How the state system and reimbursements work

The French healthcare system is widely cited as one of the best in the world in terms of quality of care, affordability and accessibility.

France provides residents, including non-nationals, with universal healthcare coverage. Everyone registered under its national health insurance system is guaranteed healthcare that is either fully or partly funded. Any outstanding amounts are typically reimbursed by private health insurance policies, which are regulated and so remain affordable.

For some common aspects of care there is a part of the costs that is paid upfront and then reimbursed by the state and/or the patient's private insurance provider. This is not always the case – for example at pharmacies and for in-patient care in state hospitals, and there are arrangements for certain groups, including people on low incomes, to avoid upfront payment generally.

Even so, when it comes to medical costs, references to the amount that is remboursé (refunded) refer to the amount the state covers, whether or not you literally need to pay out and then get the money back.

State coverage includes five broad categories:

1. Hospital care in public or accredited private health establishments, including rehabilitation facilities, private psychiatric clinics etc. 
2. Community care provided by GPs, specialist doctors, dentists or midwives 
3. Diagnostic examinations prescribed by doctors and carried out by private medical analysis laboratories, as well as doctor-prescribed therapy by nurses, physiotherapists, speech therapists and other paramedical professionals 
4. Medically-prescribed drugs, medical devices and prosthetics included on national lists of reimbursable drugs and medical products 
5. Medical transport such as ambulance services when prescribed by a doctor

You can find a list of tariffs and reimbursement rates for doctor consultations and other medical acts. 

The first steps to getting into the healthcare system

Your Cpam (Caisse primaire d’assurance maladie – 'main sickness insurance payment fund') will in most cases be your local state health insurance body dealing with your health reimbursements.

That is unless you come under a special regime such as being a farmer, teacher or member of the armed forces, in which case a separate body will be responsible.

Your Cpam pays out your state reimbursements and operates at the level of geographic department. French people refer to obtaining a reimbursement from la Sécu (Sécurité Sociale).

The Cpam network has a useful website (in French), ameli.fr. The name stands for assurance maladie en ligne: online health insurance. Click at the top left under Assuré (the insured person: you). It includes details of how to contact your local Cpam. Click the menu and Contacter l'Assurance Maladie, then Un autre sujet. 

Creating a personal account on this site is helpful, for example to see details of recent reimbursements received, but you can only do so once you are registered in the French system.

There is also a Cpam helpline in French on 3646 and an English-speaking line on 09 74 75 36 46 which can assist if your French is limited and should be reliable for day-to-day information. Dial 0033 first if calling from outside of France. It operates Monday to Friday 8:30 to 17:30. There is also some, limited, information in English at tinyurl.com/cpam-engl.

When you come to France, one of your first steps should be to register with the local Cpam.

If you are a salaried worker your employer should assist with this. If you are self-employed, organising this will be part of the formalities when setting up your business to pay social charges. Most such workers are now covered by local Cpams – but as mentioned there are exceptions (farmers, for example, apply to the Mutualité sociale agricole).

Registration is not essential in the case of certain early-retirees who opt to rely on comprehensive private health cover; having said this, this group may also apply to Cpam on grounds of residency.

You can apply by sending this form in to your Cpam with any supporting documents listed on the second page.

If not working (and not an S1 form holder) you are in most cases asked to supply proof that you are a stable resident, such as energy or landline phone bills covering the last three months or, if you rent, the last three rent receipts.

Non-EU citizens moving over may need a private health insurance policy for the first year (see pages 20-29), depending on their status (eg. worker, UK – or other non-EU – state pensioner, early-retiree etc) while their Cpam cover is sorted out.

You will also require a photocopy of your passport and a copy of your birth certificate, which may be in English. Translations have sometimes been asked for, however the European Commission’s spokesman on social affairs said Regulation (EC) No 883/2004, article 76 (7) states that documents in other EU languages cannot be refused. English remains an official EU language despite Brexit.

You should give details of a French bank account and, if appropriate, a copy of your S1 form (keep the original). 

Once you have applied you will be sent a temporary French social security number in the post, followed by a document called the attestation de droits, which proves you are in the system. With these, you can already apply for reimbursements if you have out-of-pocket health expenses.