You are coming to France and you are wondering if you are entitled to French healthcare as a European jobseeker? Since you are not contributing yet to the French healthcare system as a newly arrived unemployed European citizen, be prepared to provide some extra documentation and go a lengthy process, unfortunately… I detail for you the requirements and process to facilitate this process.
What is PUMA?
The French Universal Health Insurance called PUMA (Protection Universelle Maladie) has been implemented in 2016. PUMA is administrated by the CPAM (Caisse Primaire d’Assurance Maladie), the name of the French Social Security system.
Every French baby is affiliated to CPAM under one of their parent’s coverage (and social contribution payments). However, for the newcomer PUMA determines two main criteria to access French Social Security:
- The professional criteria, that I have detailed in another article
- The residence criteria applicable to European jobseekers under conditions (see below)
Many different situation types can fall under the second category, and different conditions apply. The underage accompanying dependent situation has been detailed in this article.
If you do not have a French employment contract, you may be eligible for universal health coverage under the French social security scheme after a three month waiting period after arriving depending on your personal situation.
Affiliation to PUMA under the criteria of residence (versus professional criteria) is applicable only when residing for minimum 6 months per year. It is the minimum annual duration to prove a stable residence in France. However, the request can be done from 3 months of residence in France.
For the 2 below accompanying dependents types, the 3 month waiting period doesn’t apply:
- Spouse of a French citizen
- A person under the Regroupement familial residence permit
The specific case of inactive European citizens
The European treaty differentiates between the working and the non-working individuals:
Active individuals: It is considered they have sufficient income for their subsistence (workers, independent workers, students, retirees)
Inactive individuals: An inactive European citizen is considered to be a European citizen settling in France without professional activity. Inactive family members, pre-retiree, pensioners, people living out of their capital incomes also fall under this category.
Passed the 3 month waiting period after arrival in France, it is considered that the inactive individual has the right to reside if the 2 below criteria are met:
- Have sufficient income for himself/herself and the family members
- Be covered by a complete health coverage
If these requirements aren’t met, the individual isn’t compliant with the right to reside according to the European treaty and the access to PUMA will be rejected.
During the waiting period, the European Health Insurance Card (EHIC) should be used for medical emergencies.
After 5 years residing in France, it is considered that the European citizen has established a permanent residence in France and the criteria of sufficient income and complete health coverage for inactive individuals do not apply anymore.
Therefore, the individual may complete the requirement to register to PUMA. It is possible (but not compulsory) to request a permanent residence permit as a European citizen to the Préfecture after 5 years of uninterrupted residence.
Without the permanent residence, every PUMA request is examined on a case-by-case basis.
As you can see, being affiliated to French healthcare as European jobseeker is a challenge. The advice given here is based on my professional experience in Global Mobility, the CPAM instructions and legal advice from GISTI, a legal association focusing on immigrant issues.
However, the CPAM case-by-case basis treatment can show irrelevancies that make it difficult to navigate. If your affiliation keeps being rejected and you believe that you meet all the criteria, you may want to consider getting advice from a lawyer specialized in the Social Security Law.
Step-by-step process to affiliate to French healthcare as European jobseeker
Prepare your documents
Before leaving your country (with anticipation):
If you are a European citizen or if you were previously residing in the EU as a third-country national (or French national repatriating) you should request:
- The S1 form (see INSIDER TIP 1) to the National Health Provider of your previous European country of residence.
It is a Certificate of entitlement to healthcare if you don’t live in the country where you are insured. The S1 form can be accepted as proof of complete health coverage as explained above.
- Your European Health Insurance Card
You should get a European Health Insurance Card (EHIC) for yourself and your family members before moving abroad. However, the EHIC will only give you access to necessary medical treatment (e.g. emergency treatment).
After the 3 month waiting period
An important rule that applies to most of the administrative processes you may undertake:
Never send original documents unless clearly stated! Only send copies.
Documents for every individual affiliating to PUMA:
- A copy of your ID: passport or national identity card
- Full French bank account details in your name (called RIB in French) or a joint account in both yours and your spouse’s names.
- Birth certificate (see INSIDER TIP 2) for every individual.
