How social security works in France ?
Created in 1945, Social Security “is the guarantee given to everyone that in all circumstances they will have the necessary means to ensure their subsistence and that of their family in decent conditions” (1). Clearly, its mission is to protect the French against all risks to life, by supporting them at every stage of their existence. It is based on a principle of solidarity, each participating in its financing according to its means.
Within the Social Security, the Health Insurance manages – on behalf of the general scheme – the branches of sickness and accidents at work as well as occupational diseases.
Social security is made up of 3 different types of schemes, including 2 main schemes as well as different special schemes, each covering one or more specific socio-professional categories and characterized by different management and support methods:
- The general scheme, which covers the majority of the population: salaried workers as well as self-employed workers since January 1, 2018 as well as any person benefiting from a right of residence, which is notably the case of foreign students who are not Europeans (universal health protection).
- The agricultural scheme, which covers farmers and agricultural workers.
- Many special regimes, such as that of sailors, mines, SNCF, RATP, EDF-GDF, the National Assembly, the Senate, clerics and employees of notaries.
Then, social security is made up of 5 branches. A branch is an entity that is responsible for managing one or more “risks”. These risks are defined as events which can, over a lifetime, affect a person’s economic security. They are therefore subject to consideration, redress or compensation.
Below is a diagram showing the construction of French social security :
L’Assurance maladie = The sickness branch → It covers the health expenses of the insured and guarantees access to care. It promotes prevention and contributes to the regulation of the French health system. It covers the risks of illness, maternity, disability and death.
For the general scheme, the health branch is managed by the National Health Insurance Fund and its network which is made up of primary health insurance funds (CPAM).
General health insurance finances 86% of French health expenditure.
To benefit from it, you must first obtain the “carte vitale“.
How does the second stage of your health insurance in France work (complementary / mutual)?
Health Insurance (Social Security) partially reimburses your health expenses. To cover the costs that remain at your expense, you can subscribe to a complementary health insurance (mutual). It will then reimburse the costs remaining at your expense according to the chosen contract. Some contracts allow reimbursement of services not covered by Social Security.
Choosing an insurer :
To take out a complementary health insurance contract, you can contact the following organizations in particular:
- Mutual
- Insurance company
- Provident institution
- Banking establishment
What is the benefit of a mutual health insurance ?
Depending on the formula chosen, the additional reimbursements are therefore more or less important. Their percentage varies in particular according to health expenditure items. If the medical consultation or the drugs are well reimbursed, differences exist in the costs of optics, dentistry, or those related to hearing aids.
Subscription to health insurance results in a contribution. The calculation of tariffs crosses several data: the age of the insured (the cost increases with age), the place of residence (case of regions with a higher frequency of excess fees) and the range of mutual health.
Some figures on complementary health insurance :
How does health insurance for a foreigner work in France?
The rights differ if you are a citizen of a country in the European Economic Area (EEA) or of another country. Also, the applicable rules and the steps to be taken depend on your status (employee, retiree, student, etc.).
If you are European
Below is the list of European countries: Germany, Austria, Belgium, Bulgaria, Cyprus, Croatia, Denmark, Spain, Estonia, Finland, France, Greece, Hungary, Ireland, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Norway, Netherlands, Poland, Portugal, Czech Republic, Romania, United Kingdom, Slovakia, Slovenia, Sweden.
Case N ° 1 – You are a student:
If you come to study in France, you are considered as a temporary stay and must normally be affiliated to the health insurance scheme of your country of origin.
Before your departure, however, you must verify that this plan will cover your medical expenses for the duration of your stay in France. If so, consider requesting your European health insurance card which you can use in France.
Find out well before your departure from your organization of affiliation and French health insurance.
Case N°2 – I am unemployed
If you are unemployed, receiving benefits and authorized to transfer your residence to France, during this time you remain affiliated to the unemployment insurance scheme in your country.
In order to be reimbursed for your health expenses in France, you must apply for the European health insurance card before your departure from your affiliate organization.
If you are not compensated by your country of origin, you can benefit from universal health protection (Puma), if you reside in France on a stable and regular basis.
