State Health Insurance in France
Information about the state healthcare system and French health
All residents in France are obliged by law to have health insurance. Most qualify for thestate
health insurance (sécurité sociale); in local terms, this means affiliating to the CPAM(Caisse
Primaire d'Assurance Maladie). Those who do not qualify will have to take out private health
CPAM French Health Insurance Advice Line (English-speaking) open Monday to
o Tel: 0811 363 646 (from France)
Comprehensive information from CLEISS (Centre des Liasons Européennes et
Internationales de Sécurité Sociale)
Ameli (Assurance Maladie en Ligne)
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.
For more information from Service Public: Click here (in French)
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
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
elsewhereor 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.
For more information about the Carte Vitale: Click here (in French)
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
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Family & Benefits
Card offering discounts for big families in France
French families and families from EU countries legally residing in France with at least three
children under 18 years old can benefit from a card offering a range of discounts. The card is
called a ‘Carte Familles Nombreuses’. Under the scheme, each member of the family has
their own card. The management fee for processing applications comes to €19, which the
family must pay. This amount stays the same however many cards are issued to the family.
Card began with discounts on train journeys
When the card was created in 1921, it gave cardholders discounts on journeys using the
French national railways. Families with six children or more benefit from a 75% reduction,
those with five children from a 50% reduction, those with four children from a 40% reduction
and those with three children from a 30% reduction. Parents who have or have raised five
children at the same time benefit from a 30 % reduction on second class tickets.
A poll in 2009 showed that one cardholder in four uses the card at least once a month to take
the train, 26% to go on holiday or for a long weekend by train, 31% more rarely and 17%
never. One family in four uses it at least once a month to benefit from commercial partners
other than the French national railways.
More and more commercial partners offering discounts
The card was opened up for commercial partners to give discounts in 2006, with 22 partners
joining the scheme that year. By May 2007, there were 44 partners and by January 2010,
there were 93 partners.
So now cardholders can benefit from a range of other discounts, including national museums,
supermarkets, shops and fun parks. In May 2007, the French Health Ministry reported that
over three million people held the card out of a maximum possible of seven million people. It
added that cards should be issued within an average of ten days of reception of an
application. The French national railways in charge of processing applications.
Online applications since 2007
Those applying for a card no longer have to go to train station ticket offices but can, since
2007, apply for one online. They can start their application for a card by going to
going to the ‘train’ section at the top of the screen,
clicking on ‘cartes et abonnements’
and then scrolling down to ‘cartes pour la famille’.
If they click on ‘demande’, a form will appear. The French national railways will then send
them a kit to apply for a card.
The kit comprises an application form, an explanation of what the card is for, a pre-paid
envelope and a sleeve for identity photographs. The card is valid for three years, after which
the family needs to apply for a new card. For parents who have brought up five children or
more, the card is valid for six years.
For further information
Contact: French Ministry of Labour press service