply for PUMa at any age, even after 65, as long as you fulfil the criteria required – which is, of course, living here on a stable and regular basis. Stable = the three months you know about, and regular = in your case having a valid passport and visa plus matching private heath insurance for the length of your visa. Handy Hint: When applying for private health insurance, try and find a policy that you can either downgrade to be your top-up insurance (the avg 30% not covered by PUMa) or cancel entirely before your year is up, when you receive your Carte Vitale (assuming you receive your Carte Vitale before your first 12 months are up) so you can then take out a top-up elsewhere. Hope your move and research go well! Remember, we can help you with your move (from opening a bank account to finding you somewhere to live – getting you around the classic French Catch 22 where you can’t usually do one without the other!), although I’m not too sure we’d be any good for the war research! 🙂 Best, Nicole
SERENAon 2017-05-12 at 14:56
Hi Nicole, Found your site really really helpful. We have moved here at the end of 2016 and sent off our S1 forms (we are both retired), or rather should I say , we hand delivered them at the end of March. I didn’t want any hiccups!
Around 6 weeks passed and we received a letter from L’Assurance Maladie requesting documents they needed. Naturally one of them was the birth certificate and as I gave it to the young lady, she chirped, “it’s not in French”. Fortunately, I had translated them myself with the help of apps and dictionary and she accepted them. We have yet to find out if these were acceptable or whether they will want a certified translation. Watch this space and I will let you know! Fingers crossed!!!
Nicole Hammondon 2017-05-18 at 15:34
Hi Serena – my goodness, you certainly did well to get ‘home-translated’ birth certificates accepted! It MAY be that you get by ok as your applications with an S1 need to jump through many fewer procedural and administrative hoops than those for pre-retirees. It’s a much quicker and smoother process. Applications that end up being assessed by the CREIC (international centre for PUMa applications) will be systematically asked for a certified translation. Fingers crossed! Best, Nicole
Stephen Suttonon 2017-05-15 at 16:07
Hi Nocole, what a fantastic source of information. Having read all the conversation strings, you would think I would understand everything about the French Health System.
However, being a man I am renowned for getting things wrong!, So I was wondering if you have a look at the circumstances surrounding my wife and i?
We own a property in France, which will be our sole residence in December this year, when we both retire.
We will receive pensions and it is our intention to live in France for the rest of our retired lives. Obviously Brexit has confused things and the final outcome is unknown.
Have I got the following right? We will both spend the first 3 months of our new lives using a private health insurance, after which we apply to Protection Universelle Maladie with the required evidence along with the form from your link and this in effect gives us full access to French medical care.
Also, in order for us to gain access, we have to make contributions from our pensions (we are both Public Sector Workers, so presumably we would be taxed in the UK). This calculation is based on the French authorities taking 8% of our individual pensions after a €9611 threshold; so for example if I received a net pension of €14000 per year, minus the €9611, leaving €4389, minus 8%, would be a yearly payment of approximately €351?.
This same calculation would, presumably, relating to my wife’s pension as an individual or would it be calculated as joint income?
I would also like to add to the above scenario the fact we are proposing to take my wife’s 89 year old mother to France to live with us, she is also in receipt of a Public Sector Pension and I am thinking the exact same requirements and calculation would apply to her to also gain access to the French Health system?
Your patience and help in this matter is very much appreciated.
From “very slow” in Cheshire.
Nicole Hammondon 2017-05-18 at 15:20
Hi Stephen – I understand since you posted this comment that you have spoken to Dennelle here at Renestance and are now fully informed! (Noting that the ceiling has risen this year to 9711€.) If you need any more info, please don’t hesitate to drop us a line. I’m on firstname.lastname@example.org. All the best with your move! Nicole
Remcoon 2017-05-21 at 22:43
I have a question concerning the cost of PUMA, maybe it is already been asked but I can’t find it at the moment.
I, as a french resident working outside France, do not fall under the obligatory french social security system nor any other international social security system. My tax lawyer has told me due to the french being more strict they can charge me 7.5% SS contributions on my wages. Also I could apply for the PUMA since I am resident in France in a stable manner. Will the cost for the carte Vitale then already be covered or do i need to pay another 8% on top of the 7.5% on my wages or only 8% on my rental income from properties in France??
