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Last updated: November 2020

Those who have been following my story for a while know how tricky French bureaucracy is. Getting access to the national healthcare system is a BIG win in my book.

I have a permanent numéro de sécurité sociale (social security number, which is nothing like the American one, so don’t get confused) and the highly sought after green carte vitale (health insurance card). I’ve included all the steps for how I did it in this post.

Admittedly, not my best look.

Who Qualifies?

Through Protection Universelle Maladie (PUMA), anyone living or working in France for at least three consecutive months is eligible for coverage through the national health insurance program. There are some exceptions to the three month rule. For example, family members, such as spouses and children, do not have to wait three months before applying for health insurance if they are moving to France to join a family member who is already insured and has established residence in France.

Even If you are unemployed, you may be able to access health insurance, but you need to justify that you are living in France “de manière stable et régulière” (“legal and stable manner”). I think the vagueness of this statement is intentional! It’s up to you to prove that you have established residency and plan on sticking around (for at least 6 months of the year).

Let’s move on to the paperwork, shall we?

Documents

Please note that I am writing this post based on my own personal experience as an American on a long-stay visitor visa. I am also married to a Frenchman. Use this information as a guide, but make sure you fulfill all requirements for your situation.

When working in France, getting covered by the national health insurance program is relatively straight-forward, in that the paperwork is really more of a formality. Your employer typically gets the ball rolling on your behalf (unless you’re self-employed!). Not to mention, you are a contributing member of society, so of course you are entitled to health insurance. Since I am not employed, I definitely supplied more documents than necessary, just in case!

I submitted the following documents in my health insurance application.

  • Form: Demande d’ouverture des droits à l’assurance maladie (PDF below: available in French and in English)
    • Required supporting documents are listed on the second page of this form
    • This form is used for first time requests or if you’ve lived in France previously, had a SSN, and just need the account reactivated. French social security numbers are for life, even if you’re not French.
  • Identification
    • Photocopy of passport
    • Photocopy of birth certificate with apostille & translation
      • Each local office may have slightly different preferences. I have heard that the translation is not always necessary, but I already had it, so I included it. I’ve also heard that some offices require the original birth certificate. (If that is the case, I would try to submit documents in person so that you can show them the original and then give a photocopy, otherwise you might never see it again!)
  • Legal Status in France
  • Employment status and proof of stability of residence in France
    • Employed: Employment contract or payslips (not applicable to me)
    • Unemployed: See page 2 of the form to see how you can prove your residence in France. For my situation that means proving my marriage to a Frenchman and showing his stable residence in France. 
      • Copy of Jonathan’s passport
      • Copy of Jonathan’s carte vitale (health insurance card) or Attestatation de droits (proof of benefits)
      • Acte de mariage (marriage certificate)
      • Quittance de loyer (rent receipts) or factures d’électricité (electricity bills)
        • 3 consecutive months 
    • Attestation d’hébergement—Yes, I had my husband write a letter stating he was housing me 😅
  • Relevé d’identité bancaire (RIB)
RIP Trees.

Submitting the Paperwork

You can either submit documents in person or by mail. In either case, you need to look up your local CPAM (Caisse primaire d’assurance maladie). When you go to the Ameli website, a window pops up for you to enter your zip code. The website will then auto-populate with information that you need, including addresses and contact information.

If you live in Paris, here is the address:
Assurance Maladie de Paris
75948 Paris CEDEX 19

I sent in my paperwork by mail. I don’t think that going in person makes the process any quicker, so I didn’t want to waste my time (also Covid).

You should send your documents by lettre recommandée avec accusé de réception. This means that when it is delivered, it has to be signed for. You can track the location of your mail (type in the numéro de l’envoi without any spaces) and you will also get a receipt when it has been delivered.

Contact

The office might not contact you if they need further documents or they might contact you by mail, which can take weeks. It is best to be proactive and call. (See the next section below for the 3 phone calls I made!) You can find contact information on the Ameli website after you’ve entered your zip code. You’ll need to contact your local CPAM.

