France Health Insurance for Expats – The French Healthcare System

France has one of the best healthcare systems in the world. Based on the principle of solidarity, all residents are eligible to receive healthcare no matter their financial status (universal healthcare). Additionally, the healthcare system covers every resident in the country, which includes expats who are living and working in France.

France Healthcare System: How Does It Work?

The French healthcare system (Protection Universelle Maladie-PUMA) is mostly funded by taxes and offers its citizens partial health insurance (assurance maladie). Usually, employers will sign up their employees for social contributions, and a premium is deducted from their salaries through taxes.

Then, whenever someone requires medical attention, up to 70% of their medical costs are already covered by the national health insurance— 100% if someone is dealing with a long-term condition, e.g., cancer or diabetes. Residents can cover the remaining 30% by non-profit private insurers, mutualities (mutuelles), or private health insurance companies, which they must pay by themselves.

Once a French citizen or expat is registered for healthcare, they receive a “Carte Vitale”—a smart card that carries the holder’s information. When patients visit a doctor, they use their Carte Vitale to swipe the card and send the payment information to the social security system. Then, around five days later, the patient is reimbursed for the visit.

Here is a summary of how a medical visit usually goes in France:

1. You have a medical issue you need to get checked out.
2. You visit your general practitioner.*
3. You pay for your doctor’s consultation, which is usually €25.
4. You use your Carte Vitale to forward the payment information.
5. Five days later, the public health insurance scheme automatically deposits the reimbursement amount into your account.

*Please note that while you are not obligated to visit your GP first, you’re highly recommended to do so. Especially since to encourage people to consider a general practitioner visit first, the health insurance system pays lower rates for those who visit a specialist directly (gynaecologists, dentists, ophthalmologists, and psychiatrists excluded).

Do I Need Health Insurance in France?

Health insurance in France is obligatory for everyone, even expats. So, if you plan to move to France long-term, you must register with the country’s national health insurance scheme. If you stay in France for a short period, you may purchase travel insurance with a good medical coverage plan. However, you have to keep in mind that if you’re from a country that requires you to apply for a French visa, travel insurance is obligatory.

You can compare different health insurance plans for expats in France and get a free quote at International Citizens Insurance.

How Can Expats Get Health Insurance in France?

Expats living and working in France can register for the country’s public healthcare scheme and receive health insurance. However, it usually takes around six months to be eligible for the national healthcare (PUMA), during which time you should obtain private health insurance to cover you. To be eligible for PUMA, expats in France must prove they meet the residency requirements as follows:

• Reside in France regularly. In this case, you must either have French nationality, hold a valid residence permit, or have taken the required steps to obtain a valid permit.
• Reside in France on a stable basis. You must prove that you have been living in France for three months uninterrupted.

In most cases, when you are employed, registration for PUMA is done automatically. Once you complete six months of residence, you can benefit from the international health insurance in France. After which, you can still choose to keep your private health insurance as supplementary or “top-up” health insurance to cover the 30% that is not included in public coverage. You can purchase a private health insurance plan at International Citizens Insurance.

Best Health Insurance Providers for Expats in France

Some of the best insurance providers for expats in France include the following:

French ‘mutuelles’ (non-profit insurance funds):

• MGEN
• Mutualia
• Mutuelle Générale
• Unéo
• Harmonie Mutuelle
• MNT

You can find a full list of the ‘mutuelles’ for additional insurance here.

Private insurance companies (international health insurance):

• • AXA
  • Allianz
  • Cigna.
  • GeoBlue
  • AETNA

Does France Have Universal Healthcare?

Healthcare in France is available to every resident who is legally living in the country— regardless of their employment status. However, up until 2000, healthcare was extended only to those who contributed to the social scheme, excluding the poorer population. With recent health reforms, universal healthcare is now available in France, including expats who are legal residents of the country.

Is Healthcare Free in France?

Most of the healthcare services in France are free. Public health insurance covers up to 70% of medical costs. But, the way the system is set up, first, you must pay for the services and then receive your reimbursement. However, long-term ill people receive completely free healthcare (their medical costs are 100% reimbursed).

For the rest of the 30%, most residents opt for additional coverage, “top-up”, or complementary health insurance. You can purchase additional health insurance from a mutuality (non-profit insurance fund) or private companies.In this case, expats usually prefer to purchase international health insurance, but it all depends on your situation and needs.

Cost of Health Insurance for Expats Living in France

Healthcare costs in France are generally low, especially since health insurance will cover most of the services. Usually, a general consultation costs around €25, dental care can go up to €50, and over-the-counter pain medicine goes around €1.50. However, there may be some price variations depending on your region, but expect your insurance to make up for most of these costs, leaving you with a very small amount to pay out of pocket.

How Does the Reimbursement Process Work?

