Health cover in France has two layers. The public layer is the Protection universelle maladie (PUMa), run by the Assurance maladie: if you work in France, you are covered as soon as your local health insurance office (CPAM) accepts your application. You then receive a social security number and can order your carte Vitale, the free green card that lets doctors bill the system directly. The second layer is the mutuelle, a top-up insurance that pays most of what the public system leaves. Every private employer must offer one and pay at least half of it. With both, most routine care costs you only small fixed charges.
This guide explains PUMa, how to get a carte Vitale step by step, how the company mutuelle works, what you pay at the doctor, and when private expat health insurance makes sense. Facts come from Service-Public, checked in October 2026.
PUMa: the public health cover
PUMa (protection universelle maladie) is the name for the right to public health cover. Its rules, from Service-Public:
- Two conditions: you must work or live in France in a stable and regular way.
- Regular: EEA and Swiss citizens only need an ID card or passport. Others need a residence permit or another accepted document (list of accepted documents).
- If you work: you are covered as soon as your application is accepted. There is no waiting period.
- If you don’t work (for example a partner who moves with you): rights open after 3 months of stable residence, and you must live in France at least 6 months a year to keep them.
- Every adult is insured in their own name from age 18. Children are attached to a parent.
The new contribution for non-working residents
The 2026 social security financing law (LFSS) created a contribution for PUMa beneficiaries who don’t work and don’t pay CSG or health contributions. Service-Public says the amount will be set by a decree that hadn’t been published when the page was last checked in May 2026. If your partner won’t work in France, check the Service-Public page for updates.
How to get a carte Vitale
Step 1: register with the CPAM
As a new employee from abroad, you give your employer your social security number or, if you don’t have one yet, a temporary number. To get one, you contact the CPAM for your address with (Service-Public):
- your passport or residence permit;
- a civil status document, such as a full copy of your birth certificate showing your parents’ names;
- a French translation of that document, unless it comes from an EEA country or Switzerland or an agreement exempts you.
Service-Public also lists the form “Demander l’ouverture des droits à l’Assurance maladie” for opening your rights (F34308). Many employers’ HR teams help with this step; ask yours.
Step 2: temporary number, then permanent number
If your documents are complete, the CPAM issues a temporary identification number, and the national pension fund then checks your civil status and gives you a permanent social security number. If only your ID is accepted, you get the temporary number and have 3 months to send the missing civil status document. If you still haven’t sent it after a second 3-month period, your benefits can be suspended.
The birth certificate is the most common cause of delay. Bring a recent full copy and, if needed, a sworn translation, so you don’t lose months.
Step 3: order the card
Once you have your permanent number, order the carte Vitale online from your ameli account or the Compte ameli app, or by post with the “Ma nouvelle carte Vitale” form. It takes about 2 weeks online and 3 weeks by post, and the card is free (Service-Public).
How long does it take to get a carte Vitale?
The card itself arrives 2 to 3 weeks after you order it. The real wait is for the permanent social security number, which depends on how quickly your civil status documents are accepted. Until then, ask your CPAM how to claim for care you pay for, and keep every receipt and paper claim form (feuille de soins) from your doctor.
The carte Vitale app
The carte Vitale app has been available across France since November 2025 and is free on iOS and Android. You can activate it with the France Identité app if you have a French electronic ID card, or, without one, with your ameli account (you must be over 16 and your fund must offer the app), including by a video check of your ID and face. Not all health professionals accept the app yet, so keep the physical card (Service-Public).
Lost carte Vitale
Declare the loss or theft in your ameli account, by phone on 3646, or at your CPAM, then order a new card. It arrives within 2 to 3 weeks. Replacements are free up to 3 times a year for the physical card.
Choose a GP (médecin traitant)
Declare a regular doctor, your médecin traitant. The doctor makes the declaration online with your carte Vitale during a visit, and you can change at any time (Service-Public). If you see doctors without one, you are reimbursed less. You can still see a dentist, midwife or optician directly, and a gynaecologist, ophthalmologist or psychiatrist directly as long as you have declared a GP.
