If you are moving to France or settling in as an expat, understanding the French healthcare system is one of the most practically important things you can do. And it starts with understanding three terms that are often used interchangeably but are not the same: CPAM, Assurance Maladie, and PUMa. Getting these right, and understanding how they relate to each other, makes the whole registration process considerably less confusing.
This guide explains what each term means, how the registration process works depending on your situation, how the Carte Vitale fits in, and what has changed in 2026.
Assurance Maladie is the health branch of French Social Security, the national health insurance system.
CPAM (Caisse Primaire d’Assurance Maladie) is the local health insurance fund in your area that administers your Assurance Maladie rights: opening your file, managing reimbursements, and handling your Carte Vitale. CPAMs operate by geographical area, generally by département.
PUMa (Protection universelle maladie) is the legal framework under French Social Security law that guarantees healthcare-cost coverage to people who work in France or reside there stably and regularly. It is the basis on which many non-working residents access Assurance Maladie, but it is not a synonym for the system itself.
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What does CPAM do?
Your CPAM is the local health insurance fund responsible for insured people in its geographical area. It is the administrative body you deal with when joining the French healthcare system, and it continues to manage your file throughout your time in France. Here is what it actually handles.
| What CPAM does | What this means for you |
|---|---|
| Opens and maintains Assurance Maladie rights | When you register, CPAM creates or updates your health-insurance file. For non-working residents, this typically happens under PUMa once the residence conditions are met. |
| Manages the Carte Vitale | Once your rights and identity record are established, CPAM oversees the issuing of your Carte Vitale. The card allows healthcare providers to transmit electronic care claims to Assurance Maladie. |
| Processes healthcare reimbursements | CPAM calculates and pays the Assurance Maladie portion of eligible medical costs: GP visits, hospital stays, prescriptions, lab tests, and more. Reimbursement follows statutory rates. |
| Manages cash benefits | CPAM also handles sick-pay, maternity and paternity leave payments, and workplace accident claims as part of the wider Assurance Maladie structure. |
Who needs to register with CPAM?
Most people settling in France who need French Assurance Maladie rights will go through a registration or affiliation process, but the route depends on their status and existing healthcare entitlement. There is no single process that applies to everyone, and starting with the wrong form or wrong office wastes time.
Non-working residents applying under PUMa
If you are living in France without taking up employment, as a retiree, a person living from savings or passive income, or someone in a similar situation, your healthcare rights typically arise under PUMa once certain conditions are met. Holding a long-stay visa does not itself automatically activate French healthcare. Non-working non-EU residents generally need to demonstrate three months of uninterrupted, stable, and lawful residence in France before rights can open under this route. You must also continue to reside in France for at least six months of the year to maintain them.
Workers and employees
If you work in France, your Assurance Maladie entitlement normally arises through professional activity rather than through the three-month residential PUMa route. Your employer or business formalities establish part of the administrative record. However, a foreign-born person who has never been registered in the French system may still need to provide identity and civil-status documents to CPAM so that a social-security number and Assurance Maladie file can be created.
Foreign students
Foreign students who need French health coverage generally register free of charge through the dedicated portal etudiant-etranger.ameli.fr rather than through the standard CPAM postal process. Once affiliated, their health rights are administered through Assurance Maladie and their local CPAM. Note that EU/EEA students who remain insured under a valid EHIC are treated differently.
UK nationals with an S1 form
Eligible UK residents who hold a valid UK-issued S1 can register it with CPAM so that healthcare is provided in France under the applicable international coordination arrangements. Not every British retiree automatically receives an S1; eligibility depends on the individual’s UK benefits position. Registering an S1 is a distinct process from applying under PUMa.
French law now provides for a financial contribution for certain non-working PUMa beneficiaries who meet specific conditions (Article L160-1-1 of the Social Security Code, introduced by the 30 December 2025 Social Security Financing Act). This is particularly relevant if you are a non-working resident whose healthcare rights arise through residence rather than through employment or an applicable international arrangement. The rule does not affect your eligibility to register, but it may affect your costs once rights are open. Check the current Service-Public.fr guidance when applying, as the implementing decree was still awaited as of mid-2026.
How to register with CPAM (a step-by-step guide)
The process below applies to non-working residents applying under PUMa. Workers, students, and S1 holders follow different routes, as noted above. All routes ultimately result in your Assurance Maladie file being administered by your local CPAM.
Prepare your documents
Depending on your status, CPAM may request: form S1106 (Demande d’ouverture des droits), proof of identity, proof of lawful residence for non-EU nationals, civil-status documentation (birth certificate, translation and authentication may be required), proof of French address, RIB, and for PUMa applications, evidence of continuous residence during the qualifying period.
Submit to your local CPAM
Send documents by registered post with confirmation, or attend in person if appointments are available. Address to the CPAM for your département, findable via ameli.fr.
Wait for your rights to open and social-security number to be confirmed
Once rights are opened, CPAM provides an attestation de droits. If you do not have a French social-security number, INSEE certification takes place during this period. Keep private health insurance active throughout.
Obtain your Carte Vitale
Once your rights and identity record are established and validated, you can proceed with your Carte Vitale through ameli.fr. The card arrives by post. Rights come first; the card follows.
Declare a médecin traitant
Declare a coordinating GP through your Ameli account. This keeps you within the parcours de soins coordonnés and affects reimbursement levels for many consultations and specialist referrals.
