Healthcare In France For Expats

The French healthcare system is a universal service accessible to every resident. It is mostly funded by a national government health insurance system. 

To be a legal resident in France, you must have some sort of health coverage.

This guide will help you understand the following:

• What health insurance options you have when you move to France
• How to join the state-funded health insurance scheme in France
• Top-up insurance (mutuelle)
• How to obtain a health card in France

Health insurance in France

Depending on your circumstances, there are two options for obtaining health insurance in France:

• Join the state-funded health insurance scheme PUMA
• Buy private health insurance

By law, anyone permanently residing in France must have health coverage provided under the state-funded Protection Universelle Maladie (PUMA). 

There are very few situations in which somebody can’t join PUMA when moving to France. 

To join PUMA, you need to establish legal residency. One of the requirements of a residency application is valid health coverage. 

Your UK S1 form works as proof of health coverage for this purpose. However, if you are not eligible for an S1 form, you might need private health insurance – at least for your residency application. 

You will find that when you are legally a resident, you can and will be encouraged by the government to join PUMA instead of continuing with your private health coverage.

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French health insurance scheme PUMA 

If you move to France for employment or to start your own business, you will join PUMA by paying into French Social Security, either through your employer or your company. 

PUMA is open to all those who’ve been legally resident in the country for at least three months. 

PUMA health insurance is mandatory and provides access to the same level of healthcare any French resident receives. 

PUMA covers a lot of the fees but not all, as it’s a co-payment system in France. Usually, about 70 percent of doctors’ fees and 80 percent of hospital costs will be reimbursed through PUMA. For some major or long-term illnesses, 100 percent of the costs are covered. 

The majority of your medical costs will be reimbursed through state insurance in France. You can usually expect a reimbursement in the region of 70 percent for visiting a doctor, dentist, or specialist, around 80 percent of hospital costs, and up to 100 percent of prescribed medications. 

The patient has to cover the rest of the medical fees. If you are over 65, almost all of your costs will be reimbursed through state health insurance.

Joining PUMA by registering your S1 form in France

All UK retirees permanently residing in France and receiving state pensions from the UK are entitled to state health insurance in France, paid for by the UK government. 

For this, you will need to apply for an S1 form (certificate of entitlement to healthcare) from the Department of Work and Pensions. 

You can apply for it when in France. However, it can take a few weeks to arrive. The best way is to ensure you get your S1 before leaving the UK.

If you receive a state pension from the UK and are thus eligible for an S1 form, you are covered for health insurance through this form directly by the UK government. 

When in France, you will need to join PUMA for a purely administrative purpose and won’t need to pay any contributions to it.

You should present your UK-issued S1 form to your local French health authority, the Caisse Primaire d’Assurance Maladie (CPAM). 

You can find your local CPAM center via the Ameli website. The site is in French. 

The list of required documents that you need to bring with you when visiting your local CPAM office:

• the printed form application (S1106);
• your birth certificate (translated);
• marriage certificate;
• passport or ID copies;
• proof of address (Utility Bills, a rental contract,etc.);
• your bank account details (RIB – relevé d’identité bancaire). You can find them in your French cheque book.

This application will allow your local health authorities to affiliate you with the healthcare system. You will also be issued a Carte Vitale (health card). You will need to present this card at any medical consultation, hospital visit, or pharmacy.

If you are not entitled to S1 form

In general, you can make an application after three months of residency in France (legal residency requirements). Before that, you have to be covered with a European Health Insurance Card (EHIC) or with private insurance.

If you are entitled to be covered by PUMA, you will have to pay contributions to URSSAF (Union de recouvrement des cotisations de sécurité sociale et d’allocations familiales).

However, it’s not as straightforward for EEA early retirees in France. 

The current legislation says that if you are a European citizen, you are economically inactive, and you are not eligible to get an S1 form, you can’t claim PUMA’s benefits if you have less than five years of permanent residence unless your situation has changed while you’ve been living in France (change of income, divorce, long term disease, etc.). 

The controversy is that non-EEA citizens can apply for PUMA after a 3-month legal residency.

Under pressure from the EU, the French government changed its administrative practice when it comes to early retirees and the 5-year residence qualification. The law itself, however, hasn’t been changed yet.

As a result, there’s a big possibility that if you are an early retiree, the 5-year residency condition will still be applicable to you. However, it’s always worth applying.

