Healthcare in France for newcomers: PUMa, the carte Vitale and a mutuelle

Healthcare in France runs on a “public fund plus top-up insurance” model: the state health insurance fund, Assurance Maladie, repays 70% of the official fee for a visit and a mutuelle covers the rest. Newcomers join through PUMa: people who work and business founders straight away, people who do not work after three months of residence. Until then, and for the visa itself, private health insurance for the whole stay is required.

The main difficulty is the wait. Getting from a file with the fund to a number and a carte Vitale takes newcomers from two or three months to a year, and treatment meanwhile is paid out of pocket or by a private policy. So the policy is bought with a margin, and the file goes in on the first day you are entitled to file it.

People living on capital also face the CSM contribution on dividends, interest and rent, usually discovered through a letter from URSSAF. A worked example on family figures follows below.

How French healthcare works

Most doctors in France work privately; the wider picture of the country is in the article on life in France. Healthcare costs fall into three layers.

• The fund (Assurance Maladie). It repays a percentage of the fee it sets itself: for a GP visit, 70% of €30 minus €2. Long-term conditions on the ALD list are covered at 100% under the care protocol.
• The mutuelle. Top-up insurance, private but regulated. It pays the rest of the official fee and, under a good contract, sector 2 excess fees, dental care and optics.
• Your share. A flat €2 contribution per visit and a €1 deductible per pack of medicine. Each is capped at €70 a year per person, and neither applies under 18 (ameli, ameli).

When a newcomer becomes entitled to PUMa

Entitlement to reimbursement comes from universal health protection, PUMa (protection universelle maladie). A non-EU national needs two conditions at once: lawful stay and stable residence (service-public). Here is how that works by status:

The family row comes from the application form S1106 itself: a family member who arrives with an insured person, or joins one, is covered without the three-month wait, provided the insured person works or lives stably in France (form S1106). Cover lasts as long as you live in France for at least six months a year. The fund runs random checks over the last 12 months, gives 30 days to reply, and without a reply closes the cover and claims back what it paid (ameli). For anyone splitting time between two countries, this is not a formality.

Insurance for the visa and the first months

For the visitor visa and the visitor card, health insurance for the whole stay is a mandatory condition, and an insurance certificate is filed again at each renewal (service-public). Official pages set no minimum level of cover for a D visa: the €30,000 often quoted applies to Schengen visas. The conditions in full are in the article on the French visitor visa.

• On a talent passport. A policy for the first period is also part of the visa file, and an employee is covered by the fund straight away. But the number and the card do not arrive straight away, and a private policy bridges the gap; a founder’s first-year budget is in the article on the talent passport for entrepreneurs.
• On a visitor card. For the first three months a private policy is the only protection. After that you apply for PUMa, and many people keep the private policy until the number arrives.
• What to check in the policy. The whole visa period, hospitalisation, repatriation and in-patient limits.

How to get a social security number

The application goes to the health insurance fund (CPAM) where you live, on form S1106 with supporting documents. The form asks for:

• a passport and a residence document: a D visa that serves as a residence permit, a card or a filing receipt;
• a full copy or extract of the birth certificate showing the parents, authenticated with a legible stamp; the fund will tell you whether a translation is needed;
• for employees, an employment contract or a payslip; for founders, documents about the activity;
• for people who do not work, proof of more than three months of residence: a lease, receipts, energy bills;
• a RIB, the details of a French bank account for payments; how to open one is covered in the article on a bank account in France for Russians.

The fund first assigns a temporary number (NIA), then a permanent one. Reimbursement is possible on the temporary number, but the card and the ameli account are only opened on the permanent one.

Talent passport. Since September 2025 Assurance Maladie has run a service for employers: the company registers a foreign employee who has no number, including a talent passport holder and adult members of their family. According to the fund’s guide, the other categories on that list are handled by CPAM Paris (Assurance Maladie guide). If you work for a French company, ask it to file through that service: it is faster than a file sent by you.

