The French health care system
The Assurance Maladie/CPAM (Health insurance) is the organization providing the partial healthcare reimbursement. Since 2019, every student must be affiliate to the general CPAM scheme. It is a mandatory and free procedure.
In France, healthcare expenses are divided in 3 parts:
- The mandatory portion (part obligatoire), covered by the CPAM
- The fixed contribution (part forfaitaire), paid by all
- The additional portion (part complémentaire), reimbursed by your mutual health insurance if you have one
The tiers payant is the mandatory portion covered by the CPAM.
Health costs depend on your doctor. They are 2 sectors.
Sector 1 physicians apply a pre-determined flat rate and do not charge additional fees.
Example: 25€ visit to a general practitioner.
- 16,50€ of mandatory portion (covered by the CPAM)
- 7,50€ of additional portion (reimbursed if you have a mutual health insurance)
- 1€ of fixed contribution (paid by all)
- So the visit will cost you between 8,50€ (without mutual health insurance) or 1€ (with mutual health insurance)
Sector 2 physicians, general or specialist, are allowed to charge additional fees that are not covered by the CPAM. Costs are different, so are the reimbursed/paid portions.
Example: Visit with 7€ additional fee
- 15,10€ of mandatory portion (covered by the CPAM)
- 6,50€ of additional portion (at your costs)
- 1€ of fixed contribution (at your costs)
- 7€ of additional fee (at your costs)
- So the visit will cost you 14,50€
The treating physician (médecin traitant)
He/She is the doctor (generalist or specialist, from sector 1 or 2) who freely choose and report to the CPAM with his/her agreement. He/She manages your medical records and coordinates your care pathway.
Choosing a treating physician allows you to receive better reimbursement.
If you do not choose one, the amount of reimbursement will be less important.
Example: A 25€ visit
- 6,50€ of mandatory portion, covered by the CPAM
- 1€ of fixed contribution, at your costs
- 17,50€ of co-payment, at your costs
- So 18,50€ at your cost instead of 8,50€ (without mutual health insurance) or 1€ (with mutual health insurance) with a treating physician
Enrolment for the Assurance Maladie (Health insurance) - Mandatory and free
Enrolment for Health Insurance is mandatory and free of charge.
You can enrol as soon as you are present in France and have your final certificate of enrolment at UCLy.
It can take up to 2 months for your application to be processed and your documents verified.
Therefore, we advise you to take out a private health insurance before your departure in order to be covered during the first weeks of your stay in France.
The enrolment for the Assurance Maladie means your health costs will be covered during your studies.
Before you arrive in France, make sure you have the following documents in digital format:
- Evidence of civil status: birth certificate. Make sure you don’t crop the document (stamp and header must be visible) + official translation in French
- Evidence of identity: passport
- Valid student visa
Particular case: For students from Quebec, it is not necessary to follow this procedure. Before your arrival, you must obtain a form provided by the Régie de l’Assurance Maladie du Québec (RAMQ). This form certifies that you are insured under the Quebec social security system. You can then benefit from the reimbursement of your health care expenses in France by submitting this form to the CPAM of your place of residence.
Prepare the supporting documents (preferably PDF version):
- Valid student visa or residence permit
- Full copy of your birth certificate or excerpt of your birth certificate with parentage drawn by your Consulate
- Certificate of enrolment
- IBAN of your current account (saving account is not valid)
Additional made be asked according to your country of origin.
How to enrol for the Assurance Maladie ?
- Go on www.etudiant-etranger.ameli.fr.
- Fill the mandatory information (last name, first name etc.) and submit the supporting documents (passport, visa/residence permit, certificate of enrolment etc.).
- Once you created your personal account, you will receive your French social security number (NIR). You can also download your certificate of affiliation to Social Security while your Vitale card is sent via post mail.
Once your enrolment is complete, please follow these steps in order to facilitate your reimbursements:
- Open your personal ameli account to track your reimbursements, update your personal information that is crucial for smooth communications with the French health insurance system, and ask any questions by email.
- Declare a doctor you see in France as your primary care physician (“médecin traitant”) for optimum follow-up care. Your primary-care physician will prescribe the care you need and refer you to a specialist if appropriate. Your care will also be reimbursed at a higher rate.