Case N °3 – I am an expatriate and work in France
If you come to work in France, as an employee or self-employed, you are insured in France (with some exceptions, for example if you are a civil servant). You lose your status as an insured in your country of origin and must contribute to the French social security system.
Before leaving for France, you must:
- Obtain form E 104 (certificate concerning the aggregation of periods of insurance, employment or residence – sickness, maternity, paternity) from your affiliation organization, and submit it to your French health insurance fund.
This form summarizes the insurance periods completed in your previous country of employment. These periods are taken into account as French insurance periods for the opening of your rights to health insurance benefits in France.
Your family members are also covered in France, whether they live there or not. If they continue to reside in your country of origin, you must request the S1 document (certificate for the registration of family members of an employee or self-employed person) from your health insurance fund in France. You must then submit it to the competent health insurance body abroad, so that your family members are registered there.
If you are not European
Case N ° 1 – Short stays in France
Ask your local agency if there are any bilateral agreements between France and your country of residence. If this is the case, it is possible that only emergency costs are covered. It is therefore advisable to also take out private insurance. If, however, you already benefit from it, make sure that it is still working in France (via an associated insurer or a partner). If this is the case, check which costs are covered or not.
Case N°2 – I am a student
You must register on the site dedicated to welcoming students, in order to benefit from the coverage of your health costs upon your arrival in France. Click on the following link: https://etudiant-etranger.ameli.fr/#/
Case N°3 – I am an expatriate worker
You benefit from universal health protection (Puma) if you work in France on a stable and regular basis.
Your beneficiaries (child, spouse) can also benefit from the Puma.
If your country of origin has signed a bilateral social security agreement with France, this facilitates your support in France.
→ What is Universal Health Protection (Puma)?
Protection Universelle Maladie (PUMA) is a system which allows any person working or residing in a stable and regular manner in France to benefit on a personal basis from payment of their health costs by Social Security.
→ Under what conditions can I benefit from universal health protection (Puma)?
You can benefit from PUMA as long as you have lived in France for at least 3 months. Depending on the amount of your income from activity and your income from capital, you may be liable for the subsidiary health contribution (CMS = cotisation maladie subsidiaire).
→ How to benefit from universal health protection (PUMA)?
To obtain the opening of rights to health insurance, you must complete a specific form – “Application for opening of rights to health insurance” – which you then return to the health insurance fund of your place of residence (department).
The request must also contain the following documents:
- A completed form n°S 3710 “universal health cover – basic protection” for the basic CMU or forms n°S 3711, S 3712 and S 3713 for the complementary CMU
- Photocopies of identity cards for all household members (with photos for adults)
- Proof of address (for citizens of countries outside the EU / EEA)
- An income statement
Case N°4 – I am a posted worker
It is up to your employer to take the necessary steps. It keeps you in the regime of your country.
If your country of origin has signed a bilateral social security agreement with France, it provides for the reimbursement procedures for expenses incurred for treatment received in France.
Case N°5 – I am immigrant in an irregular situation
You can get state medical assistance (AME = aide médicale d’état). It is intended to provide access to care for people in an irregular situation with regard to French regulations on residence in France. It is awarded under conditions of residence and resources.
→ What are the conditions that you must meet to benefit from it?
Justify your identity and those of your dependents by presenting one of the following supporting documents:
- Passport indicating your date of entry into France (be careful, remember to send a photocopy of all the pages of this document if you send your request by mail to your health insurance fund)
- National Identity Card
- Extract of birth certificate or family record book
- Copy of an old residence permit
- Any other document attesting to your identity or that of your dependents: for example, driving license, professional card (s) from your country of origin, student card (s), nominative document of the Ministry of Foreign Affairs.
→ How to apply for the AME (=aide médicale d’état – state medical aid) ?
In order to benefit from the AME, you must complete the form “State medical aid – admission request” (cerfa form n ° 50741 # 06) with the health insurance, on the Ameli site or on the Public Service website and send it, along with supporting documents, to the health insurance fund in your place of residence.