Paris contact information

Phone number: 3646 (The call costs 6 cents a minute!)
Paris English helpline
09 74 75 36 46 (from France)
0033 974 75 36 46 (from other countries)

Personally, I switched back and forth between the French line and the English line. I found both to be helpful, but sometimes one of them didn’t work.

Sécurité sociale & carte vitale

Unless you’ve previously lived or worked in France and had a social security number, you might be issued a temporary number first. It will arrive by mail. You will not be able to open your account on the Ameli website (used for tracking reimbursements, etc) or apply for a carte vitale until you have a permanent number. Permanent numbers are recognizable because they start with a 1 for males and a 2 for females. Your temporary number can be used right away, but you’ll need to pay in advance and then manually complete and submit une feuille de soins with each visit.

Phone Call #1

When your permanent number arrives, you can create your account on Ameli and request your carte vitale. In my case, I had previously worked in France, so my permanent number was simply reactivated. I found out that my paperwork had been successfully processed by calling. After asking why I didn’t know that my number was active (and had been for the past month and a half, btw), he immediately emailed me my Attestation de droits. This form states that you are covered by health insurance and includes your numéro de sécurité sociale. (Why was this not just emailed to me automatically?!) He told me I should set up my account online and order my carte vitale.

I attempted to create an account on Ameli (P.S. Enter just your last name when it says nom.) but was met with the message, “Votre situation actuelle ne vous permet pas de créer immédiatement votre compte ameli.” (Your current situation does not allow you to create an ameli account at this time.) Considering I had previously lived and worked in France, I tried to log in and say that I forgot my password. This didn’t work either.

Phone Call #2

When I called for the second time, the woman on the phone said that I needed a code provisoire (temporary code) to log in for the first time, and she texted me the 4-digit code. (Why was this not given to me when I called the first time?!) Feeling confident, I logged into the Ameli account, checked my information and began filling out my request for the carte vitale (Mes démarches -> Commander une carte Vitale). A new message: “Nous vérifions actuellement les données vous concernant. Pour plus d’informations veuillez contacter votre caisse.” (We are currently verifying the details of your account. For more information, contact your local CPAM.)

Phone Call #3

During phone call number three, the woman I spoke with confirmed that yes, indeed, my account was blocked, but she wasn’t sure why. As a result, I would not be able to order my carte vitale online. She would send a special green form to my address that I would use to request my card. The form would arrive within 2 weeks. (Spoiler alert: It arrived after 3 weeks.)

Feeling frustrated, but not defeated, I continued to try and order my card every day following this phone call. After a week, I was finally able to submit my request. (Never give up!) You’ll need to upload a copy of your passport and a passport size photo that conforms to French standards. I took a photo of a French-size passport photo. You will receive an email confirming your request, and you can check the progress online. My card arrived in less than two weeks. I’m still recovering from the shock of it.

Timeline

These are estimates based on my own experience and stories that I’ve heard!

  • Mail documents
    • Get confirmation of documents received by CPAM—3-5 days
  • Receive temporary number—1-2 months
  • Receive permanent number—anywhere from 2 months after receiving the temporary number to your guess is as good as mine (or perhaps you’ll be issued a permanent number straightaway!)
  • Receive carte vitale 
    • If requested online—two weeks (best case)
    • If requested by mail—three weeks (best case)

As always, there are a lot of variables at play here, and the process can take significantly longer. When I lived and worked in France with the Teaching Assistant Program, it took about 8 months for me to receive my card from when I first started the process. For some people, this whole process can drag on for a year or two, so be sure to call early on to avoid any unnecessary delays.

If you’ve been assigned a number before, if you are currently working, or if you are rather lucky, this whole process might go quicker. On the other hand, your paperwork might be lost multiple times. It’s anyone’s guess really!


Did this guide help you? Say thanks with a cup of coffee!


