What is letter from French health insurance about ‘franchise’ payments?
Everyone in the healthcare system must pay solidarity fees for appointments and medicines
Annual fees help to finance the healthcare system
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Reader Question: I received a letter from my Cpam asking for €50 for ‘franchise’ and ‘participation forfaitaire’ payments. I have 100% cover with Cpam due to a long-term health condition. The letter appears genuine so I am confused.
You are correct that this is a legitimate letter from the health services and does not contain incorrect information.
These are two solidarity payments that are levied to help fund France’s healthcare system.
They are deducted from reimbursements paid out from the state insurer (Assurance Maladie), and make up a small portion of an overall bill.
The franchise médicale is deducted from the cost of medicines, care from professionals such as nurses or physiotherapists, and the cost of hospital transportation, at a rate of €1 for medicines and care and €4 per transport journey.
The participation forfaitaire is a flat €2 rate deducted from reimbursements for medical appointments.
You say you are fully covered for 100% of costs by state healthcare because you have a long-term illness (Affection Longue Durée, or ALD).
Read more: French carte Vitale must now be presented at pharmacy to receive certain medicines
How a mutuelle works
As a reminder, most people only receive up to 70% of their costs reimbursed, with the rest coming from a top-up mutuelle bought privately or provided by their employer).
However, this coverage does not exclude people from payments of the franchise médicale or participation forfaitaire.
There is a maximum €50 limit for both of these – separately – meaning the total bill can reach up to €100 per year.
This limit is in place for all people, whether they only have normal (70%) or full-coverage through Assurance Maladie.
New plans in the 2026 budget may see maximum thresholds for the bill increase.
How to make payments?
Assurance Maladie states that payments can be made online, or via bank transfer or cheque.
If you benefit from making no upfront payments for your healthcare, then you have to pay these levies separately.
People who make upfront payments and then receive a reimbursement will instead have the amounts taken off their reimbursements.
