Haris Ashley
France has a universal public healthcare system known as Protection Universelle Maladie (PUMA). This system is funded by taxation and provides basic coverage to those who qualify. Expats can apply for the PUMA program if they have lived in the country for at least three months, with the intention of spending at least six months of the year there, and have not been in the country for more than five years. They must also be unemployed, under 65, and not receiving a pension from a European country. In addition to PUMA, most people in France have supplemental private health insurance to cover additional health and medical costs. Americans moving to France can obtain private international health insurance from companies such as APRIL International and Cigna Global.
| Characteristics | Values |
|---|---|
| Public health insurance | Available to all expats after their initial three months in France |
| Private health insurance | Mandatory for retirees or early-retirees |
| PUMA eligibility | Expats must have lived in France for less than five years, be unemployed, under 65, and not receive a pension from a European country |
| Application process | Requires proof of residency, passport, visa/residency permit, French bank account details, and a local Cpam appointment |
| Public system coverage | Covers a significant percentage of treatment costs, but some expenses like psychiatrists, chiropractors, and osteopaths are not covered |
| Private insurance providers | Allianz Care, APRIL International, Cigna Global, AXA |
| Emergency services | Efficient and reliable, managed by SAMU with a local emergency number of 15 |
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What You'll Learn
Eligibility requirements for public health insurance
France has a universal public healthcare system known as Protection Universelle Maladie (PUMa). All residents of France, including expats, have access to the public healthcare system. However, there is a three-month waiting period after establishing residence in the country before one can register for state health insurance. To apply for public health insurance, you must have your primary residence in France, meaning you must intend to live in France for at least six months of the year. You must have been living in France for at least three months at the time of applying for public healthcare.
If you are employed in France, your company will register you for public health insurance, and you will automatically be eligible for health insurance through your social security contributions. Freelancers and business owners must register themselves through the Régime Social des Indépendants (RSI) and the local department level of the national health insurance administration, CPAM (Caisse Primaire d’Assurance Maladie), respectively. Non-EU students will automatically be enrolled in Student Social Security (Sécurité Sociale Etudiante). If you are retired or an early retiree, you will need to show that you have a private health insurance policy in place to cover you for at least a year.
If you are moving to France as an expat job seeker, your entitlement to public health insurance will vary depending on your situation. If you were registered for unemployment in an EU/EEA country or Switzerland and had health insurance, you can probably use your EHIC card or transfer your rights via the S1 form. If you were not entitled to unemployment benefits in your country of origin or if you are from a nation outside the EU/EEA, you will not be able to use public French healthcare and will need to purchase private insurance or international health coverage for foreigners. Unemployed residents and low-income earners may be eligible for subsidies on private insurance or the CSS, the additional public complementary insurance that covers any co-payments.
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Private insurance options
France's healthcare system is split between public and private coverage. The public system covers a significant percentage of treatment costs, but there are still some costs that individuals must cover themselves. For example, the French state system doesn't cover psychiatrists, chiropractors, or osteopaths, and certain medications aren't covered or have a low reimbursement rate.
As a result, many people in France take out a supplementary private policy to cover these remaining costs. This is known as a "mutuelle". It's worth noting that dental insurance isn't mandatory in France, but it can be beneficial if significant dental work is needed in the future.
If you're an American moving to France, you can consider the following options for private insurance:
- AXA Global Healthcare: AXA offers international health insurance plans for expats in France, which can provide peace of mind and ensure comprehensive coverage.
- Fab French Insurance: This company provides affordable insurance policies that meet visa requirements and can assist with the visa process and application. They have plans for those up to 99 years old and policies without medical questionnaires.
- Cigna Global: Cigna offers access to a global network of doctors, specialists, and therapists, with tailor-made coverage for individuals and their families.
It's important to compare private medical insurance providers to find the best option for your specific needs and budget. Additionally, it's recommended to work with insurers who are knowledgeable about French requirements to avoid any issues with your application.
To apply for private insurance, you may need to provide proof of residency, your passport, visa or residency permit, and bank details. The specific requirements may vary depending on the insurance provider and your individual circumstances.
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Application process for public health insurance
France has a universal public healthcare system known as Protection Universelle Maladie (PUMA). The public system covers a significant percentage of treatment costs, but there is still a percentage that the patient must cover. Due to this, many people in France have both public and private health insurance.