Médecin traitant

In order to benefit from the maximum reimbursements available through your health insurance, you should declare a médecin traitant . It is not required to do so, but definitely advantageous. You can change to a new médecin traitant at any time. The médecin traitant can be a general practitioner or a specialist. This doctor, if they agree, will keep track of your medical records.

When choosing your primary doctor, you might want to ask if they are taking new long-term patients before you make your consultation appointment, otherwise you might end up wasting your time. A doctor can refuse your request. Personally, I chose to go to a medical group. In this way, the medical center will be in charge of my records and all the doctors in the group are considered my médecin traitant.

Many doctors now submit the paperwork online. In my case, the doctor gave me the paper version of the form, I filled out my information, and then I mailed it to my local CPAM. Less than a week later, I was able to see that my médecin traitant was noted in my online Ameli account.

Mettre à jour la carte vitale

Your carte vitale needs to be updated at least once per year and should be updated anytime your situation changes (i.e. employment status, marital status, pregnancy status, lol, etc. ) Failure to do so could result in your card not working properly. Updating your card involves sticking it in a machine for less than a minute. Many pharmacies have the machines to do this (it usually looks like a credit card reader) or you can do it at a borne multiservice (electronic kiosk / information point) located in a nearby health insurance agency.

Carte Européenne d’Assurance Maladie

This card facilitates the process of reimbursement for health expenses when traveling in Europe. Without this card, you still have the possibility of being reimbursed, but you’ll need to pay all costs upfront. In this case, you should be especially careful about saving your receipts.

You can request a carte européenne d’assurance maladie (CEAM) through your Ameli account under the Mes démarches tab. It is recommended to order the card at least 15 days before your departure date. I ordered mine and received it 5 days later. This card is valid for up to two years.

carte européenne d'assurance maladie (CEAM)
How to Apply for Health Insurance in France as an Expat
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8 thoughts on “How to Apply for Health Insurance in France as an Expat

  • August 12, 2020 at 2:20 pm
    Permalink

    Hello Ellen,
    Thanks for sharing your personal experience, you are right to specify that the process you detail was your personal experience as it doesn’t apply to every cases. It seems that you have nailed this process because many people do not send the affiliation documents by recorded mail and then it gets lost…
    For example, the possibility to affiliate to PUMA for inactive European citizen is very tricky and is often rejected during their first 5 years of residence in France.
    To remain in the general rule, people not working (and therefore not contributing) can request affiliation after 3 months of stable residence in France, proving their source of income and also show that they have a medical coverage (crazy you have to have a health insurance to be able to request the public one…).
    As you know, this doesn’t apply to French people spouses.

    The extra complication for European citizens (or other nationalities that were residing in another European country before coming to France) is that they must provide proof that they are no longer entitled to public health coverage in the other European country as this would cover them in France… If you are interested in the process details, I have posted a specific information on this subject.

    An extra useful tip for non-French speakers: The cerfa affiliation form now also exists in English: Cerfa nº15993*01

    Reply
    • August 13, 2020 at 9:34 am
      Permalink

      Hi Mademoiselle Guiga,

      I only write based on my personal experiences! I try to remind my readers of that on administrative posts, otherwise, they might assume that the process should be exactly the same for them. There are far too many rules, exceptions, exceptions to the exceptions, and inconsistencies for me to include them all 😅

      Thank you for sharing your knowledge regarding European citizens and people based in Europe. It is certainly not my specialty. I also appreciate the tip about the application form existing in English, and I’ve just added it to the post. Thank you!

      Reply
  • August 17, 2020 at 8:35 am
    Permalink

    Hi Ellen!!

    I was told/read that if you are applying as a spouse of a French citizen, that you can apply right away if your spouse has all their paperwork in order (I have no idea how long it takes for my husband to get back on insurance after almost 5 years abroad since I know that is one of the requirements, that his insurance has to be active, I’ve been told one month, 3 months, or that he is automatically back on when he returns full-time as a resident). So I was wondering, do I still need the Certificat de contrôle médical from the OFII apointment, or can I apply without it? I also found out on the Ameli website advice pages that if you don’t have your own bank account to give them an RIB number, you can have your spouse make a procuration bancaire and give them their RIB number instead.