Nicole Hammondon 2017-05-22 at 15:48
Hi Remco, don’t worry, you’d only pay your social charges once, Can I ask which country employs you? EU or non-EU? Just trying to get a clearer picture of your situation. Generally, if your income is made outside of France, you can apply to join the health system by declaring your global income and paying 8% of everything over this year’s rate of 9,711€. There are several permutations and answers I could give here, so I am generalising! Does this help at all? If not, please do get in touch with me, and if you decide to take our Carte Vitale Service, we’d be happy to talk and research in-depth about your personal situation? Best Nicole
Jadeon 2017-06-20 at 03:46
Hi, Thank you so much for this useful forum. My mother is Danish and has been a resident of France for the last 3 years, however she has never worked (where she previously resided in the UK) and does not have any social benefits or revenue.
She has been having trouble her carte vitale because there seems to be an issue with her situation being “regularized”. They are currently asking for proof of an end of coverage from the UK and for her last years taxes (she didn’t submit any as was not employed). So I am unsure what to do.
On the Ameli website it says “Si vous êtes ressortissant de l’EEE ou de la Suisse et que vous êtes « inactif » : vous devez être couvert par une assurance maladie et disposer de ressources suffisantes, équivalentes au montant du revenu de solidarité active (RSA) ou de l’allocation de solidarité aux personnes âgées (ASPA). Vous ne pouvez donc pas bénéficier de la CMU complémentaire.
Attention : le terme « inactif » vise les personnes qui, n’ayant ni le statut de pensionné (vieillesse, invalidité, rentiers accident du travail ou maladie professionnelle), ni celui d’étudiant (âgé de moins de 28 ans), s’installent en France sans y exercer d’activité professionnelle et sans pouvoir justifier d’une protection sociale à quelque titre que ce soit.”
Does this mean that she cannot be legally in France as an EU citizen unless she purchases her own coverage. This seems weird. Can anyone help with next steps we should take?
Thank you so much
Nicole Hammondon 2017-07-05 at 16:35
Hi Jade – I’m afraid the old adage ‘you don’t get anything for nothing’ applies here! If your mother is ‘inactive’, ie she is under state pension age and not working whilst living hre in France, she will have to pay for the benefit of receiving health care here. Se will have to provide proof of income as per the information you found above. She must have some income or savings that she lives on here? Savings proof does count. Has she filed taxes since living France? Also another legal obligation as a resident here. If so, her Avis d’Impôts will aid her in her application too. Hope this helps and best of luck! Best regards, Nicole
Paoloon 2017-07-21 at 21:51
I heard that for the first two years of residence in France EU citizens have the health insurance free of charge. Could you tell me more about this topic? Thank you in advance, Paolo
Nicole Hammondon 2017-08-08 at 14:09
Hi Paolo – no, this is not true. Please read the above blog article for a full explanation of the Assurance Maladie, the health system in France. Best, Nicole
Dennelle Taylor Nizouxon 2017-08-08 at 15:35
Hi Paolo, that is not the default case – could you please tell us where you heard that and for which context (ie. retiree, employee)? With the EHIC card, you are covered for the first three months of residency in France, but after that you would need to enter the French Assurance Maladie system for public healthcare coverage. In certain cases, you would not pay anything additional, for example if you’re receiving a state pension from your EU country, but there’s not a 2 year limit.
Amandaon 2017-07-27 at 10:00
Hi found your site which I have found really useful.
I have a problem in that on 25th July 2017 I found by accident that CPAM have cancelled my cmu de base. I do not use my Ameli.fr account often but went on to search for a specialist and noticed that there was a message dated 22 June 2017 when I opened the attachment it was a letter dated 18 May 2017 stating that they had cancelled my health cover because I had not replied to their previous letter to provide certain information. The letter of 18 May said that I could appeal the decision within 2 months but I am already out of time for this. I never received the letter of 18 May nor the previous letter they refer to. I also noted on the letter that my address is not correct .
