Paperwork
Carte Vitale & sécu: health insurance in France
France's state health insurance (sécurité sociale) covers 70–80% of healthcare costs and is mandatory for all residents. You can register with your local CPAM after 3 months of legal residence under PUMA — the green Carte Vitale card typically arrives within 2–4 weeks.
France’s healthcare system is consistently ranked among the world’s best — and navigating the insurance side is more straightforward than it looks once you understand the acronyms. This guide is written for newly arrived CIS expats living in or moving to the South of France.
What is sécu and why does it matter
Sécu is the informal name for sécurité sociale — France’s mandatory, universal, state-run health insurance. It reimburses a substantial share of doctor visits, hospital stays, tests, and medicines.
Reimbursement rates at a glance (2025–2026):
| Service | CPAM reference rate | Sécu reimburses |
|---|---|---|
| GP visit (médecin traitant, secteur 1) | €30 | ~70% = €19 |
| Hospitalisation | standard rate | ~80% |
| Psychiatrist / psychologist (secteur 1) | standard rate | 70% |
| Dentist (basic treatment) | standard rate | ~70% of base |
| Dentist (prosthetics) | standard rate | much lower |
Note: A fixed participation forfaitaire of €2 is deducted from every medical consultation — this co-payment is not reimbursed by sécu regardless of your coverage.
PUMA — who is eligible
Since 2016, France operates under PUMA (Protection Universelle Maladie), which ensures continuous health coverage for anyone who works or legally resides in France. You qualify if you:
- Work in France — affiliation through your employer, from day one of employment;
- Reside in France lawfully and stably — at least 3 months without a work contract.
For non-EU nationals, a valid titre de séjour is essential. If you hold a long-stay student visa (VLS-TS étudiant), use the dedicated portal etudiant-etranger.ameli.fr rather than the standard CPAM process.
EU citizens can use their EHIC card for short stays, but once you become a permanent resident you must register with CPAM — EHIC is not a substitute.
How to register with CPAM: documents and portal
Your registration goes through the CPAM (Caisse Primaire d’Assurance Maladie) for your area of residence. Find your local office and contact details at ameli.fr.
Documents required
- Identity document: valid passport, national ID card, or titre de séjour
- Proof of address (justificatif de domicile): utility bill, rent receipt — under 3 months old
- Proof of income for the past 12 months: pay slips, unemployment certificate, or tax assessment
- RIB (French bank account details) — for reimbursement transfers
- Birth certificate — certified translation by a sworn translator (traducteur assermenté accredited by the Cour d’Appel)
- If previously insured: attestation de radiation from your former insurer
How to apply
- Online via ameli.fr (create an account → “Mes démarches”)
- In person at your local CPAM office — booking ahead is recommended
- By post as a registered letter (recommandé avec accusé de réception)
Processing time: 1 to 3 months.
Your sécu number and interim certificate
Once your application is received, CPAM assigns you a NIA (Numéro d’Identification d’Attente) — a temporary 15-digit identifier. It starts with 7 or 8 (rather than 1 for men / 2 for women as for French nationals). You can receive reimbursements with this number, but you cannot yet open a full ameli.fr account or order a Carte Vitale.
Your permanent NIR is issued after INSEE verifies your civil-status documents — a process that can take several months.
While waiting, request an attestation de droits (certificate of insurance rights) from CPAM. It is accepted by all healthcare providers and can be downloaded instantly as a PDF from your ameli account once it is set up.
Carte Vitale — when will it arrive
The green chip card — the Carte Vitale — can only be ordered once you have a permanent NIR and an active ameli.fr account.
Timelines (2025–2026):
- Online application (ameli.fr or the Compte ameli app) — approximately 2 weeks
- Application by post — approximately 3 weeks
The card is completely free. Any request for payment is a scam.
The Carte Vitale mobile app on your smartphone is a digital alternative accepted by most healthcare providers.
Choosing your médecin traitant
Your médecin traitant is your declared primary care physician — the cornerstone of the French “parcours de soins coordonnés” system.
Why it matters:
- With a declared médecin traitant: CPAM reimburses 70% of a secteur 1 GP visit (€30 tariff)
- Without one, or when you bypass the system: reimbursement drops to 30%
How to declare one:
- Visit any general practitioner (généraliste) who accepts new patients
- The doctor completes the online declaration during your appointment via your Carte Vitale
- Alternatively, declare through your ameli.fr account by selecting the practitioner
Direct access without referral is allowed for: ophthalmologists, gynaecologists, psychiatrists, and dentists — these are statutory exceptions.
Finding a GP accepting new patients in Montpellier, Marseille, or Nice can take effort. Try Doctolib.fr and Maiia.com, and call surgeries directly — the community chat regularly shares working tips by city.
Mutuelle — do you need top-up insurance
Sécu provides a solid base but does not cover everything. A mutuelle (complémentaire santé) plugs the remaining ~30% gap.
Three main options:
1. Employer-provided mutuelle — mandatory by law since 2016. Employers must offer a group plan and cover at least 50% of the premium. An employee’s share typically runs from ~€8 to ~€35 per month depending on plan level (2025 figures).
2. Individual mutuelle — for the self-employed, unemployed, or anyone not covered by an employer plan. Costs range from €20 to €150+ per month depending on age and coverage level.
3. CSS (Complémentaire Santé Solidaire) — the state top-up for lower-income residents:
| Household size | Free CSS (annual income limit) | Subsidised CSS limit |
|---|---|---|
| 1 person | up to €10,339 | up to €13,957 |
| 2 people | up to €15,508 | up to €20,936 |
| 3 people | up to €18,609 | up to €25,123 |
Thresholds apply from 1 April 2025. Apply through ameli.fr or at your CPAM office.
The “Vibe Sud France” community chat is a practical resource for navigating French healthcare: members share which CPAMs are fastest, which GPs still accept new patients, and template letters for common situations.