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Health Cover in France for Expatriats 2007

September 2007

There are recent changes to the law governing early retirees and “inactif” people from EU Member States who are resident or about to become resident in France. 

Note: An inactif person is one who is not engaged in economic activity on an employed or self-employed basis in France. They are classed as inactif regardless of whether they receive income from sources outside France (pension, investments or other). 

Social Security (Health Insurance) 

All residents in France are obliged by law to have health insurance. Most qualify for the state health insurance (s.©curit.© sociale); in local terms, this means affiliating to the CPAM or Caisse Primaire d’Assurance Maladie. (Foreign EU citizens resident in France and not in possession of a Form E106 or E121 will not be entitled to state health cover.)

  • CPAM French Health Insurance Advice Line (English-speaking) – Tel: 0820 904 212
  • Comprehensive information from CLEISS (Centre des Liasons Europ.©ennes et Internationales de S.©curit.© Sociale) in English: Click here
  • Ameli (Assurance Maladie en Ligne) has further information in English: Click here 

The Basic System of Social Security 

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

What Social Security Provides 

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

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

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

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

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

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

  • For a table summarising the schedule of family benefits: Click here (from CLEISS, Centre des Liasons Europ.©ennes et Internationales de S.©curit.© Sociale)
Social Security for Employed People

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

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

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

Employed person

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

Take the following (and photocopies):

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

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

Self-employed person

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

  • Professionals: contact URSSAF (Union de recouvrement des cotisations de s.©curit.© sociale et d’allocations familiales) the Chamber of Commerce (Chambre de Commerce et d’Industrie, CCI)
  • Artisans (craftsperson, tradesperson): contact the Caisse R.©gionale des Artisans et Commer.§ants
  • Farming: contact the Mutualit.© Sociale Agricole (MSA)
Social Security for Retired and “inactif” People

An inactif person is one who is not engaged in economic activity (on an employed or self-employed basis). 

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

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

It proves that:

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

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

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

CMU benefits for inactif EU Citizens (September 2007)

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

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

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

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

  1. Any EU citizen moving to or resident in France has the same rights as any other EU citizen residing in France.
  2. Any EU citizen who is entitled to a Form E106 or Form E121 continues to receive benefits as long as the documents are valid. They should register or be registered with their local CPAM office.
  3. Inactif people who have been receiving CMU benefits (based on previous regulations) have six months from 1 October 2007 to take out private health insurance. During this period, they will continue to be covered by CMU.
  4. Inactif people moving to France who are not eligible for forms E106 or E121 must take out private health insurance before the move. CPAM will not be able to grant CMU benefits.
  5. Inactif people who are not covered by health insurance from another member state must take out private health insurance before or on arrival in France.

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

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

As these regulations are recently instated, not all health offices (CPAM) have up-to-date information. For further information contact the CPAM English-speaking helpline:

  • Tel: + 33 (0)8 20 90 42 12 or CLEISS
  • Tel: + 33 (0)1 45 26 33 41
  • For further information from the French Social Security website: Click here (in French)
  • For a PDF version of the European directive 2004/38: Click here

Couverture Maladie Universelle (CMU)

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

  • CMU de base (basic cover) 
  • CMU compl.©mentaire (complimentary top-up cover)

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

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

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

The following must be provided:

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

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

How to Join Social Security 

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

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

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

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

Changing address or bank

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

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

When changing address to a different d.©partement send a the sickness fund a completed Form S1104 (d.©claration de changement de situation) available from CPAM 

Send details of the new bank and a RIB (Relev.© d’Identit.© Bancaire) (or RIP) to the sickness fund, quoting social security number. 

Using the Carte Vitale

Affiliation to CPAM is proved with the green card, Carte Vitale, issued on application to CPAM. This must be used every time a medical transaction takes place.

  • Use the Carte Vitale to register the treatment. Make the basic payment (if required) and reimbursement will be automatic. A person not holding a Carte Vitale will receive a feuille de soins ( a brown receipt form) from the doctor, pharmacists or hospital staff. This is recognised by CPAM as a legitimate medical payment. It should be posted to CPAM
  • Reimbursement is made according to income level and the Tarif de Convention (or approved treatment cost) currently in force
  • A person with a Carte Blanche or top-up insurance card (private complimentary insurance) will have the treatment recorded and appropriate balance reimbursed by the mutuelle
Top-Up Insurance (Mutuelle) for Social Security 

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

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

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

Further Information and Contacts