What a GP visit costs you
For a standard GP in “sector 1” (no extra fees), the consultation costs €30 (Service-Public, figures last checked December 2024):
| With your declared GP | Without a declared GP | |
|---|---|---|
| Consultation fee | €30 | €30 |
| Reimbursed by Assurance maladie | €19 (70%, minus €2) | €7 (30%, minus €2) |
| Left for you or your mutuelle | €11 | €23 |
The €2 is the participation forfaitaire, a fixed charge on each consultation that no mutuelle can repay, capped at €70 a year. There are also small charges of €1 per box of medicine and €1 per paramedical act, with a separate cap of €70 a year (Service-Public). The rest (the ticket modérateur) is what your mutuelle covers.
The mutuelle (top-up health insurance)
Your employer’s mutuelle
Every private employer must offer top-up health cover to all employees, from the first day, and pay at least 50% of the premium (Service-Public). The contract must at least cover:
- the full ticket modérateur on care reimbursed by the Assurance maladie, with a few exceptions;
- the full daily hospital charge (forfait journalier) for hospital stays;
- dental prostheses and orthodontics up to 125% of the official rate;
- glasses every 2 years (every year for children or when your sight changes), with at least €100 for simple lenses and €150 to €200 for complex ones.
Plans vary a lot above this minimum. Ask HR for the table of guarantees (tableau de garanties) and whether your partner and children can join, and at what cost.
Can you refuse the company mutuelle?
Only in specific cases (Service-Public), for example:
- you are already covered as a dependant on your spouse’s or partner’s mandatory company plan;
- you already have an individual contract, until it expires;
- you are on a short fixed-term contract (3 months or less) or work 15 hours a week or less;
- you receive the complémentaire santé solidaire.
In most cases, joining is simply the best deal because your employer pays half or more.
Health insurance for expats in France
Do you need private expat health insurance?
If you are employed in France, PUMa plus the company mutuelle is usually enough, and you don’t need a separate expat policy. Private international cover can still help in some situations:
- The first weeks, before your rights are open, if you want to avoid paying costs yourself and claiming later.
- A partner who doesn’t work, during the first 3 months before their PUMa rights open.
- Frequent travel outside Europe or care abroad, which the French system covers only in limited cases.
- Visa applications where the consulate asks for proof of health insurance for the first period of stay. Check the visa requirements for your permit.
Compare what a policy really adds to PUMa and your mutuelle before paying for it.
EU citizens
If you are an EU, EEA or Swiss citizen working in France, you are insured in France like everyone else. For short trips back home or around Europe, ask your health insurance fund for the European Health Insurance Card (carte européenne d’assurance maladie, CEAM) (Service-Public).
Your first month checklist
- Give HR your passport, permit, and birth certificate with translation; ask whether HR registers you with the CPAM or whether you should do it.
- Join the company mutuelle and add your family if they are covered.
- Create your ameli account as soon as you have a number.
- Order your carte Vitale once you have a permanent number, and activate the app.
- Declare a médecin traitant at your first GP visit.
Our relocation checklist puts these steps alongside housing, banking and tax. If you are still looking for a job with relocation help, see visa sponsorship jobs and jobs you can apply for from abroad, and our guide to French CVs and interviews.
Frequently asked questions
What is PUMa in France?
PUMa (protection universelle maladie) is France’s universal public health cover. Anyone who works, or lives stably and regularly, in France is covered. Workers are covered as soon as their application is accepted; people who don’t work wait 3 months.
How do I get a carte Vitale?
Register with the CPAM for your address with your passport or permit and a birth certificate (with a French translation if needed). Once you have a permanent social security number, order the card online from your ameli account. It is free and arrives in about 2 weeks.
How long does it take to get a carte Vitale?
About 2 weeks after an online order, or 3 weeks by post. Before that you need a permanent social security number, which can take longer if your civil status documents are incomplete.
Is a mutuelle mandatory in France?
Your employer must offer one and pay at least half, and as an employee you must join unless you are in one of the exemption cases, such as already being covered by a partner’s mandatory plan.
Do I need expat health insurance if I work in France?
Usually not. As an employee you have public cover through PUMa and top-up cover through your company mutuelle. Private expat insurance can still be useful for the first weeks, for a partner who doesn’t work, or for frequent travel outside Europe.
What is the carte Vitale app?
A free phone app that replaces the physical card at health professionals who accept it. It has been available everywhere in France since November 2025, but not every professional accepts it yet, so keep your physical card.
This guide is general information, not medical, legal or insurance advice. Rules and amounts change; check Service-Public and ameli.fr for your situation.