Health Guidelines For France

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Health Guidelines For France

Healthcare in France has a reputation for being high quality. The public health system is made up of a network of public and private services from doctors, hospitals, and specialist providers. State healthcare in France is not free. Healthcare costs are covered by both the state and through patient co-payments. Here we set out how the health guidelines for France and how system works for expats.

You may have to pay upfront for some treatments. The French national insurance fund, Caisse Primaire d’Assurance Maladie (CPAM), will then repay you for part of the costs later.

UK nationals usually access the French healthcare system in one of these ways:

making French social security contributions through their employer or as a self-employed person
using a European Health Insurance Card (EHIC) or UK Global Health Insurance Card (GHIC) for temporary stays when studying, or as a ‘posted’ (detached) worker
registering a UK-issued S1 form with the local CPAM office

Healthcare if you live and work in France

You will need to buy private health insurance for your initial period in France. You will need to show you have health insurance when you apply for a visa and before you can register as a resident.

You can apply to be covered by the French healthcare system (Protection Universelle Maladie or ‘PUMa’) once you have been resident in France for 3 months, but the process can take a while. You will have access to state healthcare on the same basis as a French citizen.

If you’re employed in France, your employer will register you for PUMa via the employers’ online portal before you start work. PUMa is paid for through social security contributions if you are employed or self-employed in France. If you are not employed you will need to pay into PUMa yourself. There’s more information on the CPAM website (in French).

If you were resident in the EU by 31^st December 2020 you may also have the right to apply for a UK S1 if you start drawing a UK State Pension.

How to register for healthcare

You can apply for PUMa through your local CPAM office online.

Employed and self employed

If you are in salaried employment in France your employer will give a declaration of your employment to the Urssaf (Union for the recovery of social security contributions and family allowances).

Following this declaration, you will need to provide the following documents to CPAM:

the printed Form application for the right to health insurance (S1106) (PDF) ;
copy of your work contract or your last pay slips;
birth certificates for yourself and all members of your family;
marriage certificate;
passport or ID copies;
proof of residency (Utility Bills, rental contract, etc.);
particulars of your bank account (RIB – banking identity statement).
your first pay slip.

Once this has been completed the CPAM will cover your medical expenses.

Retirees

You can apply for an S1 if you were resident in France by 31^st December 2020 and receive a UK State Pension or an exportable benefit. Even if you were not eligible for a UK State Pension at that time you are still eligible for an S1 when you reach pensionable age provided you were resident in France by 31^st December 2020.

To obtain the S1 form you must request an application form by phone from NHS Overseas Healthcare Services.

NHS Overseas Healthcare Services
Telephone: +44 (0)191 218 1999
Monday to Friday, 8am to 6pm
Saturday, 9am to 3pm

Once you have an S1 form, you must register it at your local CPAM office. This will mean you and your dependants will be entitled to healthcare in France on the same basis as a French citizen. You’ll still have to pay part of your medical costs, just like other French residents.

Once registered, you’ll get a temporary social security number by post after 1 to 3 months. You will then receive a document called an ‘attestation de droits à l’assurance maladie’. This confirms your right to French state healthcare and your French social security number.

Once you’ve got that document, you can apply for your French state healthcare card, the ‘carte vitale’. Take it with you whenever you visit a doctor, pharmacy or specialist provider.

It can take 6 months or longer to get a carte vitale. If you have questions about your application, contact your local CPAM office.

If you need healthcare before you receive your card, use your social security number. Ask your healthcare provider for a ‘feuille de soins’ and send it to your CPAM office to be refunded for any treatment you’ve paid for.

If you are experiencing delays registering your S1 with local authorities and require emergency or urgent treatment, contact the Overseas Healthcare Services on 0044 191 218 1999.

If you are not entitled to an S1 you can apply for PUMa after spending 3 months in France but you will have to pay contributions to the Urssaf.

If you are entitled to an S1 you will need to provide a copy of form E 121 (S1), in duplicate, for you, and for each member of your family.

You must also provide:

the printed Form application for the right to health insurance (S1106) (PDF) ;
birth certificates for yourself and all members of your family;
marriage certificate;
passport or ID copies;
proof of residency (Utility Bills, rental contract, etc.);
particulars of your bank account (RIB – banking identity statement). These can be found readily available in your French check book.

Once registered, you’ll get a temporary social security number by post after 1 to 3 months.

You’ll then receive a document called an ‘attestation de droits à l’assurance maladie’. This confirms your right to French state healthcare and your French social security number.

Once you’ve got that document, you can apply for your French state healthcare card, the ‘carte vitale’, which you will need to take with you whenever you visit a doctor, pharmacy or specialist provider.

It can take 6 months or longer to get a carte vitale. If you have questions about your application, contact your local CPAM office.

If you are entitled to an S1 form as a dependant of a State Pensioner, your health cover will be cancelled once you begin claiming your UK State Pension. You will be sent a new S1 form to your registered address from NHS Overseas Healthcare Services. You must register this form to ensure continuation of healthcare cover.

How much you’ll pay

State healthcare in France is not free. You may have to pay some of the cost of any treatment.

Make sure you understand what you’ll be charged and how much of that you’ll get back through state healthcare cover. There’s information (in French) about reimbursements online.

You can also get top-up insurance from Mutuelles d’Assurances.. This will cover all or part of your medical costs not covered by the state.

Getting treatment in the UK

The NHS is a residency-based system and so UK nationals who move abroad on a permanent basis lose their entitlement to free NHS healthcare.

If you are a UK national and move to the EU, you should not expect to be able to use NHS services for free when visiting the UK unless you have an EHIC, PRC or S2 to show your healthcare costs are funded by the EU country in which you now live, or another exemption applies.

Some former UK residents do not have to pay for NHS treatment when visiting England. This includes:

UK war pensioners
UK government employees
UK nationals living in the EU on or before 31 December 2020, once they have a registered, UK-issued S1

Moving Abroad Checklist

Initial Considerations

Will your partner be travelling with you?

If so, what will they be giving up in your present home and will they be able to continue with their career in your new home? You will need to check whether a separate visa is required for your partner to work or if your visa gives that right. If they are unable to work you will need to decide on the effect on your finances and what alternatives are available to give a fulfilling life (home business, training, voluntary work).

Are you taking family with you?

Moving with family raises many exciting opportunities, but also can create challenges. The HSBC Expat Explorer survey indicates that expat kids can take six months to settle in to their new country (see article). Getting young or even older children to prepare to move and leave their friends and family behind can be a challenge and should be thought through.

The options for education is another area that needs to be thought through.

Moving your child to a new country with a different education system can be a great opportunity to broaden their experience, but if they are close to key exams the timing can make this inadvisable. If you do take your family with you, it is important to decide between joining the local school system or choosing an international school.

Where will you be living?

Whether you will be living in a house or apartment, furnished or unfurnished, these decisions will affect what you need to take with you. The time you are planning to live overseas will also affect whether you should leave your property at home empty, rent it out or sell it. See the article Sell, Store or Ship.