    Reply
    • August 18, 2020 at 9:21 am
      Permalink

      Hi Emilie!

      The fact that he will be working (I believe you previously told me he has a work contract?) and the fact that he is reactivating his health insurance (as opposed to having a new account created) means that the process “should” go fairly quickly for him. I’m not sure what your timeline is… for example when you arrive in France versus when his contract starts. Even if he is not enrolled in the health insurance program by the time you arrive in France, I believe it will be retroactive back to the date of his contract starting.

      As the spouse of a French citizen, your enrollment, in order to bypass the 3-month wait period, will be contingent upon him being insured and establishing his residence. I linked a legal code in my post: https://bit.ly/31ZRAik Number three is the one that you’ll want to look at.

      As far as supporting documents go, take a look at the form that I’ve linked in the article. I included the English version. You would fall under this situation: “You are a family member of a French-insured individual working or residing in France in a legal and ongoing manner whom you are moving to France to accompany or join.” The documents you will be submitting will be more about proving this statement than anything else. I wouldn’t worry about the OFII appointment (I’d assume they’re super backed up now, anyways!)

      I don’t know anything about power of attorney and bank accounts. Make sure you find out what this would mean for US taxes and reporting. Personally, I’d recommend that you try to open your own bank account as soon as possible. Maybe call/email to set up an appointment for arrival? I was able to open one very quickly with LCL (I walked out with my bank account number that day, and it was active a couple of days later.) and lately, I’ve heard that HSBC is good with Americans as well. I have a couple of blog posts about it. Having your own account can facilitate other things later (like renewing your residence card in a year!).

      I hope this helps 🙂

      Reply
      • August 18, 2020 at 9:46 am
        Permalink

        We logged onto his Ameli account today, and for some reason it’s shown as active, haha, even he was confused. We both wonder if it activated or never deactivated because he had to prove his French residency to renew his passport a couple of years ago and to prove his French residency to the Embassy when we got married. He had his mom add him to her gas and electricity bills, and because of this his passport even has this address.

        Where I saw the thing about the procuration bancaire was on the Ameli website.

        https://forum-assures.ameli.fr/questions/1524962-procuration-bancaire

        but I think you might be have something there with the US taxes, though I was going to do a joint account with my husband for my account anyways, should I not even get a joint account with him to keep the IRS away from him?

        Reply
        • August 19, 2020 at 5:03 am
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          Awesome! If that’s the case, you can download his “Attestation de droits” (proof of benefits) and put that with the paperwork you are going to send in. It can be found under the “Mes démarches” tab on the Ameli website.

          As far as taxes and banking goes, I will be the first to admit that I have more research to do! From what I understand, FATCA is the reporting requirement that holds foreign banks accountable. If a US person has an account with them, it is the bank’s responsibility to let the US government know. FBAR is another reporting requirement, but it’s aimed at American citizens themselves. If the total value of your foreign accounts exceeds $10,000, you need to file FBAR.

          Generally speaking, I think if your name is on the account, it is considered your asset (even if it’s joint, but I don’t know how power of attorney plays into that!). I don’t think you necessarily need to avoid having a joint account. In both of these cases (FATCA/FBAR), the money in the accounts is not being taxed. The government just wants to keep track of you!

          Reply
  • November 18, 2020 at 2:58 pm
    Permalink

    please tell me where I can find les feuilles de soins a remplir par le docteur in the USA. J’ai la carte Vitale et une amie française m’a dit que je pouvais me faire rembourser le vaccin pour “Shingles” (zona je crois) qui est très cher. je n’arrive pas a les trouver! please help, thank you. M.Darsses

    Reply

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