A new look at how 'Puma' healthcare changes affect expats

Universal reimbursements system seems to retain similar principles to old CMU

This year saw a change to French healthcare with the replacement of the former universal reimbursement system (‘CMU’) under which family members could be dependent (‘ayants droit’) on someone in the system by the new Protection Universelle Maladie (Puma) where everyone has their own individual healthcare rights determined by residence.
We look at the change and how you may be affected.

What is Puma?
Puma is the name for the new ‘universal’ French health reimbursements system which came in at the start of 2016. It is concerned with an individual right to healthcare based on residence in France. Previously health rights were considered primarily a right derived from having paid into the system (sécurité sociale) via cotisation payments on work income or a right you held via being ‘attached to’ someone else as their dependant (ayant droit, meaning ‘having the right’).

Questions were raised when the changes were announced a year ago as to whether expats’ rights would be affected, for better or worse, by the change but, so far, this does not appear to be the case in either direction for most people.

A spokeswoman for the Direction de la Sécurité Sociale (DSS, the government branch in charge of social security) told Connexion at the time that it would not deprive anyone who is already in the system in their own right, of their entitlements, and that dependants would keep their rights if they were stable, legal residents.

State healthcare reimbursements website ameli.com also states “if you are an adult ayant droit of an insured person you will continue to benefit from healthcare cover without any change.”

This policy change follows years of controversy over the healthcare rights of non-working (early-retiree) EU citizens who moved to France, known as ‘inactives.’

They were considered to pose a problem because they had no healthcare rights from previous work in France and were not able to benefit from the European S1 form system through ...

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