State Health Insurance in France

Information about the state healthcare system and French health insurance requirements...

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 (Caisse Primaire L'Assurance Maladie). Those who do not qualify will have to take out private health insurance. 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 May 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 pay slips, pension statements, or earnings from capital such as bank deposits, coupons from government bond holdings or share dividends.

Joining French Social Security

Visit a local CPAM office and ask for affiliation. Affiliation should then take place that day either as attestation provisiore if not all the documents are available, or as attestation d'affiliation. Claims from that day forward are covered by CPAM to the percentage appropriate to the applicant's status. The following may be needed when completing the form N° Cerfa : 60-3406 (declaration en vue de l'immatriculation d'un pensionné, ou de sa veuve, ou d'un orphelin):
  • Proof of identity: passport or Titre de Séjour
  • Details of place of birth (and for partner and children)
  • Proof of address in France with proof of ownership (deeds) or rental agreement
  • Date of permanent arrival in the departément
  • Proof of having lived in France for at least three months (three months' utility bills, rent statements, or mortgage payments or a notarised statement of home purchase)
  • Marriage and birth certificates, if partners are to be included
  • A RIB (Relevé d'Identité Bancaire) provided by the bank
  • Evidence of income for at least the previous 12 months, whether in France or elsewhere or an avis d'imposition or latest French tax bill

The Carte Vitale

Once affiliated to the social security system, a Carte Vitale (green card) is issued. The Carte Vitale is the national insurance card issued to anyone eligible aged 16 and over. It gives evidence of membership and rights to French health insurance - an affiliation to CPAM. It contains all the administrative information necessary for the refund of care:
  • Social security number
  • Details of health insurance scheme and top-up insurance
  • Details of the relevant health insurance office
  • Full name and date of birth of the card holder and their dependants
  • Details of any exemption or reduction that apples to payments or entitlement to supplementary universal cover
The Carte Vitale does not carry personal medical information. The Carte Vitale should be handed over at every health appointment (doctor, clinic, hospital, pharmacy) that is equipped with a computer able to read it. The patient will generally receive reimbursement for treatment or medicines directly into their bank account within five days. Reimbursement is made according to income level and the Tarif de Convention (or "approved treatment cost") currently in force. A Carte Vitale has no expiry date but must be updated annually inserting it in the green box which can be found at all CPAM offices and some hospitals and pharmacies. A person without a Carte Vitale eligible for state health insurance will receive a feuille de soins (a brown receipt form) from the doctor, pharmacist or hospital staff. This is recognised by CPAM as a legitimate medical payment. It should be signed and posted to CPAM (along with the doctor's prescription if medicines were issued) for reimbursement.

The new Carte Vitale

The "nouvelle Carte Vitale" is a new, upgraded version that is being issued to card holders across France. A form is sent, to which a recent identity (ID) photograph must be added, the form signed and returned in the envelope provided, along with a copy of ID (resident's card or passport). Updating a Vitale card can be done at most pharmacies or at the multi-service kiosks available at Health Insurance points.