Puma: France’s universal healthcare scheme

The state health reimbursement system as we know it today, providing universal medical coverage to almost all residents, has actually only been in place since 2016. Previously, access to healthcare was generally more closely linked to having contributed to the French social security system and access for early-retirees moving to France, notably, was a grey area.

Puma, the system that was implemented in 2016, stands for Protection universelle maladie; and guarantees universal healthcare coverage for all people residing legally in France. This includes nationals and non-nationals alike.

Conditions to access Puma

The main aim of the Puma system is to ensure that residents are able to maintain uninterrupted access to healthcare services and beneficiaries continue to be issued their medical reimbursements without pause in the event of life-changing circumstances, whether loss of a job, loss of home, drop in income, divorce, illness etc. 

Prior to the implementation of Puma, such events could lead to interruptions in coverage. Since 2016, however, this is no longer the case, and all beneficiaries are covered uniformly under Puma. The same protection extends to all legal residents living in France.

Who qualifies?

To qualify for Puma, you must have resided legally in France in a stable and uninterrupted manner for more than three months. You must be able to prove this with, for example, electricity bills (see the form link later for more examples of what is acceptable). 

People who are legally authorised to work in France and are salaried employees are automatically eligible. The universal healthcare protection provided by the Puma regime assures eligible beneficiaries the right to coverage for their healthcare expenses on a personal basis and continuously while they remain residents of France. 

Generally, Puma rights expire when a person ceases to be a resident and moves abroad or six months after the expiry of a person’s residency status, for example starting with the expiry date listed on a foreign resident’s residency permit if the permit has not been renewed. 

Individuals who live legally in France but are not actively employed, fill out a form to apply: Cerfa n° 15763*02. Salaried employees are not required to take this step as it is for employers to declare employees’ entitlements to the authorities.

Puma for young people

Minors are automatically entitled to healthcare coverage but in practice, they are typically registered under the name of a parent or legal guardian. It is, however, possible to apply for Puma on an individual basis as early as 16. All eligible minors are automatically registered as individual beneficiaries upon reaching the age of majority at 18. 

This means that they can open their own online Ameli healthcare account and provide their banking information so as to receive any reimbursements directly. Note that under Puma, all non-working resident adults are entitled to healthcare coverage in the same way as salaried employees who make regular contributions to social security. 

The previous system whereby some people registered for their healthcare as the dependent of a registered beneficiary has been lifted.

Contacting Urssaf to pay a fee

People eligible to pay a fee for their Puma coverage (mostly early-retirees) can contact Urssaf, the body responsible for collecting such fees, to make a payment. 

They can also ask to review their Puma record regarding tax liability, contribution amounts, payment difficulties etc. To do this you can call 08 06 804 267 or visit this website. You can also have an account on this website. 

To activate such an account first-time users will need to provide their 15-digit social security number as well as a temporary code that will be provided in the first assessment notice sent regarding payment of the fee.

Useful to know

If you have recently moved to France and joined your local Cpam you will have submitted documents to demonstrate your eligibility to healthcare. More information will be required in the case of any changes in personal circumstances that may impact your status as a beneficiary or the level of reimbursements. 

Examples include the birth of a child, changes in employment or income, work-related accidents or occupational diseases, disability, a new address or bank account or a change of GP. To find out more about how to update your Cpam, visit the Ameli website and in the main menu on the left click Contacter l’assurance maladie and then Un changement de situation.

The universal healthcare protection provided under the Puma system guarantees eligible beneficiaries the right to personal and continuous coverage of their healthcare expenses as long as they remain residents of France.

In general, Puma rights end when a person stops being a resident and moves abroad, or six months after their residency status expires. For example, this may begin from the expiry date shown on a foreign resident’s permit if it is not renewed.

People who live legally in France but are not working must fill in an application form: Cerfa n° 15763*02.

Salaried employees do not need to complete this form, as employers are responsible for declaring their employees’ healthcare rights to the authorities.

The Puma tax: who pays this – and how much?

The Puma system is financed through mandatory social security contributions, which are essentially government taxes levied on beneficiaries’ income. All salaried employees in France contribute a part of their income to cover healthcare. It is for employers to collect these charges from workers’ salaries each month so the sums are automatically deducted before salaries are paid out.

Who must pay a fee? 

Workers with small wages but large investment incomes and early-retirees may be eligible to pay the Puma fee if they earn ‘capital’ income over a threshold set annually by the government. This is calculated in relation to an annual figure called the PASS (plafond de la sécurité sociale), which is €47,100 as of 2025 (it was €46,368 in 2024). 

Examples of capital income include property income from rents and non-professional furnished letting, income from shares and bank accounts, capital gains from the sale of property, and certain other rights that bring in income and are not directly linked to work. Retirement pensions, declared as such in your French income tax declaration, are not concerned.

The Puma tax is officially called the cotisation subsidiaire maladie and it is collected by Urssaf (Unions de recouvrement des cotisations de sécurité sociale et d’allocations familiales). The amount of the contribution is calculated on the basis of a person’s previous year’s income tax return, ending December 31.

How is the sum calculated? 

Urssaf considers tax filings individually and, where applicable, calculates the contribution for each individual member within the household. People who were living in France in 2024 and who earned work income of less than 20% of the PASS (equivalent to €9,420) but who collected capital income, may be liable to the Puma fee and may expect a notice of assessment from Urssaf in November 2025. 

Many people will however have nothing to pay as there is an allowance against the first €23,550 of capital income. This corresponds to 50% of the PASS. 

The basis on which the fee is levied (total amount of taxable capital income) is also capped at eight times the PASS (€376,800 in 2025), meaning the fee can rise as a percentage of sums up to that amount of capital income, but not beyond. The tax rate levied on eligible incomes after the allowance is 6.5%. Officials can also factor in lifestyle if it appears luxurious when calculating the amount on which the 6.5% is levied.

Where both members of a couple are eligible to be assessed for a fee, the €23,550 is applied individually to each member’s part of relevant household income. Each part is calculated at 50% if a more precise share-out is not clear. Those with only a low level of work income from part-time work – but substantial income from non-work sources – have to pay a Puma cotisation on their capital income at reduced percentage rates, on a sliding (reducing) scale up to work earnings of €9,420/year at which point there is nothing to pay. Payments can be made online via your personal space at the Puma website if you create one or otherwise by cheque or bank transfer.

Who is exempt?

Several groups are exempted including registered unemployed people, state pensioners and students. People on low incomes are exempt generally in view of the high allowance that is made against income. This will be determined by Urssaf upon examining income declarations from the previous year. 

People who have received a disability pension from France during the year for which their contribution was due are not liable for the Puma tax, in the same way as retirees who received a government pension. These groups are not required to take any specific steps.

Since the system is still fairly new, people from exempted groups have sometimes wrongly been served with notices to pay, in past years. If you have been asked to pay and believe you are exempt you should contact Urssaf to clarify the situation.