Let’s say you must visit your GP while in France and finish your visit, after which you have to pay for the service as follows:

So, at the end of the general consultation, you must pay only €1 out of pocket if you also have complementary health insurance. If you’re only covered by the statutory health insurance scheme, you have to pay €8.50 (€7.50 + €1).

How Do Employed Expats in France Obtain Health Insurance?

Employed expats, i.e., those working under a French employer, are registered by their employer for social contributions. As a result, they are automatically eligible for public health insurance. However, you have to wait at least six months to benefit from the public health scheme. So, expats advise you to have private coverage during this time, so you don’t remain uninsured.

How About Self-Employed Expats?

Self-employed expats must go through an application process to register with PUMA and access public health insurance in France— the application goes as follows:

1. Fill in the application form. You need to fill out the application form for insurance affiliation, which you can find here. If you haven’t received your social security number yet, make sure you get that first since you must have a valid social security number to be eligible for the health insurance scheme.
2. Prepare your documents. Along with your form, you have to prepare several documents, which usually include your passport, ID card, proof of address, proof of fulfilling the residency requirements, a copy of your contract, etc. Make sure you submit notarised or certified copies of your documents— don’t submit originals unless specifically requested.
3. Send your application. Finally, once your documents have been prepared, you have to send them to your closest office of the primary health insurance fund (CPAM-Caisse Primaire d’Assurance Maladie). You can find the correct address for where to send your application here. You can send the file can by mail or in person.
4. Wait for an answer. Once you submit your application, it may take several months to get approved and receive your Carte Vitale. If you need to visit the doctor during this time, ensure your reimbursement sheet (Feuille de soins) and the prescriptions. Then, you can send the Feuille de soins to the CPAM office and request reimbursement— keep in mind that reimbursement is possible only for the last two years you have been living in France.

To prove you meet the residency requirement, you must submit several documents, including your electric bill, phone bill, lease agreement, etc. Some expats advise you to save most of your receipts from the moment you enter the country to use them as proof of residence. Additionally, if you are living with a family member, you may be required to submit a written statement from your host.

Remember— from the moment you meet the residency requirements and then get your application approved for the public health insurance scheme, the entire process can take up to a  year. During this time, you are without insurance. As a result, you have to purchase private health insurance, and you can either opt to register with a local company or buy international health insurance that caters to expats.

Can International Students Get Health Insurance in France?

Before starting their study program in France, international students who are not EU/EEA nationals must register with the appropriate website, which you can find here. Registration, in this case, is mandatory and free of charge. Once your registration is approved, you’ll receive a social security number and be eligible for the public health insurance scheme.

However, you must remember that before entering the country, you may require a French student visa, for which you must submit proof of purchased travel insurance with medical coverage.

How Does Health Insurance Work for Retired Expats in France?

Retired expats must undergo a lengthy process to benefit from public health insurance in France. You have to apply to join the healthcare scheme because you aren’t working, i.e., not paying social contributions directly to the social security fund. But, you must ensure you meet the residency requirements before submitting your application.

Do EEA/EU Citizens Need Health Insurance in France?

If you’re an EEA/EU citizen living in France, you must bring your EHIC with you. The European Health Insurance Card enables you to receive medical treatment in EU countries outside of your home the same as citizens of that country. In France, all medical services are paid first and then reimbursed by the public health insurance scheme. So, when you visit a doctor in France, bring your EHIC with you and then fill out a Feuille de soins for reimbursement.

If you lose your EHIC, or it gets stolen, or you haven’t received your card in time, make sure you get an EHIC Provisional Replacement Certificate (PRC) from your local health insurance office. This certificate is only temporary; you still need to retrieve your EHIC.

Health Insurance in France for US Citizens

As a US citizen living in France, you’re also eligible for the country’s health insurance scheme. The affiliation process depends on your employment, i.e., if a French employer employs you, they will register you for social security, and as a result, you’re eligible for the PUMA. If you’re self-employed, you have to take several steps to complete your application to join the healthcare system.

Before you depart to France, you can check with your current insurance provider in the US to see if they can cover you while you are abroad or whether they have an international plan you can purchase.

Health Insurance in France for UK Expats

UK expats who are living in France are eligible for health insurance as long as they register with the national healthcare scheme. However, suppose you are a posted worker, i.e., someone employed or self-employed in the UK but temporarily working in a European Economic Area (EEA) country. In that case, you can benefit from the healthcare system in France via one of the following options:

• Using a GHIC. UK Global Health Insurance Card is an insurance document issued by the NHS Business Services Authority to allow UK citizens to receive healthcare abroad. The GHIC comes in place of the EHIC after Brexit. If you have your GHIC with you, just present it when you require medical attention while in France.
• Using an S1 form to register. You need to retrieve this from the NHS before you depart for France. There are specific provisions as to who is eligible for an S1 form. Once you have the form, you must register it with your local health insurance fund in France.

Pros and Cons of the French Healthcare System

Here are some of the pros and cons of the French healthcare system: