How to benefit from the French social security as an international employee ?

The baguette (French typical bread) might not be the only cool thing to enjoy in France!

Indeed French healthcare system is considered as one of the best healthcare coverages. French might complain about it but they are very much attached to it as they know how lucky they are compare to the rest of the world.

In France you can see some of the best specialists, receive top treatments at an affordable cost or for free. Sometimes you won’t even have to advance a penny!

Which compared to certain countries where you must sometimes take a loan to afford a simple -and very necessary- surgical procedure might sound like medical heaven!

The whole system is a bit more complex even though it has been simplified through the years. You just got to France or planning to come and want to receive a heads up on how to handle such an important matter for you and your family?

Here are some tips to understand and walk your way through your future healthcare situation as an expatriate in France.

An overview of the healthcare system in France

Here is a summary of the different types of healthcare practitioners you will find in France and how to access them.

The network is pretty tight with the highest concentration of medical professionals in Paris. Of course if you live in a small village in the countryside, you might sometimes have more difficulties to access a doctor within a short period of time.

Who are the medical professionals?

• Most general practitioners (also called “family doctors”) have private offices. They are more and more often regrouped as an office of 2 or 3 doctors. Same for specialists, physical therapists, nurses (who usually perform both “at home” visits and “in office” appointments), dentists and radiologists.
• Outside of usual office hours, you can either call “at home” doctors who will visit you (it’s a bit more expensive but also reimbursed by the social security) or sometimes you can go to a “healthcare house” (“maison de santé”) where a doctor welcomes you after 8PM or on the weekends. In Paris, you can check out https://www.sosmedecins.fr/
• For serious and urgent matters, you should dial the 15 (ER ambulance service called SAMU) or the 18 (firefighter department) or go directly to an ER service.
• For specific procedure or surgery, you can either go to a public hospital or to a private clinic (which offerings such as beds, food, etc. might be nicer but also more expensive than in a public hospital).
• Pharmacies have regular store hours. Outside these hours, there is a list of “on duty” pharmacists that will provide you with the needed medicines. There are also a few pharmacies in Paris which are usually open 24/7 or late and on weekends.

Basic drugs such as aspirin or antidiarrheal pills for instance are usually available (in specific dosage) without a prescription. But most medicine such as antibiotics or strong painkillers will only be delivered with a prescription.

• In a public hospital, you can usually see a specialist for a public appointment or a private appointment. Public will be cheap, long –awaiting and very short time with the actual specialist. Private will be more expensive, faster to obtain and the doctor or professor will spend more time with you.
• You have to officially “declare” a doctor that will then become your usual doctor. It’s a document that your doctor will complete and sign for you. Otherwise you won’t get fully reimbursed by PUMA. Of course if he/she is on holiday or unavailable, you can go and see another doctor. You can also change of “usual doctor”.
• The down side of this great affordable system is that you might have to wait a couple of months to get an appointment with certain specialists -even in Paris. The most common delays are for dermatologists and gynecologists (and some ophthalmologists too) and you might also have to wait quite some time for certain types of exams such a MRI scan.

PUMA (incl. maternity leave, sickness leave, etc.)

This is how is being called the latest reform act put in place by the French government. PUMA is the French acronym for “Universal healthcare protection”.

It means your healthcare expenses will be taken care of as long you work and /or live in France on a regular basis. It does not matter anymore (it used to) if you lose your job, get divorced or move to another city.

If you are an expatriate living in France, you will be then covered by PUMA instead of your Medicare for instance (if you are American).

It also takes care of any sickness leave (where you will still receive most of your salary during your absence from the office) and maternity leave (16 weeks minimum but it can be more).

Once you are registered, you will receive a registration card (“carte vitale” which is the size of a credit card) with your name, photo and info on it. You will have to present it anytime you go to the doctor or the pharmacy.

The website that can give you most of the updates and information on your social security situation is https://www.ameli.fr/assure. There are a few English pages.

You can also talk to someone by calling their hotline. Just follow instructions from the website.

Health insurance

Even though the social security covers many expenses, you are strongly advised to subscribe to a health insurance contract that will cover some or all of the expenses PUMA does not cover or does not entirely reimbursed.

