How to join the French healthcare system

Moving to France is exciting. Figuring out how to join the healthcare system isn’t.

Between the paperwork, long processing times, and French-only forms, many newcomers get stuck before they’re even “in” the system.

The good news is that the process is predictable once you understand the basics. The tricky part is the terminology and the right pathway for your situation.

Indeed, “many people mix up ‘Sécurité sociale,’ ‘Assurance Maladie,’ and ‘CPAM,’” says Eloi Lanthiez, Feather’s French healthcare expert. “Understanding what each one means is the first step to navigating the process.”

In this guide, you’ll learn:

• What you’re actually signing up for (Sécurité sociale vs. Assurance Maladie vs. CPAM)
• Who’s eligible, and which enrollment route applies to you (job, self-employed, student, or PUMa)
• Exactly which documents you’ll need to avoid delays
• The step-by-step process to get your social security number, Ameli account, and Carte Vitale
• What to do while you’re waiting, including bridge insurance and reimbursement tips
• How reimbursements work once you’re enrolled, and why most people add a mutuelle

By the end, you’ll know how to get enrolled with confidence, track your file, and start using French healthcare properly.

What you're actually signing up for

Before diving into the process, let's clear up the terminology.

Sécurité sociale is France's social security system. It covers more than just healthcare—retirement, family benefits, unemployment, and work accidents all fall under this umbrella.

Assurance Maladie is the health branch of Sécurité sociale. This is what pays the statutory share of your healthcare costs.

CPAM (Caisse Primaire d'Assurance Maladie) is your local health insurance office. These are the people who process your file, enroll you in the system, and manage your benefits. Day-to-day, you'll interact with CPAM through the online portal at ameli.fr.

PUMa (Protection Universelle Maladie) is the legal basis for coverage if you don't work in France. To qualify, you need to reside in France "stably and regularly"—typically meaning three consecutive months of residence.

One common misconception: "Many people think past stays 'years ago' count toward the residence requirement. They don't. CPAM looks at current, continuous residence."

How france differs from other systems

If you're coming from the UK, forget the NHS model where everything is free at the point of use. In France, you typically pay upfront and get reimbursed afterward (usually 70% for doctor visits). You can add private insurance called a mutuelle to cover most of what's left.

Coming from the US? You'll find French healthcare far more affordable and predictable. There's a universal base that covers everyone, so you won't face the cost exposure common in American healthcare.

The key difference: France uses a statutory-first model. The public system (Assurance Maladie) pays its share, then your mutuelle tops up the rest. Average medical costs are much lower than in the US, especially for serious conditions.

Who's eligible?

Your enrollment pathway depends on your situation. Here's how each one works in practice.

Employed workers

If you have a French work contract, your employer declares you to the system. CPAM affiliation follows automatically through employer paperwork. You still need to complete some steps yourself—providing ID, address, and bank details (IBAN)—but the process is largely handled for you.

Self-employed and freelancers

After declaring your activity and getting your SIRET number, you're insured through the general scheme. Your health coverage runs through CPAM, while your contributions go through URSSAF. You'll need to provide proof of activity start along with your other documents.

Students

International students are eligible through enrollment and residence. Provide your student status documentation plus residence and ID proofs. You can register directly through the dedicated student portal at etudiant-etranger.ameli.fr.

Non-working residents (PUMa)

This is where people get confused most often. To qualify under PUMa, you need:

• Stable and regular residence in France (typically three consecutive months)
• Lawful stay documents (for non-EU citizens, this means a valid visa or residence permit)

CPAM checks that you've lived in France continuously for roughly three months. They want to see sequential proofs—not just one document, but evidence that shows ongoing residence.

EU vs. Non-EU citizens

EU/EEA/Swiss citizens: You'll need your passport or ID card plus residence proofs. If you're coming from another EU country's healthcare system, bring coordination forms like the S1 if relevant.

Non-EU citizens: Same requirements as above, plus your residence permit or visa. This is non-negotiable—without valid legal status, you can't enroll.

What's changing

Eloi notes there's currently discussion in the French government about charging a fee for people who benefit from public healthcare without paying taxes. "Italy charges €2,000 annually in similar situations," he says. "Nothing is finalized, but it's worth watching."

Documents you'll need

Getting your documents right the first time is crucial. "If your file isn't complete when you submit it, that's when the delays start," Eloi warns.

Everyone needs…

• Cerfa 15763*02 – The official form for opening your rights. Download it from service-public.gouv.fr
• ID document – EU citizens: passport or national ID card. Non-EU citizens: passport plus residence permit or visa
• Proof of address – Preferably three consecutive months of documentation if applying under PUMa
• Birth certificate with filiation – Required if you're creating a social security number for the first time
• IBAN/RIB – Your bank details for receiving reimbursements

You might need…

• Employed: Work contract or employer attestation
• Self-employed: SIRET number and attestation d'activité
• Students: School enrollment certificate
• With children: Form S3705a. Download it from ameli.fr
• With a partner: Family documentation forms if including them on your file

What counts as proof of address?