I have contacted them through the Ameli site and I am awaiting a response. Can they just cancel my health cover like this
Nicole Hammondon 2017-08-08 at 14:08
Hi Amanda – it seems you have fallen into a horrible black hole in the CPAM administration. In my opinion, the best thing you can do is to physically go into your local CPAM office and explain the situation, ensuring they change your address on the spot and insisting, in the nicest way possible, that they reinstate your CMU-C. I find a smile and back-foot, but gentle stubbornness, goes a long way! Take as much paperwork as you have – print the letters out and take them. Also take a piece of ID, eg passport, and a colour photocopy of it. Good luck. Best, Nicole
Dennelle Taylor Nizouxon 2017-08-08 at 15:40
Hi Amanda, what a terrible surprise! You’re doing the right thing by contacting Ameli and pursuing an appeal. If you still haven’t heard back, you should call the phone line (there is an English-speaking help line, if necessary). What information were they requesting? I would provide it ASAP to help your appeal. If the problem is that they had an incorrect address, I don’t see why they wouldn’t reinstate your coverage.
Maxon 2017-08-29 at 00:53
Like so many others here have said, your site is an oasis in a desert of information!
I have two questions, both pertaining to pre-existing medical conditions. As background, my wife receives regular (every few weeks) chemo-related “maintenance” infusions, which are extremely expensive (at least by American prices, perhaps they are cheaper in France?). We live in America and have good HI here, but we are beginning to explore how realistic it would be to move to France.
So, 1) Under PUMa, without a mutuelle, are people expected to pay ~30% for those sorts of meds, or is there possibly special pricing for chemo drugs? And 2) Are there realistic private HI plans that will cover these sorts of costs and procedures?
Thank you in advance!
Nicole Hammondon 2017-08-29 at 11:26
Hi Max – Once you are in the health system here in France, there are ranges of % of co-payment for different procedures and consultations. The average covered by Assurance Maladie is 70%, but, for instance, some consultations (eg cardiologists) are 60%. Cancer care is covered 100% as it is considered a life-threatening condition. Obviously, you’d need to look at the bigger picture in regards to a move to France though; can you afford to support yourselves whilst here (need to prove this to secure a visa)? Or even is your income going to be so high that if you are paying 8% of your income over the allowance, will that actually be a higher amount than if you took out fully private insurance? Once you have your Carte Vitale, you can apply for top-up insurance. If you choose a ‘mutuelle’ (a not-for-profit organisation), then you will not be asked to complete a medical questionnaire (ie, divulge your medical history). A company that provides top-up, or complementary, health insurance that is NOT a mutuelle may well refuse cover or refuse to cover pre-existing conditions. Hope this helps! Please do fee free to contact us if you’d like any help or advice with a potential move. We offer a Migration Consultation service by Skype or email to chat through your top concerns, followed by a written report of said discussion and ensuing research. Best, Nicole
Maxon 2017-08-29 at 17:11
Thank you Nicole for your quick and helpful reply – regarding fully private insurance, is it realistic to find a plan that would cover those sorts of meds, given my wife’s pre-conditions?
Nicole Hammondon 2017-08-30 at 10:00
Hi Max – I’m afraid you’d need to approach a few insurers directly to find out this information. Each one has different policies. You could try contacting Paulette Booth at AXA International – email@example.com. She’ll be able to tell you a bit more. She is English, but based in France and works with many different insurance companies to find the best one for each client. Hope this fills you in a little more! Best of luck to you, Nicole
Kenon 2017-10-10 at 12:53
As US citizens living in France we have recently embarked on getting our Carte Vitale. I will say that the process, like all things involving French paperwork, is not for the faint of heart. My application was rejected 5 times (each involving a 30-day wait), for resubmission of various documents. Each rejection required submitting a copy of a document that was previously not requested. It was all a bit of a mystery, and our local insurance office was at a loss as to why. Finally after 6 months I was approved (along with my son). My wife, who was born in Indonesia but is a nationalized US citizen is still awaiting approval. They requested a copy of her US birth certificate (as well as the Indonesian birth certificate they already had), since she is a US citizen! We had to write a letter explaining that it is impossible to be born in two countries. I also had to submit multiple affidavits confirming she lives with me, since all the rent and utility bills are in my name. We know friends who said their application took 18 months to get approved. So yes, it is possible, but expect to be subjected to a ridiculous amount of bureaucracy in the process!
Nicole Hammondon 2017-10-23 at 08:34
Hi Ken – My goodness, you have been through the mill, haven’t you? I’d like to say your case is unusual, but I am afraid it is not. We pick up many applications, just like yours, mid-way though and try to untangle the web of bureaucracy that applicants have been caught up in. Fortunately, having seen most requests and situations now, we can spot a quick route to resolution, circumnavigating the repeated requests for the same paperwork or documents that no longer, or never, existed. One clue for you, going forwards, Ken, and for others in your situation, would be to add your wife’s name to a utility bill. EDF is easiest as they have an English-language helpline (0969 36 63 83) and can do it on the spot, then send you an attestation in both names. We hope your wife’s Carte Vitale arrives imminently and that your French admin life settles down for a while after that! Best, Nicole
Karen Scanlonon 2017-11-17 at 08:03
Not sure if you can help on this one.