Applying to join PUMA

To apply, you need to prove the following:

• You have been resident in France for at least three months;
• You have a required minimum level of income;
• You have valid health cover.

If you are under 65 years old, the minimum level of income you need to demonstrate is  €560 a month for a single person and €840 for a couple. 

If you are 65 or older, it’s €868 for a single person and €1,347 for a couple.

It’s worth bearing in mind that these numbers are minimum. If your income just reaches or is slightly over the required minimum, it will be worth showing that you have savings and/or other capital resources. Then you will have a greater chance of being accepted. Also, remember to provide the documents to prove your financial status.

If you are accepted, your social insurance charge for PUMA will initially be based on your declaration. Then it will be calculated based on your French tax return.

In some cases, when it comes to demonstrating valid health cover, your EHIC might be enough. While this isn’t always the case, you might want to take out temporary private health insurance to submit with your application. 

You should apply through your local health authority, your Caisse Primaire d’Assurance Maladie (CPAM). Print out and complete the application form S1106 and Form 710.

You might also need to confirm that you are not entitled to the UK health system by providing an ‘attestation de fin de droits’. You can get this from the Pensions Service in Newcastle. They issue a letter in both French and English confirming you are no longer resident in the UK and so are not entitled to an S1 form. 

If you are not accepted, your options are either to start a business in France or to get private health insurance. 

If you set up a business in France, you are no longer ‘economically inactive’ and automatically qualify for health cover. 

Another option is an international health insurance plan, but that will cost quite a bit. The most basic cover from the International Medical Group (IMG), for a couple aged between 60 and 65, starts from €840 (£750) a month. 

When registering with your local CPAM office, make sure you choose and declare a ‘medécin traitant’ (your general practitioner). This will help you be reimbursed at a higher rate than if you have not declared one.

Top-up health cover in France – mutuelles

If you worry about the gap, you can choose to top up your health cover with a private health insurance policy, known as a mutuelle. 

Most mutuelles will cover the remaining 30 percent of your general healthcare costs, including emergency hospital treatment. 

The basic plan for a couple can start from as little as €80 (£72) per month; however, it does depend on your age and current health. 

Mutuelles do not guarantee faster treatment or access to private doctors. They simply pay for what the national French healthcare insurance does not.

Dental care in France

When you visit a dentist in France, you must pay directly after the visit. You will be issued a treatment certificate, called a ‘feuille de soins’.

This treatment certificate will help you claim any refunds in France. Generally, you can claim back around 70 percent of the standard treatment cost.

Optical care in France

Opticians in France are not covered by public health insurance, and the reimbursement rate for a consultation and glasses is very low. 

A consultation with an ophthalmologist might cost you between €30 and €80, of which only €15 will be reimbursed by the social security system. 

Glasses can be reimbursed up to €2.84 for the frames and up to €7.32 for the lenses. It’s not a lot, and the total cost may be quite considerable. If you need regular optical care in France, it’s advisable to take out top-up health insurance that covers your eye care.

Prescriptions in France

In France, you obtain your prescribed medicines from pharmacies (pharmacie). You need to show your treatment certificate (‘feuille de soins’) and prescription.

Usually, you have to pay the pharmacist directly for your medicines. 

However, some medicines’ costs can be reimbursed. This is true for reimbursable pharmaceutical products. Reimbursement rates vary between 15% and 100% of the sale price and depend mainly on the seriousness of the disease they are designed to treat. 

There’s 100% reimbursement for medicines used in life-threatening conditions. They usually display white barred price labels and include diabetes drugs, AIDS, cancer, chronic diseases, and hospital-only medications.

Drugs for non-serious conditions are reimbursed at a 35% rate. They have blue price labels and are the biggest group of medications. More than half of the registered medicines in France are classified as reimbursable at a 35% rate. 

The third group is reimbursed at 65% and includes antibiotics and drugs against certain infectious diseases. They have white price labels.

You might find useful:

• Living In France Guide – everything you need to know to plan your move and settle down in France;
• The Best Places to Live in France – a detailed overview of France’s most popular locations for expats.
• Opening A Bank Account In France As An Expat
• Renting A Property In France
• Buying A Property In France
• Understanding International Health Insurance: A Comprehensive Guide