Although France’s healthcare system often tops charts as one of the best globally, the process of registration for l’Assurance maladie (state health insurance) has historically been known to be a little arduous for many expats. Preparing in advance and knowing what to expect can minimise the stress of expatriating. So read on for our advice, along with top tips from expat bloggers living in France, to find out how you can best ensure you have the right tools and knowledge to apply.
The French healthcare system
The universal system in France is regarded as being of excellent quality, and it is highly subsidised therefore the cost of healthcare for people moving to France is low compared to many other countries. It is compulsory to enrol with l’Assurance maladie (often referred to as Sécu, short for Sécurité sociale) if you are a resident in France, which is usually after three months.
For a plain-English expat guide to the French healthcare system and French health insurance, visit our France destination page. Our guide explains the different health insurance options for expats, offers examples of the average cost of healthcare and gives information on finding doctors and specialists.
How will the January 2016 healthcare law changes affect expats?
Major new laws were put in place in 2016, making it easier for foreigners to apply for state healthcare in France. The Protection Maladie Universelle (PUMA) now grants all residents in France, including expats, easier access to healthcare in France as long as they have lived in the country for three consecutive months on a “stable and regular basis” and will continue to do so for at least 183 days per year in the future.
The requirements for expats and residents in France to qualify for healthcare are now more simplified, as healthcare access will now be an automatic right of all residents (including in overseas territories of France). However, the PUMA system is still new, and despite it seeming a lot simpler for expats, it will be likely to undergo some teething problems for a while.
There have been reports of applications taking an extremely long time, and the changeover has resulted in some confusion over which information is correct. Expatriation advice and assistance website Renestance gave some practical advice on its blog, highlighting one particular obstacle that some PUMA applicants have been facing. It has been reported that some officers have been advising that non-working expats must reside in France for five years to be eligible for healthcare, rather than the three months stated elsewhere. Renestance gives a link to a helpful page on the official Ameli website (the online home of the Sécu, being an acronym for assurance maladie en ligne or ‘health insurance online’) and advise: “Print it out to take with you to your local CPAM office (Caisse Primaire d’Assurance Maladie) with your application pack, or use it to quote to the Ameli team. We have been informed that it works!”
Compared to non-working expats, it is generally more straight-forward for employed expats in France to enrol in the French healthcare system. In general, your employer should take care of your registration, although they are not obliged to. Read the public service’s factsheet on registering for French social security with your first job for more information. If you do take care of your own registration, you must do so within the first eight days of employment in France, and you will need to ensure you take proof of employment (usually an employment contract) with you to the CPAM office. If you are an employee in France, you are generally entitled to apply for healthcare coverage straight away without a waiting period, and it is not necessary to have completed a minimum amount of hours of work.
Another new system being put into practice is a change in the way in which self-employed workers (travailleurs indépendants) will access social security in France. The former social security agency for the self-employed (called the RSI or régime social des indépendants) will be taken over by the general social security bodies by 2020. Under the new system, CPAM will deal with health insurance for the self-employed, rather than a separate organisation. Therefore, you will now need to apply for the French healthcare system directly to CPAM the same way as anyone else, as well as register as self-employed. To read more, visit the Sécurité sociale indépendants website or read the English pages on the Cleiss website (Centre des Liaisons Européennes et Internationales de Sécurité Sociale or Centre for European and International Social Security Liaisons).
What do I need to apply for French healthcare as an expat?
It is important to prepare your expatriation well in advance as administrative procedures, especially those to sign up to the local healthcare system, can be long and cumbersome. Make sure you take as much important documentation abroad with you as possible.
On her blog Paris Unraveled, American writer Allison Lounes advises: “The last thing you want to do is to have to order copies of documents from your home country and pay for them to be sent internationally, which can take 6-8 weeks or longer, so it’s best to ensure that you have some essential documents with you when you travel.”
Typical paperwork you may need to provide will be likely to include: proof of identity and legal residence (passport and visa, if applicable), original and copies of birth and marriage certificates, proof of three-months’ residence in France in some cases (utility bills or a rental agreement), employment contract, bank details (RIB), evidence of income and your declaration de médecin traitant (registration with your general practitioner).
Be aware, however, that documents written in your native language might not be accepted in some circumstances or areas of France. “You may need official, court-certified French translations,” warns Allison, who has a whole section of her blog dedicated to helping readers with aspects of French bureaucracy. “You should not have your documents translated before arriving in France. You can obtain a list of official translators for your department from the local mairie (town hall) or the préfecture, or by searching for ‘traducteur assermenté’ and your region.”
Where do I go to register for French health insurance?
Take all of the necessary documents to your local CPAM office, which you can find by visiting the Ameli website. For more information you can read Ameli’s English pages or call the CPAM’s English-speaking helpline on (+33) 9 74 75 36 46 (fees apply).
If you are working in France, you are entitled to French health insurance without a waiting period through the social contributions you pay to the French social security system. Speak to your employer about declaring your status as an employee and discuss with them whether they will organise the formalities of your application, or whether it will be your responsibility.
Should I get a French mutuelle health insurance?
A mutuelle is a top-up or complementary health insurance plan that covers what the standard obligatory Sécu doesn’t. “While most doctors’ offices won’t break the bank in France, other healthcare services can get expensive,” says Allison. “If you expect to need certain prescription medications that are reimbursed at a low rate, or significant dental or eye care, you may want to consider getting a mutuelle. Dental care and ophthalmology have really low reimbursement rates compared to the cost of services.”
