The French Social Security System
The French social security system was created in October 1945. Its aim was to establish a common system of social protection for the entire French population. It was managed by a single public service and is now the mainstay of the French health system. In May 1946 a law was written that extended social security to all categories of the population resulting in the formation of several regimes which come under the umbrella of four main groups.
- Le Régime General: employees in the private sector, private sector retirees and civil servants, students etc. (in general all those who do not fall under a specific scheme)
- Les Régimes Agricoles: farmers and agricultural workers
- Le Régime Social Des Indépendants: craftesmen, tradesmen, entrepreneurs etc.
- Les Régimes Spéciaux: civil servants, local authority employees, soldiers, EDF – GDF, agents of the SNCF, miners, students etc.
In addition to the above, in 1919, a Régimes Spéciaux was created that only applies to the departments of Moselle, Bas-Rhin and Haut-Rhin.
The social security system has four areas of responsibility, these areas are known as branches.
La Branche Famille
La Caisse Nationales des Allocations Familiales (CNAF) provides help to families with children. The department pays family benefits which include family allowance, housing allowance, back to school allowance, etc. To qualify, a beneficiary must be resident in France, or in a French overseas department, and have one dependent (DOM) child or more, under the age of 20, residing with them full-time.
La Branche Maladie
La Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS) pays towards health care, pharmacy, hospitalisation, maternity and medical equipment costs etc. The state health insurance also pays a daily allowance for loss of salary if you are unable to attend work for health reasons. It also provides disability pensions, a sum or an annuity, in case of accident or occupational disease, and a sum in the case of death. From the 1 January 2016 a new universal healthcare system (Protection Universelle Maladie/Puma) came into force. This states that anyone working or residing in France in a ‘stable’ or ‘regular’ manner for at least 3 months has the right to state healthcare insurance. The old ‘Universal Healthcare Coverage’ (CMU) program no longer exists.
La Branche Retraite
La Caisse Nationale d’Aassurance Vieillesse (CNAV) is the department which deals with the payment of pensions.
La Branche Recouvrement
L’Agence Centrale des Organismes de Sécurité Sociale is the national fund and is the head of the social security scheme. It manages the treasury and coordinates the action of the unions covering social security contributions and family allowances (Urssaf ), which, at the local level, ensures the collection of premiums and contributions.
How to enter the French health system
Entry into the social security system requires a social security number known as the numéro INSEE and is normally allocated at birth to French nationals. If you are not a French national it is necessary to request a social security number by contacting one of the following organisations, depending on your situation.
- Caisse d’Assurance Maladie (CPAM): for someone who is employed (except for agricultural workers), unemployed or without work.
- Caisse de la Mutualité Sociale Agricole (MSA): For those employed in agriculture/farming.
- Caisse du Régime Social des Indépendants (RSI) : For those who are self employed, i.e. craftsman, tradesman.
In all cases, supporting documents will be required including identity documentation and proof of marital status.
Once a social security number has been obtained, a Carte Vitale can be issued. The card is required by all medical facilities including doctors, hospitals, dentists, pharmacies etc., and allows you to obtain any reimbursement to which you may be entitled. In most circumstances only a percentage of the cost of any treatment is reimbursed so it is up to the individual to cover the remaining amount. Most people have a top-up or complimentary insurance policy which covers the remaining costs. Both private insurance and non-profit mutual (mutuelles) companies offer these policies. The policies can vary extensively in the level of cover and cost so it is advisable to obtain several quotes and be certain of the exact cover being offered. It is necessary to provide the relevant insurance company with your French bank account details as the reimbursements are paid directly into your bank account. If you are suffering from a long term illness you may be entitled to 100% cover. To find out which conditions are eligible for full-cover see Droits et démarches (Rights and procedures) on ameli.fr
Applying to join the French health care system is dependent on your situation. To make an application to join the French health system you need to be considered as ‘legally resident’ i.e.:
- Resident in France for at least three months
- Have a minimum income level of around €9,000 pa per person or €15,000 pa per couple.
- Have health insurance cover
Nominating a doctor
To fully benefit from the coordinated medical care the French health system offers, it is necessary to nominate a doctor of your choice (called a Médecin Traitant). The nominated doctor can be your family doctor or any other physician, general practitioner or medical specialist. You can make this declaration online with your chosen Doctor or by filling in form S3704 and returning it to you your Caisse d’Assurance Maladie. Whilst this is not obligatory, if you not do not declare your choice of doctor then you may not be entitled to the full percentage of reimbursement, i.e.
- If you have declared a doctor then you are deemed as being in the coordinated care pathway. This means that when you have an appointment with your Doctor your health insurance will reimburse you 70% of the consultation fee.
