If you’re moving to France or already living here as an expat, understanding how the French healthcare system works is essential, and that begins with knowing what the CPAM is.
CPAM (Caisse Primaire d’Assurance Maladie) is the public body responsible for managing access to state health insurance in France. It handles everything from your health registration to reimbursements for medical expenses and issuing the carte Vitale, the green health card used at appointments and pharmacies.
Registering with CPAM is a key step for accessing Assurance Maladie (France’s universal healthcare coverage, also known as PUMA), and it applies to expats, students, retirees, and workers alike.
In this guide, we’ll explain what CPAM does, how to register, and what to expect when using your French health coverage, so you can settle in with confidence and peace of mind.
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What does CPAM do?
CPAM (Caisse Primaire d’Assurance Maladie) is the local branch of Assurance Maladie, responsible for managing public healthcare in France at a regional level. It plays a central role in administering access to the national health system for both French citizens and foreign residents.
Here’s what CPAM does as part of the healthcare framework in France:
Manages Registration for State Health Insurance (PUMA): CPAM processes applications for PUMA (Protection Universelle Maladie), which is the French universal health coverage system. Whether you’re employed, self-employed, retired, or a dependent, your entry into the public system begins with CPAM.
Issues the Carte Vitale: Once registered, CPAM issues the carte Vitale, the green health card used to access healthcare services in France. This card links you to Assurance Maladie and allows automatic processing of medical reimbursements.
Processes Reimbursements and Healthcare Claims: CPAM reimburses a portion of the cost for doctor visits, hospital stays, prescriptions, lab work, and more. Reimbursements are made directly into your bank account or handled via your mutuelle (top-up insurance provider), depending on your coverage.
Handles Sick Leave, Maternity Pay, and Social Security Benefits: In addition to medical coverage, CPAM manages benefits such as sick leave compensation, maternity and paternity leave payments, and accident at work claims. These are all integrated into the broader Assurance Maladie system and require proper registration and documentation.
Understanding the function of CPAM is crucial for any expat navigating healthcare in France, as it’s the first and most important step toward receiving long-term medical care and financial protection.
> You might be interested in this article: Guide to healthcare system in France for American expats
Who needs to register with CPAM?
Anyone planning to live in France long-term and access the public healthcare system must register with CPAM to be covered by Assurance Maladie. Registration is not automatic for foreign residents, even if you hold a valid visa or residency card.
The following groups are required to register with CPAM:
- Long-Stay Visa Holders and Expats: If you move to France with a visa de long séjour or are applying for a Carte de Séjour, you’ll need to register with CPAM to access healthcare in France beyond emergency care.
- Employees and Self-Employed Workers: Once you start working in France, your employer or URSSAF (for freelancers) will typically notify Assurance Maladie of your employment. However, you may still need to submit your initial registration documents directly to CPAM.
- Retirees and Passive Income Residents: If you’re not working but living in France permanently (e.g. as a retiree), you can apply for state health coverage under PUMA after three months of legal residence.
- Students: International students registered with a French institution must also enrol with Assurance Maladie. CPAM handles their application and issues a carte Vitale.
- UK Nationals Post-Brexit” UK citizens living in France after Brexit must register with CPAM under one of the standard residency or employment categories. Those holding an S1 form from the UK can also register through CPAM to access healthcare funded by the UK.
Being registered with CPAM is essential for consistent reimbursement of medical costs, access to specialists, and inclusion in France’s broader social security system.
How to register with CPAM (step-by-step)
Registering with CPAM is the first step to accessing Assurance Maladie and the wider healthcare system in France. The process can vary slightly depending on your status (worker, retiree, student), but most applications follow the same basic structure.
Step 1: Prepare your documents
To register with CPAM, you will need to submit a complete application file including the following:
- Proof of identity (passport or national ID card)
- Valid visa or residence permit (for non-EU citizens)
- Proof of residence in France (rental contract, utility bill, or housing attestation)
- Birth certificate (official, long-form version, often with certified translation)
- French bank account details (RIB) for reimbursements
- Completed registration form (form Cerfa 736 or available through Ameli.fr)
- Proof of stable and regular residence (e.g. a letter stating you’ve lived in France for more than 3 months)
Depending on your situation, you may also be asked for:
- Employment contract or payslips (if working)
- Attestation of school enrolment (for students)
- S1 form (for UK pensioners or retirees covered by a foreign system)
Step 2: Submit your application
You can submit your documents to your local CPAM office by post. In some areas, you can make an appointment to deliver them in person.
- Use a registered postal service with confirmation of receipt
- Address it to your local Caisse Primaire d’Assurance Maladie office (findable via ameli.fr)
Step 3: Wait for confirmation
Once your file is processed (which can take several weeks), CPAM will send:
- A temporary attestation of rights to Assurance Maladie
- Your Numéro de Sécurité Sociale (social security number)
- A request for a photo to issue your carte Vitale
Step 4: Receive your Carte Vitale
After you’ve submitted your ID photo and any remaining documents, your carte Vitale will arrive by post. You can then use it for doctor visits, pharmacy reimbursements, and all interactions with the French public health system.
Registering with CPAM can take time, so it’s advisable to have private health insurance or a travel policy to cover you during the transition.
What is the Carte Vitale and how do you use it?