The certificate must mention:
- Your date and place of birth
- Your gender
- Your father’s and mother’s name
Depending on which language your birth certificate is written you may be required to provide a translation done by a sworn translator approved by a French Court of Appeal and authenticated or stamped with an “apostille.” (see INSIDER TIP 3)
- The Form S1106 in English or French filled in for each adult
- The Questionnaire recherche de droits ressortissants européens inactifs (with the required back up documents as stated on the form depending on your situation)
- Proof of right to access French health care:
- S1 form, or
- Attestation proving end for your healthcare rights in another EU country, or
- Copy of you EHIC, or
- Private healthcare coverage attestation
- You must be able to prove you have been a resident for at least three months in France. You can provide documents such as:
- If you are a tenant:
an energy bill such as electricity, gas, water, and landline phone, Internet in your name. CAREFUL: the mobile-phone bill is usually not accepted.
Lease or rental contract, successive rental payment receipts,
- If you are staying at a hotel or a residence: proof of residence + receipt for the previous month rent.
- If you are being hosted: a hand-written certificate of residence signed by your host + your host last energy bill + a copy of your host’s proof of identity
- If you are a tenant:
- Proof of financial resources in France or country of origin
- Form s3711: if you wish to submit the public health complementary request (only available if you annual global incomes are under 12,193 € – 2020 data)
- If you have children: Application form to add minor children to one or both parents’ account
INSIDER TIP 1
With the S1 form, you will benefit from the same level coverage as any other person registered with PUMA paid directly from the CPAM. Then, the French Social Security (CPAM) will liaise directly with the National Health Insurance who provided the S1 form to receive the corresponding reimbursement.
INSIDER TIP 2
If you are registered to Pôle Emploi and receive French unemployment benefits, you may be eligible to French healthcare as a European jobseeker.
INSIDER TIP 3
Only birth certificates in French, Albanian, German, English, Danish, Croatian, Spanish, Finnish, Hungarian, Italian, Latvian, Lithuanian, Dutch, Norwegian, Polish, Portuguese, Romanian, Slovak, Swedish, Czech and Turkish are accepted without translation by the French Social Security.
Birth certificates in any other languages must be translated into French by a sworn translator approved by a French Court of Appeal and in some cases apostilled or legalized (see INSIDER TIP 4).
INSIDER TIP 4
Health Insurance requires birth certificates from certain countries to be stamped with an “apostille” or legalized. In either case, this certifies that the document is official. Some countries have bilateral agreements preventing their citizens from the need for apostille or legalization. Check out the legalization table attached to see if this applies to you.
Where to send your request file?
You will find the address of your local CPAM in the below link.
I strongly advise you to send it by postal mail. A centralised department will receive it. If you bring it in person to your local CPAM office mailbox, it can take about 3 weeks to reach the appropriate department.
On the Ameli website, in the section “Adresses et contacts”
> Click on “Sélectionner votre Caisse”, provide your French postcode to find the relevant CPAM address.
> Click on “Confirmer” and you will see the postal address where you should send your affiliation document. Keep the address, as you will also use it to send your first reimbursement claims.
It can take about 2-3 months to receive your health insurance card (Carte Vitale)… If you are lucky, it can be faster, it depends on the region you apply for it.
What to do while waiting for your Carte Vitale
In the meantime, you can still go to the doctor and keep the receipts (called Feuille de soin) together with the corresponding prescription. Once you have been provided with a social security number, you will have to fill in the top sections of the Feuille de soin and don’t forget to sign it. This is a comment oversight that will delay the reimbursement.
- Your first name and last name – Prénom et nom
2. Your 15 digit-social security number – Mon N° d’immatriculation à 15 chiffres de Sécurité sociale
3. Your date of birth (day/month/year) – Date de naissance
4. Your address in France – adresse
5. Don’t forget to sign it on the bottom right-hand side section!
CPAM can reimburse medical expenses for the past 2 years maximum.
You have received your Carte Vitale. How to use it?
Every time you go to the doctor; you need to provide it.
The CPAM will have the information on the doctor’s rate, and you will automatically receive the relevant reimbursement amount on the bank account you have provided the details.
This means that you always have to pay the doctor at the end of the consultation. This will prevent you from sending paper documents as explained above.
How to avoid the affiliation process as inactive European?
It can sem a piece of easy advice to give, but finding a job is the best way to get affiliated with French healthcare.
Any job will open your rights to French healthcare from the first full day of work! So doing an unskilled job were languages skills are not required will give you access to PUMA. Make sure you have a signed work contract and receive a payslip and you will be able to request your affiliation based on the professional criteria.
To summarize, getting French healthcare as a European jobseeker is a challenge but it not impossible. Put all the chances on your side by following all my tips.
For more information on French healthcare, check out my other related posts:
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