How does universal health coverage work in France?
Residents pay a portion of healthcare costs upfront for certain services, though they are reimbursed either by the state or by their private insurance providers.
The Protection Universelle Maladie (Puma) system provides universal healthcare coverage to all legal residents in France
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France's healthcare system is renowned globally for its high quality, accessibility, and affordability.
The country offers universal health coverage to all residents, including non-nationals, through a comprehensive national health insurance scheme.
This system ensures that everyone’s healthcare coverage is guaranteed to be either fully or partially funded, with private health insurance covering any remaining costs.
These private policies are regulated to remain affordable while ensuring that care is accessible to all.
Key features of the French healthcare system
Under France’s universal healthcare system, residents pay a portion of healthcare costs upfront for certain services, though they are reimbursed either by the state or by their private insurance providers.
Some services, like medication from pharmacies or inpatient care at state hospitals, are fully covered, so no upfront payment is required.
The state’s reimbursement system ensures that the costs of various medical services are partially or fully covered, depending on the service. These covered services fall into five broad categories:
Hospital Care: This includes treatment at public or accredited private health establishments, including rehabilitation and psychiatric care.
Community Care: Services from general practitioners (GPs), specialist doctors, dentists, and midwives.
Diagnostic Tests and Therapy: Prescribed medical tests in private laboratories and doctor-prescribed therapy services like physiotherapy and speech therapy
Medications and Medical Devices: Includes reimbursable drugs, medical devices, and prosthetics listed by the national health system.
Medical Transport: Ambulance services and other prescribed transportation are also covered.
Puma: France's universal health insurance system
Since 2016, the Protection Universelle Maladie (Puma) system has provided universal healthcare coverage to all legal residents in France, including nationals and non-nationals.
Before Puma, healthcare access depended on employment status and contributions to the French social security system, which sometimes created gaps in coverage, especially for early retirees or those facing life changes.
With Puma, residents are guaranteed uninterrupted access to healthcare, even in situations like job loss, divorce, or a decline in income.
This system aims to ensure continuous healthcare coverage for everyone, regardless of life circumstances.
Eligibility for Puma coverage
To qualify for Puma coverage, you must meet the following criteria:
Legal residency: You must have lived in France for more than three months and can prove your residence through documents like utility bills.
Employment: Employees who work in France and contribute to social security are automatically eligible for Puma.
Non-Working Residents: Those who do not work can apply individually for Puma using a specific form (Cerfa n° 15763*02).
Puma coverage continues as long as you remain a legal resident in France. Coverage ends if you leave the country or if your residency permit expires and is not renewed.
Special provisions for minors
Minors in France automatically receive healthcare coverage but are generally registered under the account of their parent or guardian.
At 16, minors can apply for individual coverage under Puma, and once they reach adulthood at 18, they are registered as independent beneficiaries.
This means they can manage their healthcare account and receive reimbursements directly.
How to make payments for Puma coverage
Some residents, particularly early retirees, may need to pay a fee for their Puma coverage.
To do so, they can contact Urssaf, the French agency responsible for collecting social security payments.
The Urssaf website allows users to manage their contributions, check their payment status, and resolve issues like tax liabilities or payment difficulties.
New users can create an account on the Urssaf website by providing their social security number and a temporary code from their first assessment notice.