Once you’re registered with CPAM, you’ll receive a carte Vitale, your key to accessing healthcare in France efficiently. This green chip card connects you to the Assurance Maladie system and ensures that medical reimbursements are processed quickly and electronically.
What the Carte Vitale does
- Identifies you as a registered user of the public health system
- Links your medical expenses to your CPAM account
- Automatically applies standard reimbursements at the time of care
- Stores essential health coverage data (but not your full medical history)
You present the carte Vitale each time you visit a doctor, go to the pharmacy, attend a hospital appointment, or undergo medical testing. If your healthcare provider is connected to the system (most are), the reimbursement claim is sent directly to Assurance Maladie without needing paper forms.
What happens without a Carte Vitale?
If you don’t yet have your card, you can still receive care, but you’ll need to:
- Pay upfront for the consultation or service
- Submit a feuille de soins (care form) manually to CPAM
- Wait for your reimbursement to be transferred to your French bank account
Keeping your carte Vitale updated (e.g. when changing jobs, mutuelles, or status) is important to avoid delays in coverage.
How reimbursements work with CPAM
One of the core functions of CPAM within the Assurance Maladie system is processing medical reimbursements. Once you’re registered and have your carte Vitale, most routine healthcare expenses in France are partially reimbursed directly to your French bank account.
Standard reimbursement rates
The Assurance Maladie system covers a percentage of healthcare costs based on national rates. Typical examples include:
| Medical service | Standard fee | Reimbursement by CPAM | Out-of-pocket cost (before mutuelle) |
|---|---|---|---|
| GP consultation | 25 € | 70% (17,50 €) | 7,50 € + 1 € flat-rate contribution |
| Specialist consultation | 30 € - 60 € | 70% | Varies |
| Prescription medication | Varies | 15% to 100% | Depends on the medicine |
| Hospital stay (public) | Varies | 80% (more for long-term) | 20% + daily hospital fee |
Rates are indicative and may vary based on location, doctor, and coverage level.
How it works in practice?
- With your carte Vitale: The provider sends the treatment record electronically to CPAM. Reimbursement is automatic and typically appears in your bank account within 5–10 days.
- Without a carte Vitale: You must pay in full and manually submit a feuille de soins to CPAM, which delays the reimbursement process.
What isn't fully covered?
CPAM usually does not cover:
- Full specialist or private clinic fees
- Dental and vision costs beyond basic treatment
- Additional hospital charges or private rooms
To limit out-of-pocket costs, most residents take out a mutuelle (complementary health insurance) that covers the remainder.
To maximise your reimbursement, always choose a healthcare provider who is conventionné (agrees to state-set rates).
> You might be interested in this article: Choose and declare your GP in France
Useful resources and contacts
Setting up your Ameli.fr account
Once you’ve received your Numéro de Sécurité Sociale (French social security number), you can create an account on Ameli.fr, the official portal for Assurance Maladie.
With your Ameli account, you can:
- Track reimbursements from CPAM
- Download your attestation de droits (proof of health coverage)
- Order or update your carte Vitale
- Upload supporting documents
- Communicate with your CPAM office securely
Account setup requires your social security number and bank details. If you don’t yet have your number, you’ll need to wait until your CPAM registration is processed.
Find your local CPAM office
Your local CPAM office is where you’ll submit documents, attend appointments (if requested), or get in-person support.
To find your nearest branch:
- Visit ameli.fr/assures/adresses-et-contacts
- Enter your postcode or town
- The system will show address, opening hours, and contact details
You can also book an appointment online for certain services.
Who to contact if you're missing documents or unsure of your status
If you’re having trouble completing your registration or haven’t received confirmation from CPAM:
- Call 3646 (from France) to reach your local CPAM customer service. For English assistance, try calling early in the day or ask for support in “anglais”
- Visit your local CPAM office in person with your file and ID
- Send a message through your Ameli account once active
Always keep copies of submitted documents and postal receipts. Processing delays are common, especially during peak times.
FAQs: CPAM and French healthcare for expats
Do I need a carte Vitale to access healthcare?
No, but having a carte Vitale simplifies everything. Without it, you’ll pay upfront and must manually submit care forms for reimbursement. You can still access Assurance Maladie benefits without the card once registered.
Can I register with CPAM without a job?
Yes. You can apply for state healthcare through PUMA after three months of stable residence in France, even if you’re not working. This includes retirees, spouses, and dependents.
What if I lose my carte Vitale?
Log in to your Ameli.fr account and request a replacement. You’ll need to upload a new ID photo. While waiting, you can still access healthcare, but you’ll need to submit a feuille de soins for each appointment to claim reimbursement.
Can children be included on my CPAM file?
Yes. Dependent children can be added to a parent’s file. This allows their healthcare costs to be processed under your Assurance Maladie account. You’ll need to submit their birth certificate and proof of guardianship to CPAM.
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Final notes: Why understanding CPAM matters
Registering with CPAM is a key step in accessing reliable and affordable healthcare in France. Whether you’re an employed expat, a retiree, or a long-stay resident, the process ensures you’re covered under Assurance Maladie and can benefit from France’s high-quality medical system.
By understanding what CPAM does, how to register, and how to use your carte Vitale, you can settle into life in France with confidence, knowing your health needs are supported.
For more guidance on living in France as a foreign resident, explore our other practical resources on the blog and our free guides.
First published: February 2024
Updated: May 2025