In practice, going by several years of reports in newcomers’ chats, talent files from the regions, founders and families included, also end up with the Paris fund, and the wait runs from two or three months to a year. Founders often receive a request as if they were employees, for a contract and payslips, and answer with a letter explaining their status and enclosing company documents. The number URSSAF sends when a micro-entreprise is registered may not be visible to the fund. The other steps after arrival are in the article on what to do after arriving in France on a D visa.

The carte Vitale and the ameli account

• Ordering. With a permanent number, the carte Vitale is ordered from the ameli account or the Compte ameli app by uploading a photo and an ID. The card is free, so any request to pay for it is a scam; it arrives within two weeks (ameli).
• Until the card arrives. Show the doctor the certificate of entitlement (attestation de droits) from the ameli account. Without a card the doctor often issues a paper claim form (feuille de soins), which is posted to the fund.
• The app. Since 18 November 2025 the carte Vitale can be activated on a smartphone. Video activation needs a document from a set list, including a French residence permit; a Russian passport is not on it. The doctor needs a reader, so carry the plastic card as well (service-public).

Your own doctor and what is repaid

The first thing to do once the number arrives is to declare a médecin traitant, your registered GP. It applies from age 16, and the declaration is filled in with the doctor. Without it the refund for the same visit falls from €19 to €8.40 (ameli). You can go directly, without losing reimbursement, to a dentist, a gynaecologist or an ophthalmologist for glasses, and children under 16 are reimbursed normally without a registered GP.

Sector 1 doctors charge the fund’s fees. Sector 2 doctors may charge more, and the fund never repays the excess (dépassement d’honoraires). Doctors in OPTAM have agreed to keep excess fees in check, and their base is higher. If a sector 2 specialist outside OPTAM charges €120, the fund repays €14.10 and the rest is a matter for your mutuelle (ameli fee table). A doctor’s sector and fee are shown in the ameli.fr directory before you book; for Paris, see the article on life in Paris.

The mutuelle: what it tops up

A mutuelle is not compulsory if you are not an employee, but without one you carry 30% of the fee, sector 2 excess fees and nearly all dental costs. Employees get a group mutuelle from the employer, which pays at least half of the premium; a founder or a visitor needs a contract of their own.

• 100% Santé. Crowns, bridges and dentures from the 100% Santé basket are paid in full if you have a “responsible” contract (contrat responsable), which is about 95% of contracts on the market. The dentist must give a quote that includes an option from that basket (ameli). There is a similar basket for glasses (ameli).
• Outside the basket. Implants, freely priced ceramics, frames dearer than the basket and excess fees of doctors outside OPTAM depend on the contract. Look for them line by line in the table of benefits, together with annual limits and waiting periods.

The CSM contribution for people living on capital

PUMa is not entirely free for people who do not work. If you have little or no earned income in France but substantial capital income, URSSAF charges the CSM contribution (cotisation subsidiaire maladie), commonly called the “taxe PUMa”. For 2025 income the conditions are (URSSAF):

• earned income in France below 20% of the annual social security ceiling: €9,420;
• capital income (rent, dividends, interest, capital gains) above 50% of the ceiling: €23,550;
• a 6.5% rate on the part above €23,550, a base capped at eight ceilings, and a lower rate as earned income approaches €9,420;
• a couple filing jointly splits the income in half, with the €23,550 allowance for each; if either partner earns more than €9,420, both are exempt.

Example. A couple lives on visitor cards with €120,000 of capital income for 2025 and no work in France. Each is counted on €60,000, €36,450 remains after the allowance, and the contribution is €2,369.25 per person, €4,738.50 for the couple. The bill arrives in the fourth quarter of the following year, based on the French tax return, and can be paid at once or in three instalments. In the year of the move it is prorated to the months you were covered. How the income itself is taxed is in the article on taxes in France.

