Make sense of… France’s Puma health system

The idea behind France’s Puma system is that healthcare rights come automatically with right of residency.

This means the rights are not reliant on the user having paid into the system.

In practice, Puma mostly refers to the system of access to healthcare for those who have not built up any rights through social security cotisations via a salary or self-employed work.

It includes those who do not have an S1 form, usually held by EU state pensioners.

This group consists mainly of early retirees and state pensioners of non-EU states.

Those affected should apply to join their local Cpam state health reimbursements body by falling back on the right on residency grounds.

Dependent on their means, they may have to pay an annual fee, known as cotisation subsidiaire maladie (colloquially a “Puma cotisation”).

Despite Puma supposedly being “universal”, France has never moved unambiguously to allow early-retiree newcomers from other EU countries to join its reimbursements system.

Instead, it has ...

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