We got our Carte Vitales on July this year after starting the process in February last year when we had lived here for 6 months. After sending them everything they asked for we were expecting to have to pay the 8% from earnings we had before we moved to France. I am assuming that because we had submitted 2 tax returns by the time the application was sorted and we received the cards, and the fact our income was below the threshold we did not have to pay anything. We did get a social security charge of €800 on our last tax bill for the monies we had declared on our tax return this year though.
I sent off 3 documents to CPAM for treatment in October 2016 for a dog bite. I have noticed they have sorted the doctors fee but I have only received 30% of the €23. Is this because we are early retirees with no form of income apart from our savings so we get a lower percentage? I have not seen anything for the pharmacie form or the nurses charge – would these be done separately or will they not reimburse.
My husband has just signed up as a micro entrepreneur so it may solve the % issue once he is classed as “working”.
Just wondering if my thoughts are correct so other people will not expect the 70% back if they are early retirees like us and not earning in France.
andyon 2018-07-10 at 13:11
I am about to make our French house the place i call home, as a UK citizen who has lived in the middle east for 20 years its time to have roots somewhere and call it home, however I will continue to maintain my middle east business and travel to the region 2-3 weeks month to work
I will continue to pay myself a salary from my business (and declare this of course) but to a foreign bank account (middle east bank)
I cannot find any info on what i need to do to be covered for any type of healthcare in france
or how i cover myself for any emergency medical aid i might need.. for example if I am injured whilst doing renovation work on my house..
Any advise would be warmly welcomed
KAREN CHAFEon 2018-09-21 at 18:15
Hello, My husband and I retired to France from the US, both of us are over 65 and have now been here continuously for 11 months. We have not applied for health coverage as we have been so busy with OFFI, Driver’s Licenses, Carte de Sejour appointments and moving around trying to figure out where it is we would like to live. But now we are thinking about this, I can find NO definitive information on how the premiums for PUMA are calculated. Some say that pure pension monies are not used in the calculation, monies that come from a large “pot” of money that you do not have control over, you are just the recipient of a benefit like US Social Security and pensions. That IRA’s ARE included in the calculation because you have an account with your name on it and you control the monies in the account – even though this is considered retirement income in the US. Is there any formula for this calculation? Such as the first €_______ of income (appx 10,000) is exempt – is this per person or per household? The Pension and SS income are not counted, add up all other income _________(converted to euros as of what date) x’s 8% and voila THIS is what you would pay appx. I just cannot find this information out and one person tells me the pension income is lumped into all income, the next person tells me it is not and is exempt. We are lucky in that our medical insurance from the US works here – that we can submit and get reimbursed, however nothing in France is ever as much as the co-pays in the US and the ins. company will not do a credit if the cost is less. So we are basically paying $530.00 per month just “in case” we spend more than the co-pays in the US or if we happen to be visiting in the US and need the doctor or hospital. Obviously if the French cost is less, plus we would be reimbursed, it would benefit us and we could buy travel ins. perhaps for visits to the US plus our Medicare there would cover any hospital costs less co-pay. Thank you if you solve the mystery of the secret pricing on PUMA!
Andreion 2018-11-05 at 15:42
I’ve come in France with my wife 7 months ago, I am working, she is not.
I got my SSN in a few months, but she still cannot take it (and our baby is due in less than 2 weeks). This is how it went:
Applied after 3 months of residence – CPAM cannot find the file
CPAM found the file after 2 months – Rejected – got the documents missing after, took CPAM Antibes appointment to make sure that they are ok with the files – we were assured that she will get the SSN in 2 weeks
CPAM took 1 month to answer – Rejected again – Took appointment with CPAM Antibes again
At this point today, we need to give ALL bank extracts, mine and hers, french and foreign, and the E104 form (which takes 2 months to get our hands on).
We were given a phone number to call at CREIC dept., but the lady is not answering at all.
Are we doing something wrong? Is there something we can do more than give them what they ask for or do what they ask us to do?