Valid proofs include:

• Rent receipts or lease agreement
• Utility bills (electricity, gas, internet)
• Housing certificate (attestation d'hébergement) plus a bill from your host
• Domiciliation certificate
• Hotel invoices

What doesn't work: "Airbnb receipts are often not accepted," Eloi notes. "Confirm with your local CPAM before relying on them."

Do you need to translate your documents?

Everything needs to be in French. "A simple translation is enough," says Eloi. "You don't necessarily need certified or sworn translations, but the documents must be readable in French."

For birth certificates and other official documents, a professional translation is safest. Some CPAM offices are stricter than others.

The most common document mistake

Make sure your full name appears exactly as written in your passport. Discrepancies between documents cause delays. Double-check spelling and the order of your names before submitting.

Step-by-step enrollment process

Here's what the process actually looks like from start to finish.

Step 1: Collect your documents

Gather everything listed above based on your situation. Don't start the application until you have every required document. Incomplete submissions create the biggest delays.

Step 2: Complete the Cerfa form

Fill out Cerfa 15763*02 carefully. If you have children, also complete form S3705a. Take your time—errors here slow everything down.

Step 3: Submit to your local CPAM

Find your local CPAM office based on your postcode at ameli.fr. You have two options:

In person: Eloi recommends this approach. "You can get immediate feedback if something's missing."

By post: If you mail your application, use "recommandé avec accusé de réception" (registered mail with return receipt). This proves CPAM received your documents and protects you if anything gets lost.

Step 4: Wait for processing

This is where patience becomes essential. Timelines vary by department—expect several weeks to a few months. Delays typically come from:

• Document corrections requested by CPAM
• Residence proof verification
• The Carte Vitale production step

During processing, CPAM may issue a temporary social security number first. Your definitive number comes later.

Step 5: Create your Ameli account

Once you have a social security number and your RIB is on file, create your account at ameli.fr. You'll validate via an emailed link.

The ameli portal lets you:

• Track your application status
• View reimbursements
• Download attestations
• Message CPAM securely

Step 6: Receive your Carte Vitale

The Carte Vitale is your physical proof of coverage—a green card with a chip. You'll be invited to submit a photo and ID for production. Once it arrives, you're fully operational in the system.

How to track your application progress

Log into your ameli account to check status. If you need to call:

• French line: 36 46
• English line: 09 74 75 36 46 (availability varies—try during low-traffic hours)

You can also visit your local CPAM office in person for updates.

What to do while waiting for coverage

The gap between applying and receiving your Carte Vitale can feel risky. Here's how to handle it.

Keep all your receipts

If you need medical care while your application is processing, you can still see doctors and get treatment. Keep every invoice. Once your rights are confirmed, you may be able to get retroactive reimbursement from your effective entitlement date.

Ask CPAM whether retroactivity applies in your case—it depends on when your rights are officially recognized.

Handling emergencies

If you have a medical emergency before enrollment, seek care immediately. French hospitals won't turn you away. Sort out the billing afterward—your health comes first.

If you have expat insurance, contact them right away. If not, keep all documentation and work with CPAM once your rights are open.

Get expat insurance

"You can get expat health insurance that you can cancel when you join Sécurité sociale," Eloi suggests. This provides coverage during the waiting period without locking you into a long-term commitment.

Having insurance while waiting is practical, yes. But it's also technically required. France expects residents to have health coverage, whether through the public system or private insurance.

Understanding your coverage once enrolled

Now for the part everyone wants to know: what does coverage actually look like?

How reimbursement rates work

Sécurité sociale sets official prices for every medical service. When you get care, they reimburse a percentage of this official rate—not the actual price you pay.

Here's what that looks like in practice:

Doctor Visits

• GP visit official rate: €30
• Sécurité sociale reimburses: 70% (€21), minus a €2 participation fee
• Your reimbursement: €19
• Your out-of-pocket: €11 (without mutuelle)

Specialists follow the same 70% rule, though rates vary by specialty.

Medications

• Most prescribed medicines: 65% reimbursed
• Some are 30% or 15%, depending on their therapeutic value

Laboratory Tests and Imaging

• Usually 60-70% reimbursed, depending on the test

Hospitalization

• 80% of the official rate is covered
• You pay the remaining 20% (ticket modérateur)
• Plus €20 per day in hospital (forfait journalier)

Dental Care

• Routine work (checkups, basic fillings): 70% of official rate
• Crowns and prostheses: official rates are much lower than real prices, so your reimbursement is small
• Dental implants: not covered at all by Sécurité sociale

Glasses and Optical

• The public system reimburses around €30 for a pair—that's it
• 100% Santé options cover the full cost when combined with a mutuelle
• For other glasses, your mutuelle fills the gap

Why do you need a mutuelle?

A mutuelle is private health insurance that works alongside the public system. It covers what Sécurité sociale doesn't—the ticket modérateur, hospital daily fees, and services not on the public list.

Here's why it matters:

GP visit with mutuelle: You pay €30. Sécurité sociale reimburses €19. Your mutuelle covers the remaining €9. You pay only the €2 participation.

GP visit without mutuelle: You pay €30. You get €19 back. You're out €11 every time you see a doctor.