The 2026 social security financing act also introduces a contribution for non-working members who do not pay CSG and CRDS under international agreements; the amount will be set by a decree not yet published (service-public).

Travel: the EHIC and insurance outside Europe

The fund issues people insured in France with a European Health Insurance Card (CEAM): one for each family member, free, for up to two years. It is ordered from the ameli account at least 15 days before travelling. The card covers only care that becomes necessary during the stay, in the public sector of the country visited (ameli).

A limitation few people know: non-EU nationals cannot use the CEAM in Denmark, Iceland, Norway, Liechtenstein, Switzerland or the United Kingdom. There they pay themselves and claim reimbursement on their return. For travel outside Europe the fund recommends separate insurance.

Common mistakes

• Cancelling the private policy as soon as the file is with the fund: the number may take six months.
• Waiting for the fund to “add the family by itself”: spouses and children are applied for separately, children on form S3705.
• Not preparing a full, stamped birth certificate and its translation in advance: it is asked for almost every time.
• Living on capital without budgeting for the CSM, or not knowing that one partner’s pay above €9,420 exempts both.

Healthcare is one line in a relocation plan, alongside the residence route, schools and taxes. If you are planning a family move, describe your situation and we will review free of charge which route to take and in what order. What else the first months involve is covered in the articles on how to move to France and schools in France for foreign children, and the talent passport categories in the article on the French talent passport.

Frequently asked questions

Is healthcare in France free or paid?

Paid, with reimbursement. A GP visit costs €30, and the fund repays €19 if the doctor is your médecin traitant and €8.40 if not. The remainder, sector 2 excess fees, dental care and optics are topped up by a mutuelle. Long-term conditions on the ALD list are covered at 100% under the care protocol.

What health insurance do I need for a French visa?

A D visa and a visitor card require health insurance for the whole stay, and the certificate is filed again at each renewal. Official pages set no minimum cover for a D visa: the €30,000 figure applies to Schengen visas. The policy should cover hospitalisation and repatriation.

How long does it take to get a carte Vitale?

People who work and business founders are covered straight away, people who do not work after three months of residence. The card itself is ordered from the ameli account once you have a permanent number and arrives in two weeks. In practice, getting from the file to a permanent number takes newcomers from two or three months to a year.

Can I get a carte Vitale without a residence card?

Yes. Form S1106 accepts as proof of residence a D visa that serves as a residence permit, as well as a filing receipt. The plastic card is not needed for the file. You need a passport, a birth certificate, a RIB and proof of work or of three months of residence.

Where do I send my carte Vitale file on a talent passport?

If you work for a French company, you can ask it to register you through the Assurance Maladie service for employers. Otherwise the application is made on form S1106; according to the fund’s guide these categories are handled by CPAM Paris, and in practice talent files from the regions end up there too.

Does CPAM need a translation of my birth certificate?

Form S1106 asks for a full copy or extract of the birth certificate showing the parents, authenticated with a legible stamp, and the fund says itself whether a translation is needed. In practice funds almost always ask for a sworn translation, so it is best to have one made in advance for every family member.

Does a visitor pay a health contribution in France?

If capital income is above 50% of the annual social security ceiling and there is little or no earned income in France, URSSAF charges the CSM: 6.5% of the part above €23,550 for 2025 income. For a couple with €120,000 of capital income that is €4,738.50 a year.

Official sources

• service-public: PUMa, conditions and the new 2026 contribution; ameli: universal health protection; form S1106 and the list of documents
• Assurance Maladie: foreign workers registration service, 2025; ameli: getting a carte Vitale; service-public: the carte Vitale app
• ameli: the médecin traitant and the care pathway; ameli: consultation fees from 1 January 2026; ameli: the €2 contribution; ameli: the deductible
• ameli: 100% Santé in dental care; ameli: glasses and lenses; URSSAF: the CSM contribution
• service-public: the visitor card; ameli: travel and the CEAM