Registering with the state health insurance system or “sécurité sociale

If you have stable employment or residence in France, you are entitled to cover for your health costs throughout your life. The state health insurance system is called the “Protection universelle maladie (PUMA)”, also known as the “sécurité sociale”.

Verified by Comede on 29/11/2023

What is involved?

Protection universelle maladie (Puma)”, also known as “sécurité sociale”, covers part of your medical expenses.

Most of the time, you have to pay your medical expenses first, then you receive a reimbursement in your bank account.

It does not cover 100% of medical costs. The amount reimbursed depends on the treatment you receive. A full list of reimbursement rates is available here.

It is recommended to have a private health insurance policy known as a “mutuelle” to get reimbursed for part or all of the amount not covered by the state system. If your income is too low to pay for a “mutuelle”, you can request additional state healthcare insurance or “Complémentaire santé solidaire (CSS)”.


If you do not have valid residency rights, you can request “ Aide médicale d’Etat (AME)” under certain conditions.

The procedure

  • Normally, your employer will contact the organisation that manages your health insurance entitlements, known as the “caisse d’assurance maladie”, to allocate your entitlements. You can check with them to see if these steps have been taken.

  • You must complete the application form for entitlements to health insurance, known as “sécurité sociale”, and send it to the organisation that manages your entitlements, known as the “caisse d’assurance maladie”.

    • If you do not know what your “caisse d’assurance maladie” is, you can contact a “Caisse Primaire d’Assurance Maladie (CPAM)” near you to find out more. Contact details can be found on this site.
    • Attach the required documents to your application:
      • proof of your residency rights, such as a photocopy of your valid residence permit or “titre de séjour”, or your “attestation” of application for asylum
      • any document proving the stability of your residence in France if you do not work, for example rent receipts, gas or electricity bills, or a letter from the person hosting you, known as an accommodation certificate or “attestation d’hébergement
      • your bank account certificate or “relevé d’identité bancaire (RIB)”, with the IBAN number so you can receive your reimbursements straight to your bank account
      • if possible, your tax notice
      • if possible, a full copy of your birth certificate or an extract of your birth certificate with parentage, or an equivalent document obtained by the consulate of your country in France. If you are a political refugee in France, you must not contact the authorities of your country of origin.
    • Keep a copy of your application or take a photo of it before sending it.
    • Send the letter by registered post with recorded delivery or “lettre recommandée avec accusé de réception”, which is the only way to prove your letter has been received. Keep the receipt or “preuve de dépôt” as proof of postage.

After the application

Processing times may vary. If you have not heard anything two months after you sent your application, contact your “caisse d’assurance maladie” for an update.

Once your application has been accepted, you will receive a document confirming your healthcare rights called a “attestation d’ouverture de droits”. This document will specify your unique social security number or “numéro de sécurité sociale”.

The letter will also include the form: “Ma nouvelle carte vitale”.

  • The "carte vitale" is a healthcare card that contains all the information you need to be reimbursed for your healthcare costs. It is recommended that you apply for one.
  • While you are waiting to receive this card, you can get your health expenses reimbursed by presenting the certificate of your entitlements or “attestation d’ouverture de droits” sent by your “caisse d’assurance maladie”.
  • Once you have received your “carte vitale”, you need to activate it by going to a pharmacy and asking them to complete an update or “mise à jour”.
  • You have to present your “carte vitale” at your medical appointments and at the pharmacy to get your healthcare expenses reimbursed.

Find support

In France, there are many services that can support you, give you advice, and assist you with procedures and paperwork. Most of them are free of charge.

  • Comede” is an organisation that helps immigrants and refugees to have access to health care.

    • These services are free of charge.
    • They can assist you to access healthcare and help you with your paperwork, in particular via their telephone service.
    • Languages available: interpretation possible in all languages.
    • Contact: by phone.
  • The "PIMMS Médiation" are organisations that inform, guide or support in administrative procedures in many areas: access to public services, access to health care, applications for state financial assistance, tax declarations, declarations to “France Travail”, etc.

    • This service is free of charge.

    • Languages available: mainly French.

    • Contact: you can find a “PIMMS Médiation” near you in this directory.

  • Social workers or “travailleurs sociaux” and “assistants sociaux” are professionals who support people in their administrative procedures and help them find solutions according to the difficulties they are faced with.

    • These services are free of charge.
    • You can make an appointment to receive personalised advice according to your situation and help you with the next steps, for example: applications for state financial assistance, applications for social housing, registration with the French unemployment office “France Travail”, etc.
    • Available languages: mainly French.
    • Contact: you can request an appointment with a “travailleur social” with:

While the utmost care has gone into providing you with the most accurate and up to date information, this page is not intended to replace legal or professional advice. Laws and procedures change regularly so it is important to consult qualified professionals.

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