Your company has to offer you to subscribe to one. It is usually cheaper and more interesting in terms of advantages than an individual one because of course it was negotiated on a wider scale for all employees.

You usually will be able to put your entire family under the same contract.

So what does health insurance take care of?

For instance, an insurance will complete the small or big part of any expense reimbursed by the social security. It can be a couple of euros or much more if you are seeing a doctor with extra fees.

It will also cover expenses such as a single bedroom, optical or dental care and some “well-being” appointments such as osteopathy.

Once your contract is established, your health insurance will contact social security to settle a direct connection and documents transmission (“télétransmission”) between them so you don’t have to send anything twice and most of time you don’t have to advance anything neither.

A few extra things to know

• Some specific expenses are not covered or poorly reimbursed by social security –that’s why you will need a health insurance- for instance optical glasses. Some on the opposite are completely covered such as a flu shot.
• A “general” doctor will usually charge 25€, a specialist from 45€ and more.
• If you need to go and see a specialist, you need a letter from your usual doctor except for gynecologist, dentist, psychiatrist and ophthalmologist.
• Some doctors and clinics are allowed to apply a higher consulting fee (three different levels, 1, 2, 3). It’s a flexibility given to doctors but it is usually under careful watch from the social security to avoid any excess. It’s common (especially in Paris) but not THAT common so don’t worry, it’s not that difficult to find affordable and competent doctors. Your insurance will usually reimburse this additional fee anyhow. And you are absolutely allowed to ask for an estimate quotation to figure out how much will your insurance will cover and how much you will have to pay yourself.
• What’s “tiers payant”? « Tiers payant » is a system that will pay directly a medical professional so you don’t have to advance any money except the health insurance part (but in your pharmacy for instance, they usually record your health insurance details as well to get paid by them directly too so you don’t have to advance anything).

• What’s “100%”? It refers to certain cases of long-term diseases (ALD) such as cancers, certain mental issues, diabetes, etc. In these established cases, social security will cover all expenses (“100 %”) related to that disease. It will be notified on your profile and on your “carte vitale”.
• Generic drugs. Social security has requested doctors and pharmacists to prescribe and deliver more and more generic drugs when available (because they cost less). You can refuse but if you don’t really have a specific reason, pharmacists might give you a bit of a hard time.

How to apply to the French social security

Depending on your country, your status, there might be slight differences, so this is how it goes down:

Are you eligible?

The real question is: are you eligible to PUMA?

You are if:

• You have been a resident in France for at least three months
• You are an employed worker of a French company
• You are 16 years old or younger (no matter how long you have been here)

If you are a foreign student in France so supposedly staying temporarily:

• If you come from Europe, you should be covered by the social security system from your country.
• If you come from Quebec and Andorra you are covered by the conventions established between France and your country.
• If you are a foreign student outside of the EEE (European Economical Era) and Switzerland, then you are covered by PUMA immediately.

How much will it cost you?

• As an employee in a French company, the contribution to the financing of the French social security is paid partly by your employee, partly by yourself. But the amount is deducted and taken before you receive your pay check -which is a net amount. That’s why when you negotiate your salary, you always need to make sure to know if you are talking about a gross or a net salary.
• Health insurance: For all the reasons explained above, it is strongly recommended to subscribe to a health insurance contract (called mutuelle or complémentaire santé in French). Cost usually varies from 20€ to 120€ a month.

NB: low income don’t pay anything as they are eligible to free state-funded healthcare.

Things to do/ documents to supply

There will be forms for you to complete in and documents to provide to get affiliated. All certified copies and documents to provide are listed at the end of the form below.

In all cases, you must provide your bank details for you to get reimbursed and a copy of your passport or any other ID.

If you are working in France, you must provide documents like copy of your work contract or your salary sheet.

• If you are a French resident, you must provide anything that can prove this such as housing renting contract, visa and/or residence permit.

https://www.ameli.fr/sites/default/files/formualires/168/736.cnamts.pdf

• If you want to register your kids, you will have to provide a birth certificate and a copy of your family record book or something equivalent and fill the following document:

https://www.ameli.fr/sites/default/files/formulaires/175/s3705_puma_version_ameli_remp.pdf

Go and check on Ameli as documents can change from year to year.

You can also ask your HR department to help you in this task !