French Health Insurance & Social Security in France

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French Health Insurance & Social Security in France

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 Sécurité 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 Séjour)
• 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) is 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 Sécurité Sociale et d'Allocations Familiales) or the Chamber of Commerce (Chambre de Commerce et d'Industrie/CCI)
• Artisans (craftsperson, tradesperson): contact the Caisse Régionale des Artisans et Commerçants
• Farmers: contact the Mutualité Sociale Agricole/MSA

S Forms

S forms are recognised by all EEA member countries. They provide a universal system that allows citizens of another EU member state to receive benefits in France. The S form required depends on the benefits to be claimed.

Form S1 (former E106), for employed persons

This is defined as "A certificate concerning the right to receive sickness and maternity insurance benefits in the form of services by a person residing in a different country to the competent country".

This Form is issued by the health service of the country of residence and is issued to (for example) people working in France who have declared their place of residence in another country. It gives the holder the right to receive medical care on the same terms as a French citizen while also retaining the right to receive all types of medical care in their country of permanent residence.

Social Security Entitlements for Retired and "Inactif" People

Changes to the law in 2007 affected "inactif" people from EU Member States who are about to become resident in France. 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 inside or outside France (from a pension, investments or other source).

• Information is available on the French Social Security website: Click here (in French)

Retired EU Citizens (European Conventions and Form S1)

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 receive health cover and pay nothing into the French social security system provided that they have a Form S1 (former E121). This puts an expatriate in France onto exactly the same legal basis as a French national. The S1 form 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, birth and marriage certificates are 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 register for healthcare cover using form S1 (former E106). This is a certificate of entitlement to health cover for a limited duration. 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).

Couverture Maladie Universelle (CMU)

Couverture Maladie Universelle, CMU (Universal Health Insurance Coverage) provides two slightly different state insurances:

• CMU de base (basic cover)
• CMU complémentaire (supplementary Universal Health Insurance Coverage)

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 complémentaire 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.

• Full details from the CMU: Click here (in French)
• For a list of all CPAM offices: Click here

CMU benefits for inactif EU Citizens

EU citizens moving to a member state or resident for less than five years in a member state have 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

This means that:

1. Any EU citizen who is entitled to apply for health cover using Form S1 (former E106 or E121) continues to receive benefits as long as the documents are valid. They should register or be registered with their local CPAM office.
2. Inactif people moving to France who are not eligible for Form S1 (former E106 or E121) must take out private health insurance before the move. CPAM will not be able to grant CMU benefits.
3. 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.

EU citizens gain the right of permanent residence in France after 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 dependent 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 members of their direct family.

EU Citizens living in France by 23 November 2007

All inactif EU citizens who were resident in France before 23 November 2007 have access to French health benefits if:

1. They were registered with CPAM and granted basic CMU benefits.
2. They held a valid Form E106 at that time.

For further information contact the CPAM English-speaking helpline:

• Tel: 08 11 36 36 46 or CLEISS
• Tel: +33 (0)1 45 26 33 41
• Clear information from the EU: Click here
• Further information from the French Social Security website: Click here (in French)
• Comprehensive questions and answers from French Social Security: Click here (in French)

Social Security: French State Health Insurance

All residents in France are obliged by law to have health insurance. Most qualify for the state health insurance (sécurité sociale); in local terms, this means affiliating to the CPAM or Caisse Primaire d'Assurance Maladie.

• CPAM French Health Insurance Advice Line (English-speaking) open Monday to Friday 09:00-18:00: Tel: 08 11 36 36 46
• Comprehensive information from CLEISS (Centre des Liasons Européennes et Internationales de Sécurité Sociale) in English: Click here
• Ameli (Assurance Maladie en Ligne) has clear information in English: Click here
• Ameli branch in the Charente-Maritimes provides details on the French health care system and how it applies to British citizens: Click here (PDF in English)

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.

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
• 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.

Note: In Alsace and Moselle the percentage level of reimbursement for medical care is higher than in the rest of France. However, salary contributions are higher for the employee. Employers do not make greater contributions.