Took appointment with CPAM –
Mike Eatonon 2019-01-22 at 12:40
We are an English couple, tax resident in France.
We run a small internet software house, based in the UK which has UK clients. We have been paying UK PAYE and making UK NI contributions
We had been getting S1 cover from the UK, as we have been working in both countries and the French authorities ruled that it should be the UK that should cover us.
We then filled in a Cleiss form last year. Being much more France-based now, the CPAM (Bayonne) adjudication changed, and we were told we should contribute NI in France.
I have set up a French company to enable the payment of URSSAF cotisations. I am going through the TFE in Strasbourg as advised by CPAM.
THe TFE is still compiling my dossier after 2 months and I am unable to sign on to the website to complete any of my URSSAF forms.
I perform about 10 hours a month of work (the software company pretty much runs itsself) and my wife even less. The company has only the 2 of us.
We have other revenue sources including a gite and investment funds.
Our salaries will be so tiny, compared to our other revenue, I feel we are taking the mickey a little.
In addition, I am having to join us both to various employment schemes, including a union! Hardly appropriate for a husband and wife team working less than a total of 1 hour a day.
I am fairly sure I should be on the PUMA scheme, and that the TFE is an immense red-herring not suitable for our purposes.
Do you have any advice for us?
How would I go about changing schemes?
Whose decision would it be?
Does the CLEISS form maybe need updating to take account of multi-revenue foyers in the light of this relatively new system of health cover?
It looks like you might need some involved answers here. Please could you email me on firstname.lastname@example.org and we’ll get you on the right track! Best, Nicole
Alexander03on 2019-12-26 at 17:31
My partner and I (Irish and British, both early-retirees with funds to support ourselves) have been living in France since June 2019.
We have submitted our healthcare applications to CPAM and later passed on to CREIC in Nines. And yet our applications are still being processed.
Could you tell me if we ever have to pay contribution for the healthcare, if our applications are approved later on? As i have read articles somewhere saying we will have to pay 8% of our previous two years income to be considered and accepted in the system.
Hi Alex – Unfortunately, applications for Carte Vitales do tend to take a long time. It’s definitely always worth a call to the English-speaking améli helpline to ask where they are though; this seems to often miraculously ‘unclog’ them from wherever they are in the system! The no is 0811 36 36 46. In terms of payment, previous years had an allowance of c.10k€ before applying the 8% to your income (excluding pensions). This should be reduced to 6.5% with an allowance of c.20k€ from the last tax year. Hope this helps! Best, Nicole
theoon 2020-02-11 at 22:05
Question #1: Are part-time residents (e.g., 180 days) eligible? I hope my research is flawed and that my conclusion is wrong, but thought it best to pose the question to the experts. Eligibility appears to be contingent upon a stated intent to reside in France on a “regular basis.” Several years ago there was quite a lot of ambiguity associated with the term “regular basis.” Now, most authorities appear to take the position that one must reside in France in excess of 183 days to achieve eligibility. But here’s the catch: For American expats, while residing in France for 183+ days is clearly a good thing for health care purposes, it would be an absolutely catastrophic thing for tax purposes (particularly retired persons dependent upon investment income). So the follow-up question is: Does healthcare eligibility trigger income taxation under the French regime? If so, its clearly best to retain one’s “tax home” in the U.S. by spending less than 183 days in France, even if that means never gaining access to the French healthcare system.
Hi Theo – The short answer to your question is that your conclusions are right – you need to be a fiscal resident in France to apply for PUMa, and therefore you’d have to pay the PUMa tax. This makes sense, as it is only fair that ‘real’ residents, if you like, benefit from the advantages of the French healthcare system. It may be worth talking to a French healthcare specialist attorney/lawyer or accountant to calculate how much you’d pay, in theory. There is a capping system in place, and not all income is considered taxable. Let me know by email to email@example.com if you’d like the name of our bilingual French healthcare attorney. Best, Nicole
theoon 2020-04-11 at 16:37
Thank you, Nicole. For someone dividing time evenly between France and another country, paying the PUMa tax would be absolutely fair and just. It’s all the other taxes I’d be worried about were my fiscal home to be France. The French flat rate (30%) on Interest Income, Dividend Income, and Capital Gains would translate to a 100% increase! For retired persons such as myself, living in France full time (or in access of 183 days) would appear to be untenable. But I’ll keep looking for ways to soften the fallout.