What the Carte Vitale does, what it does not do, and how to keep it working correctly
The Carte Vitale is a green chip card that contains the administrative information needed for your healthcare provider to transmit your care claim electronically to Assurance Maladie. It does not store your full medical history. It is issued once your Assurance Maladie rights and identity record are established, it is evidence of your entitlement, not the legal source of it.
What happens when you present the Carte Vitale
Your healthcare provider reads the card and transmits the electronic care claim (feuille de soins électronique) directly to Assurance Maladie. This does not necessarily mean you pay nothing at the appointment: whether you pay upfront depends on whether your provider operates tiers payant (a separate arrangement under which you do not advance the Assurance Maladie portion). With electronic transmission via Carte Vitale, Assurance Maladie states that reimbursement is normally made within five days.
Without the Carte Vitale
You can still receive care. Where electronic transmission is not possible, the healthcare professional may provide a paper feuille de soins, which you submit to your CPAM for reimbursement. Your underlying healthcare rights are not lost because the physical card is missing.
Keeping your Carte Vitale up to date
Ameli recommends updating your Carte Vitale at least once a year, and after relevant changes such as a change of address, a birth, a new professional activity, or a change of health-insurance scheme. You can do this at any pharmacy with a Carte Vitale terminal, or through your Ameli account.
The 2026 appli Carte Vitale
Assurance Maladie is progressively rolling out a smartphone version of the Carte Vitale. It is free and optional. Ameli currently recommends retaining the physical card because not all healthcare professionals yet accept the app. If you use the digital version, check with your provider before each appointment.
How Assurance Maladie reimbursements work through CPAM and what affects how much you get back
CPAM calculates and pays the Assurance Maladie portion of eligible healthcare costs. Reimbursement is based on official rates and reimbursement bases, not on the full amount charged by the provider. Understanding how this works helps you plan complementary insurance appropriately.
A practical example: a médecin traitant consultation in sector 1, within the parcours de soins coordonnés, has a standard rate of 30 €. Assurance Maladie reimburses 70% of that base minus the 1 € statutory deduction (participation forfaitaire), resulting in a reimbursement of 20 € in the standard case. The remaining portion is what a mutuelle (complementary health insurance) typically covers.
| Type of care | Assurance Maladie reimbursement (indicative) | Notes |
|---|---|---|
| GP visit (sector 1, coordinated pathway) | Around 70% of the official rate | Statutory participation forfaitaire deducted; rate depends on pathway and circumstances |
| Specialist consultation (with referral) | Around 70% of the reimbursement basis | Fee overruns if sector 2 or 3 are not covered by Assurance Maladie |
| Hospital stay (public hospital) | Around 80% after forfait journère | Daily hospital fee applies; complementary insurance often covers the remainder |
| Prescription medicines | 15%–100% depending on classification | Varies by classification: irreplaceable, essential, moderate, or low service |
| Laboratory tests (prescribed) | Around 60%–100% | Depends on the nature of the test and whether within pathway |
Figures are indicative and based on official Assurance Maladie guidance. Actual reimbursement depends on type of care, reimbursement basis, care pathway, and individual circumstances.
What affects how much you are reimbursed
- Whether you follow the parcours de soins coordonnés. Staying within the coordinated care pathway, starting with your declared médecin traitant, affects reimbursement levels for most consultations and specialist referrals
- Whether your provider is conventionné and whether they are sector 1 (no fee overruns), sector 2 (authorised overruns), or sector 3 (non-conventionné). Assurance Maladie reimburses on the official basis regardless of what the provider charges; fee overruns are your responsibility unless your mutuelle covers them
- The type of care. Reimbursement percentages vary by category of service
- Complementary insurance (mutuelle). Where your complementary insurer is electronically linked through the Noémie system, reimbursement data flows automatically so the mutuelle can calculate its additional payment
Check whether your practitioner is conventionné, and if so, whether they are sector 1 or sector 2. Sector 2 practitioners can charge authorised overruns above the official rate, which Assurance Maladie does not reimburse. Following the parcours de soins coordonnés by going through your declared médecin traitant for specialist referrals also affects your reimbursement levels for many consultations.
How to manage your Assurance Maladie rights online through Ameli.fr and how to contact your CPAM
Setting up your Ameli account
Once your Assurance Maladie record and social-security number are in a form accepted by the online service, you can create your account at ameli.fr. With your Ameli account, you can:
- Track reimbursements from Assurance Maladie
- Download your attestation de droits (proof of health coverage) for administrative procedures
- Manage your Carte Vitale requests and updates
- Upload supporting documents to your CPAM file
- Send secure messages to your CPAM
- Declare or change your médecin traitant
Finding your local CPAM office
To find your nearest CPAM branch, visit ameli.fr/assures/adresses-et-contacts, enter your postcode or town, and the system will show the address, opening hours, and contact details for your local fund. Online appointment booking is available for certain services.
Contacting Assurance Maladie
From France, Assurance Maladie can be reached on 3646. Ameli also lists an English-language advice line on 09 74 75 36 46 for English-speaking residents. If you are having difficulty with your registration, keep copies of all submitted documents and postal receipts. You can also send a message through your Ameli account once it is active, or visit your local CPAM office in person with your file and ID.
FAQs about CPAM and French healthcare for expats
| 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 |
Updated August 2026
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