Expats can apply to the PUMA program if they have been in the country for less than five years, are unemployed, are under 65, and do not receive a pension from a European country. Non-European students over 28 with no salaries and British early retirees with no salaries are also eligible.
To apply for public health insurance, you must have your primary residence in France and intend to live there for at least six months of the year. You must have lived in France for at least three months at the time of applying for public healthcare. You will need proof of residency (e.g. a rental contract, rent receipts, or energy bills), as well as your passport and visa/residency permit. You will also need a French bank account and will have to give your bank details (Rib).
You apply for health insurance through your local Caisse Primaire d’Assurance Maladie (Cpam), where you can make an appointment to register. The Cpam appointment will be in French, so if you cannot speak the language, you should bring someone with you who can translate. After the meeting, you should be able to apply for the carte Vitale, France's health insurance card. The length of time it takes for applications to be approved can be variable, but it can take several months. In the first instance, you should receive an attestation de droits (proof of rights), and in the second stage, you should obtain a carte Vitale, which makes the reimbursement process simpler. Before you get your card, you will have to pay upfront and keep forms proving your costs, called feuilles de soins, which you can send to Cpam for reimbursement into your bank account.
If you are employed by a French company and pay social contributions, you will automatically be eligible for health insurance through your social security contributions on work, and your employer should deal with this. Freelance sole traders and limited company business owners can access medical insurance in France through the independent social security system.
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Additional costs for public health insurance
France has a universal public healthcare system known as Protection Universelle Maladie (PUMa). As a resident of France, having health insurance, either private or public, is mandatory. If you are employed by a French company and pay social contributions, you will be automatically eligible for public health insurance through your social security contributions on work, and your employer should deal with this.
However, French public health insurance only covers a certain percentage of the cost of medical treatment. When you visit a doctor, dentist, or other professional, you will be reimbursed for a set amount and left with 10-40% to pay out of pocket. This is why an estimated 95% of French residents have private health insurance on top of their public healthcare. Private health insurance covers the remaining costs that public healthcare does not.
If you are unemployed or a low-income earner, you may be eligible for subsidies on private insurance or the CSS, the additional public complementary insurance that covers any co-payments. You can assess your eligibility for complementary healthcare using this calculator from l’Assurance Maladie.
If you are a retiree or early retiree, you will need to show that you have a private health insurance policy in place to cover you for at least a year. This should provide similar cover to French state reimbursements.
If you are on a work mission from a foreign company, your situation may be more complicated. It depends on how the company is registered in France, so it is best to ask your employer or contact Cleiss.
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Private insurance for retirees
If you are an American retiree moving to France, you will need to take out a private health insurance policy to cover you for at least the first year of your stay. This is because retirees moving to France are not eligible for state health insurance (PUMA) until they have been living in the country for at least three months.
There are several options for private health insurance for retirees in France, including French and foreign providers. Some popular providers include:
- Allianz Care: Covers everyday medical expenses, emergency treatment, dental consultations, maternity, surgery, and outpatient fees.
- APRIL International: A health and travel insurance provider operating in 180 countries, offering tailored plans for expats.
- Cigna Global: A leading global insurer with a network of doctors, specialists, and therapists worldwide. Cigna Global offers modular plans that can be tailored to your needs and budget.
- GeoBlue Xplorer: Offered in association with Blue Cross and Blue Shield of America, with access to a network of high-quality doctors and hospitals worldwide.
When choosing a private health insurance plan, it is important to compare different offers and find one that suits your specific needs and budget. You may also want to consider taking out a mutuelle top-up insurance policy, which can help cover additional healthcare costs not paid for by your state social security contributions. While this is not mandatory for retirees, it is highly recommended, especially for those who may have higher healthcare costs.
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Frequently asked questions
France has a universal public healthcare system known as Protection Universelle Maladie (PUMA). Expats can apply to the PUMA program if they have lived in the country for at least three months and intend to stay for at least six months of the year. If you are employed by a French company, you will automatically be eligible for health insurance through your social security contributions. If you are not employed, you will need to take out comprehensive private health insurance for the duration of your stay.
The public system covers a significant percentage of treatment costs, but there are some costs that must be covered by the patient. For example, only 70% of costs from doctor visits are covered by the state. Certain professionals, such as psychiatrists, chiropractors, and osteopaths, are not covered by the public system, nor are certain medications.
Popular options for private health insurance in France include Allianz Care, APRIL International, and Cigna Global. These companies offer plans that can be tailored to individual needs and cover a range of medical expenses.