- Order your French health insurance card (“carte vitale”): your card will need to be updated once a year, and whenever you have a change in your family/professional situation. You can update it at the terminals available at all local health insurance funds (“CPAM”) and at most pharmacies. This guarantees that all of your information is up-to-date and streamlines the reimbursement of your health care expenses.
You should know that the CPAM partially covers your health expenses but not all of them. In order to be better reimbursed, it is strongly recommended to take out a complementary health insurance. Find out more on our section “Complementary health insurance / CSS”.
Don’t forget to watch videos from the Assurance Maladie and Campus France which will provide you with more details and guide you step by step through the online process:
Complementary health insurances / CSS
You have difficulties to access health services or to pay for your health care costs ?
In order to be better reimbursed, it is strongly recommended to take out a complementary health insurance. A large choice is available and offered by insurance companies, banks, student complementary insurance companies etc, do not hesitate to compare the different offers and ask for a quote.
The amounts of reimbursment depend on the contracts and compagnies.
Advice: Verify that your complementary health insurance covers you in your student and private life.
The Complémentaire Santé Solidaire – CSS
Under conditions (read below), you can benefit from the Complémentaire Santé Solidaire (CSS), an exceptional and punctual support from the CPAM (Ameli).
According to your financial resources/incomes and the composition of your household, the CSS is without a financial participation (free) or with a financial contribution.
The CSS covers every members of your household (partners and dependents under the age of 25 years old).
With the CSS, you won’t have to pay:
- The doctor
- The dentist
- The nurse
- The physiotherapist (kinesiologist)
- The hospital
- Your medicines
To benefit from the CSS, you have to:
- Being affiliated to the CPAM (Ameli)
- Your financial ressources do not exceed the limitation (fixed every 1st of April)
Check if you could obtain the CSS (simulator):
Every person who is asking for the CSS must provide a tax notice (avis d’imposition).
If you lived outside France over the past 12 months before asking for the CSS, you have to provide all proofs of your fiscal and social situation in this country.
The 1st year you ask for the CSS, if you do not have these documents, you can provide a sworn statement mentioning that you do not have any proof of your fiscal situation.
Caution: you will mandatory have to provide a tax notice (avis d’imposition) at the end of this 1st year.
How to ask for the CSS?
Connect on your ameli.fr account, click on “Mes démarches”.
List of supporting elements:
- N° allocataire from the CAF
- List of person composing your household
- Proofs (depending on your situation: tax notice, property tax, CAF certificate etc.)
- Organization that will administer your CSS (mutual company, insurance company, pension institution etc.)
To choose your organization, get inform on this official website: https://www.complementaire-sante-solidaire.gouv.fr/choix_oc.php
The Assurance Maladie will have 2 months to process your application.
If your application is validated, you will receive a notification of your rights to the CSS, your subscription form and a debit mandate.
Your rights to the CSS will be opened after sending back the completed, signed, dated subscription form and a bank account identification or any other means of payment. You have 3 months to send these documents.
Caution: After these 3 months, you will have to reapply for the CSS from the begging of the process.
When the Assurance Maladie received your documents, you will receive a proof of the right (attestation de droits). Update you Carte Vitale and you won’t have to pay for the doctor, dentist, nurse, physiotherapist (kinesiologist), hospital and/or your medicines.
Your rights to the CSS are established:
- From he 1st day of the month following the validation of your application
(For example: if your application has been validated the 25th of June, your rights are established on the 1st of July)
- In case of emergency*, from the 1st day of your application
(For example: if you apply the 27th of May, your rights are established on the 1st of May)
- In case of hospitalisation*, up to 2 months before you admission to the hospital
(For example: if you have been hospitalised on the 19th of April, you rights cover your costs from the 19th of February)
*In these situation, don’t forget to provide all proofs and supporting documents (hospital report, medical bills etc.)
Do you need help?
If you have any questions about your file or your reimbursements, please contact the CPAM directly:
Line in French
Tel: 36 46 / From abroad: +33 184 90 36 46
Line in English
Tel: 09 74 75 36 46 / From abroad: +33.9220.127.116.11
If you need additional information or guidance, the International Student Desk will be happy to assist you.