“The monthly rate you’ll pay for a mutuelle depends on several factors: your age and gender, your status (student, salaried employee, unemployed, etc.) and where you live.”
Pre-existing conditions aren’t taken into account when applying for a French mutuelle health insurance, meaning people can’t be turned away due to health reasons – great news for many expats. Private-sector employers must now offer a supplementary mutuelle option, so speak to your employer if this is the case for you.
Should I get international health insurance as an expat in France?
On top of the obligatory Sécurité sociale (and optional mutuelle), expats living in France can additionally subscribe to an international medical insurance policy which will cover their medical expenses abroad. Note that, importantly, international health insurance cannot be taken out instead of enrolling with the obligatory state system, and must be taken out alongside it.
If you only want to be treated in France, an international health insurance is likely to be unnecessary, but if in the event of a serious illness you would want to be repatriated to your home country for treatment in order to be close to family, then an international health insurance policy would allow you this peace of mind. It would fully cover you within the limits of your policy, and whilst there are bilateral agreements within the EU, the European health insurance card is only meant to cover in the event of an emergency, and therefore not suitable for planned and ongoing treatments.
At Expat Assure, we help you identify the international health insurance policy best adapted to your needs. Don’t hesitate to contact us to request your free and impartial insurance comparison.
I am not from the EU or EEA, can I still apply for healthcare in France?
If you are a non-EU citizen and you are intending on moving to France, you must first apply for a visa before considering healthcare options. Contact the French embassy in your home country to find out which visa would be suitable for you, along with the requirements. You can also read more about the types of French residency permits and visas here.
People working or residing in France stably and regularly will be covered by health insurance, which includes non-EU citizens living in France on a long stay visa. Therefore, once you are granted a long stay visa, the onward procedure to apply for healthcare in France is the same for EU, EEA or non European nationals. There are just a couple more obstacles involved for non-EU nationals: you must have a document ‘attesting the regularity of your situation’, and you will need to fill out a form to apply for entitlement to health insurance, which can be found on the official French public service website.
How do I use the French healthcare system once I am registered?
You will receive your unique French social security number, which you will use for the whole time you are living in France. The carte Vitale is your key to accessing care and gaining reimbursements efficiently – it is a green credit card-sized microchipped card which holds your necessary social security information. However, unfortunately, getting hold of the card for the first time can prove anything but efficient. There are countless tales of the lengthy periods of time it’s taken for expats to receive their elusive carte Vitale, not least Chloe, a Brit blogger living in Paris. “It took me two years to get my carte Vitale and I nearly turned grey over it,” she says in her helpful insider guide for how to get your carte Vitale as an expat on her blog: My Life Living Abroad.
“It is recommended to ask for an ‘attestation de couverture sociale’ or a temporary French health insurance card,” advises Diane of Oui in France, an American blogger based in the Loire Valley. You can use it while you wait for your permanent card, which she agrees can be a slow process. Although once you’ve finally received your card, Diane found it impressively easy. “Just show your carte Vitale and there are no headaches with health insurance,” says Diane. You will need to show your green plastic card at every health appointment, and you will receive reimbursement directly into your bank account within a week.” You will also need to show your card at the pharmacy when collecting medication.
Another initial step, which will give you better reimbursement rates, will be to select your médecin traitant. “You can go to whichever doctor you want,” says Diane. Appointments with specialists, however, can involve weeks or even months of waiting, so a little know-how is needed. Diane’s tried-and-tested tip? “Be extra polite – that’s important! The French seem to make room for you if they can sympathise. This has worked on several occasions when I was first told the schedule was full for the week.”
Be prepared for appointments to potentially give you a bit of a culture shock! Diane was surprised to find that French doctors don’t tend to be in a rush during appointments, despite the large queues in the waiting room. “They actually take the time (in most cases) to thoroughly examine you and ask questions. The wait might be a little frustrating at first, but once you realise it’s how things are done, you’ll appreciate the power of a good book or smartphone app,” she says. “If your doctor is late, don’t get mad. It’s just because he/she is doing the job right.”
A great tool to help you book appointments is the Annuaire santé website (in French only). You can search for healthcare professionals, types of procedures or healthcare facilities by location. The search results handily show the costs and reimbursement rates for each service. Visit our expat guide to the French healthcare system for examples of different healthcare costs.
Is French healthcare cheap?
Diane she agrees that undoubtedly French healthcare is less costly than in her home country, and any worries of not being able to afford healthcare are eradicated, Diane points out that the system is not actually as cheap as it’s often thought to be. “Let’s not forget that the French pay heavy social charges (plus income tax, real estate tax, TV tax, that further diminish take home pay) – they pay into the system, along with employers on the back end.”
Having been through the expatriation process herself, Diane has penned anecdotes on her living abroad lifestyle blog about the trials and tribulations of the French healthcare system. “Even though the flat fee of €23 (at the time of writing – currently €25) is cheap for a general doctor’s visit (and most of that is reimbursed by the social security system, and even more if you pay for supplementary insurance) the French do pay a hefty sum for their healthcare but it’s not when services are rendered,” Diane says. “Every pay check you get shows the deductions for social charges (including healthcare) and you pay into the system whether you’re sick or not.”
Do you have any further tips for expats signing up to the French healthcare system? Did you find this article useful? Let us know in the comments below.
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