- If you have not declared a doctor then you are deemed as being out of the coordinated care pathway and your health insurance will only reimburse you 30% of the consultation fee.
Note: you are free to change your nominated doctor at any time but you must make a new declaration.
Your nominated doctor will maintain your medical records and is also able to refer you to specialist doctors i.e. rheumatologist, cardiologist, dermatologist, and other healthcare professionals such as physiotherapists, nurses etc. Referral by your Médecin Traitant (declared doctor) ensures that your rate of reimbursement will not be affected.
If you are prescribed medication by your doctor you will be given a prescription (Ordonnance) to present to a pharmacy of your choice along with your Carte Vitale. The pharmacist receives payment for the medication direct from your Caisse d’Assurance Maladie. If the full cost is not covered by your Caisse d’Assurance Maladie, you will have to pay the pharmacist the balance. If you have a top-up insurance policy and you have presented your Carte Vitale then your insurance company will automatically be informed of the transaction and reimburse you accordingly. Some prescribed medications are non-refundable but the pharmacist will inform you of this. In most cases your prescription is valid for up to 3 months. If your doctor issues you with a repeat prescription, it is necessary to present the original to the pharmacist on each visit, so be sure to keep it in a safe place.
For more detailed information on what healthcare expenses are covered, go to cleiss.fr where you will find information available in English, Spanish, German, Italian, Portuguese as well as French.
If you require medical treatment prior to your acceptance into the French health care system and have not yet received a carte vitale, your medical professional will provide you with a form known as a Feuille de Soins. This document gives details of the name of the medical professional you have consulted, your treatment and the cost of this treatment. Complete the form as necessary and present it to your Caisse d’Assurance Maladie office, who will reimburse you for any costs you may be entitled to.
If you have to make a visit to a hospital in an emergency, remember to take along your Carte Vital, Complimentary Health Insurance documents and Passport or Identification Card to present to the reception of the emergency department.
If you are attending hospital as an outpatient, you must first go to the administration office (Soin Externe) and present your Carte Vital, Complimentary Health Insurance documents and Passport or Identification Card. After your appointment with your specialist you must return to the administration office for billing purposes.
The Carte Vitale
The carte vitale is your insurance card and proves your membership and rights to French health cover, and entitles you to reimbursements for any medical costs incurred. It is issued by your Caisse d’Assurance Maladie and contains all the necessary information required when visiting a medical professional or establishment.
- your identity and that of your dependents under the age of 16
- your social security number
- the health insurance plan you are affiliated to
- the Caisse d’assurance Maladie to which you belong
- exemptions or complimentary cover that may be applicable to you.
A carte vitale has to be updated once a year and is done by inserting the card into a multiservice terminal found in your Caisse d’Assurance Maladie office and following the on-screen instructions.
Any children included on your carte vitale will automatically be required to apply for their own card once they reach the age of 16. If they are not responsible for their own medical costs their card can still be linked to your bank account for reimbursements.
The information contained on a carte vitale is strictly confidential and can only be accessed by your health insurance office or the health care professional you have presented it to.
Working in France
When relocating to France for work, health care funding is dependent on whether you are an employee or self-employed. As an employee your employer will make the necessary arrangements to collect from you and pay your social security health contributions. If you plan to start up your own business then you will have to apply to the Caisse du Régime Social des Indépendants (RSI), who will be responsible for collecting your social contributions and also for paying your reimbursements for any health care costs. Contact your local RSI for more information.
It’s important to remember that if you are receiving health cover from the French State then you are liable to pay social charges on any income received both in France or anywhere else in the world.
Retiring to France
Some countries have reciprocal arrangements with France for health cover but are often only for a set period of time. It is therefore advisable to check with the social security department of your home country to see what provisions, if any, are available for health cover provision when you move to France.
Application is made via your local Caisse Primaire d’Assurance Maladie (CPAM) office. You will need to complete an application Form 736 (Demande d’affiliation au régime général sur critère de résidence), for more information from ameli.fr. You must provide details of your income/resources along with any supporting documents. A final decision of acceptance can take many months so it may be prudent to have in place private health insurance to cover any eventualities that may happen in the mean time.
If for any reason you are refused admission to the French health system, you have the right to appeal to the Commission de Recours Amiable (CRA). You should receive a rejection letter stating the reasons for the refusal. Once this letter has been received you must send your appeal to the CRA by recorded delivery within two months of the date of the written rejection.
If the CRA rejects your appeal, then you have up to two months to present your case to the social security and health tribunal – Tribunal des affaires de sécurité sociale (TASS). If all else fails you can also make a complaint to the EU Commission by contacting them at EU Citizens Complaints.
French medical centre search map
To help you find a French medical centre in your area of interest, use our map below by entering a town/postcode and a distance area. If your search doesn’t show any results broaden it to the next distance setting.