Dental crown example:

• Real price: €600
• Official rate: €120
• Sécurité sociale pays: €84 (70% of €120)
• Without mutuelle: you pay €516
• With a good mutuelle (covering 250% of official rate): you pay around €300

A mutuelle can also cover things the public system doesn't touch:

• Alternative medicine (osteopathy, podiatry, chiropractic)
• Private hospital rooms
• Glasses above the basic reimbursement
• Certain vaccines not on the public list

When choosing a mutuelle, check the dental and optical coverage levels. These are where the biggest gaps exist.

How mutuelle reimbursements work

Two ways this plays out:

Pay and get reimbursed: You pay the full amount at the doctor or pharmacy. Sécurité sociale deposits their share in your bank account. If your mutuelle is linked via télétransmission, they automatically reimburse their share too.

Tiers payant: The provider bills Sécurité sociale directly, so you don't advance the statutory portion. This is standard at pharmacies and increasingly common at doctors' offices. Your mutuelle can top up automatically if connected.

"With télétransmission, we're linked to Sécurité sociale," Eloi explains. "As soon as you use the Carte Vitale, it triggers the refund on our side as well."

Common problems and how to solve them

Even with perfect preparation, things can go wrong. Here's what to watch for.

1. Non-consecutive or stale proofs of residence. CPAM wants to see continuous residence, not just one document from months ago. Make sure your proofs are sequential and recent.
2. Missing RIB/IBAN. Without your bank details, they can't reimburse you. Include this from the start.
3. Missing or incorrect civil status documents. Birth certificates with errors or missing filiation information cause delays.

If your application is stuck

First, read any communication from CPAM carefully. They'll tell you exactly what's missing. Supply the requested documents promptly and precisely.

If you've heard nothing:

• Check your ameli account for updates
• Call the French line (36 46) or English line (09 74 75 36 46)
• Visit your local CPAM office

Try calling during low-traffic hours. Early morning or late afternoon often works best.

Transferring from another EU country

If you're coming from another EU healthcare system, don't assume automatic transfer. You need to actively declare your situation to CPAM and provide proper coordination forms (like the S1 if applicable).

Bring your French address and RIB, plus any EU health documentation. CPAM needs to formally open your file in France—your old coverage doesn't just follow you automatically.

Next steps after enrollment

Getting your Carte Vitale is a milestone, not the finish line. Here's what to do next.

Declare a médecin traitant

This is crucial. A médecin traitant is your designated primary care doctor who coordinates your healthcare.

With a médecin traitant: GP visits are reimbursed at 70% (€19 back on a €30 visit after the €2 participation).

Without a médecin traitant: Reimbursement drops dramatically—you might only get €8.40 back on the same visit.

You can declare your médecin traitant through the ameli portal or directly at your doctor's office. They'll handle the paperwork.

Finding a doctor

Use Doctolib to find doctors in your area. You can filter by language—helpful for finding English-speaking practitioners.

If you're struggling to find a doctor accepting new patients (common in some areas), try:

• Expanding your geographic search
• Looking at group practices
• Asking your mutuelle for recommendations

Set up your Ameli App

The app lets you:

• Track reimbursements in real-time
• Download attestations when you need proof of coverage
• Update your Carte Vitale photo
• Message CPAM securely
• View your complete reimbursement history

Keep your contact details and RIB updated. Features evolve regularly—check ameli.fr for the latest options.

Understand the parcours de soins

The parcours de soins is France's coordinated care pathway. The basic principle: see your médecin traitant first, then get referrals to specialists when needed.

Sticking to this pathway means better reimbursement rates. Going directly to specialists without a referral (except for certain exceptions like gynecologists, ophthalmologists, and psychiatrists) means lower reimbursement.

Get a mutuelle

If you don't already have one through your employer (who are required to provide one in France), shop for individual coverage. Compare:

• Dental and optical levels (where gaps are biggest)
• Hospital coverage
• Alternative medicine if you use it
• Whether they offer English-language support
• Télétransmission compatibility

Your mutuelle makes the difference between paying €11 per GP visit and paying €2.

Key takeaways

1. Get your terminology straight. Sécurité sociale is the system. Assurance Maladie is the health branch. CPAM is who you deal with.
2. Gather complete documents before applying. Incomplete submissions cause most delays.
3. Submit in person if possible. You'll get immediate feedback on any issues.
4. Use bridge insurance while waiting. Expat health insurance keeps you covered during the gap.
5. Declare a médecin traitant immediately. The reimbursement difference is significant.
6. Get a mutuelle. The public system covers 70%—a mutuelle handles most of the rest.
7. Keep all receipts. Especially while waiting for your Carte Vitale. You may get retroactive reimbursement.

Useful Resources

• ameli.fr – Your portal for everything health insurance
• service-public.gouv.fr – Official government forms and information
• etudiant-etranger.ameli.fr – Student enrollment portal
• Doctolib – Find and book doctors online

CPAM Contact:

• French: 36 46
• English: 09 74 75 36 46

This guide provides general information about joining the French healthcare system. Individual situations vary, and processes can change. For specific advice, contact your local CPAM or consult with a specialist.