How do early-retirees enter the system?

Initial permission for a non-EU national to live in France is, among other issues, conditional on them having enough money to support themselves – around the level of France’s minimum wage (€1,426 a month net) – and to not be a burden on the state.

Once a legal resident of France with a visa – and later a residency card – the person can join the French system on the basis of residency. This right is known as Puma, which stands for Protection universelle maladie.

For many people this costs nothing but an annual fee can be payable for some.

If you are a national of an EU country and move to France certain rules apply based on EU free movement. Obviously this no longer applies to UK nationals.

These regulations do not oblige France to allow long-term residence (more than three months) to so-called ‘inactive’ people (non workers) who could become a burden on the social security system and who have built up no healthcare rights in France, such as through work.

Under France’s current Puma system, however, if residency is established after three months of continuous stay, it becomes possible to access the healthcare system on this basis and this applies to EU and non-EU citizens.

Retirees with a UK or EU (but not French) state pension are not concerned as their rights are secured via an S1. If you or your spouse are UK or EU citizens and reach state pension age, you will move to the S1 system unless you also have rights via a French pension.

Joining Puma is up to your own initiative if you are an early-retiree moving to France. You should, however, be able to demonstrate that you have made France your home with a permanent address, three months of utility bills in your name etc.

The right to belong to Puma, once obtained, continues indefinitely and future contribution levels, if relevant, are checked by reference to income tax returns (all long-term residents of France must make annual declarations to the tax authorities).

Prior to the Puma system being put into place in 2016, and also for some time afterwards as the system was finalised, there was doubt as to the automatic right of early-retirees to join the scheme. There was discretion as to whether or not their applications would be accepted, based on factors such as whether they had suffered unexpected changes in life situation and income since coming to France. 

They were previously encouraged to take out a comprehensive private health insurance policy instead.

Some early retirees, for example those with large investment and property incomes who may pay a high ‘Puma’ fee, still look at the option of staying long-term on a comprehensive private policy, as opposed to limiting this to the year of moving over while they get into the French system.

We are not aware of any private policies that are designed to exactly replicate the French state cover and cover varies according to what you pay for, from ‘hospital only’ policies to ones covering community-based care with doctors, medicines etc as well.

Some also offer additional benefits such as insurance while travelling in other parts of the world.

However, according to Urssaf, the body responsible for collecting Puma payments and other social contributions, if someone qualifies to join Puma by virtue of being a stable long-term resident, then they can, if their income makes them eligible, become liable for a Puma fee even if they do not register to join the French system.

The Connexion has not heard reports of readers being affected by this but we did speak to one well-off recent arrival who reluctantly joined his local Cpam health insurance body after receiving advice from a tax lawyer that this may be the case.

Puma applications should be made (to a local Cpam) by people who have lived in France for three months, said an expert from Cleiss, the European social security advisory body.

The European Commission says that local health authorities (Cpams) do not have to allow applications in English or to supply English-speaking help. However, it states that French bodies may not refuse documents such as birth certificates in another EU language for health and social security issues. English continues to be an official EU language despite Brexit – it is one of the official languages of Ireland and Malta. 

If a Cpam requires a document in French it may ask Cleiss to provide the translation.