CPAM & PUMA: how France actually enrols you in healthcare

There's a moment, a few weeks into life in France, when British arrivals realise that "getting healthcare" isn't a single act but a small bureaucratic relay — and that the baton they're chasing lives at an office called CPAM. It's an unglamorous acronym for something genuinely important: the local caisse that decides you belong in the system and lets you in. Understanding what CPAM does, under which scheme, with which form, is the difference between a smooth enrolment and a file that sits in limbo while you pay full price at the pharmacy. So let's take it properly.

The cast of acronyms, briefly

Four names do all the work, and keeping them straight makes everything clearer. L'Assurance Maladie is the national health insurer. CPAM is its local branch — the office for your area that handles your paperwork and issues your number. PUMA is the legal scheme under which you claim entitlement, on the basis of residing here. And Ameli is the website and app you'll manage it all through. You apply to your CPAM, under PUMA, and once you're accepted you get a number and open your Ameli account. This guide is about that first, decisive stage: CPAM and PUMA.

Are you eligible? The three-month residence test

PUMA's entitlement rests on residence. The headline rule is that anyone living in France stably and regularly — broadly, present for the bulk of the year and settled rather than visiting — is entitled to public health cover, and in practice CPAM looks for around three months of continuous, stable residence before opening rights. "Stable" is the operative word: a holiday home you visit doesn't count, but a tenancy, a job, children in a local school, and utility bills in your name all build the picture CPAM needs. Gather that evidence, because you'll be proving it.

Which route is yours: S1106 or S1?

Almost everyone enters through one of two doors, and choosing correctly is the most important decision in the whole process. Open each to see which fits you.

Most commonThe standard route — PUMA form S1106 (most people)

If you're working, or simply resident without a qualifying pension, you enrol under PUMA using form S1106 (Demande d'ouverture des droits à l'Assurance Maladie, cerfa 15763). You download it, complete it carefully, and post it — ideally by registered mail — to the CPAM covering your home address. Get the address right using the Ameli address finder; sending it to the wrong CPAM is a classic delay.

PensionersThe S1 route — for UK pensioners with Withdrawal-Agreement rights

If you receive a UK state pension and hold protected rights as a pre-2021 resident under the Withdrawal Agreement, the S1 form is your route. Obtained from the UK health authority before you apply, it transfers your healthcare rights to France so the UK effectively foots the bill — meaning you're covered without paying French health contributions on your pension. You still enrol with CPAM; you just hand over the S1 rather than proving contributions.

The documents CPAM wants

Whichever route, the dossier is broadly the same, and — as with the carte Vitale — one document does most of the delaying. Open each for detail.

RequiredIdentity & right to be here

Passport, plus your visa validation or titre de séjourThe umbrella term for a French residence permit. as a British national. Your legal residence underpins your right to cover.

The usual snagFull birth certificate (sworn French translation if needed)

The long-form certificate with parents' names, translated by a traducteur assermenté if it's in English. The perennial bottleneck — arrange it early.

RequiredProof of address & of stable residence

A justificatif de domicileProof of address (a utility bill, say) — asked for constantly in French admin. within three months, plus evidence you genuinely live here: payslips, an employment contract, a tenancy, a child's school enrolment. This is how you satisfy the three-month residence test.

RequiredA French RIB

Reimbursements are paid into a French account, so your bank details — your RIBRelevé d'identité bancaire — your French bank-details slip, handed over to set up any payment or direct debit. — go on the form. Another reason to open a French account early.

What happens after you send it

You post the dossier to your CPAM (registered mail is wise, so you have proof), and then the wait begins. Validation typically takes anywhere from two to twelve weeks depending on how busy your département is; issuing the card follows a couple of weeks after that, for a total of roughly three to six months end-to-end for a first-time foreign applicant. Somewhere in the middle, CPAM issues your thirteen-digit social-security number — sometimes a temporary one first, then a definitive number — and that's your cue to create your Ameli account and, from there, order the card.

The reassuring part, worth repeating because it calms a lot of needless anxiety: you are covered from acceptance, not from the card. Once CPAM opens your rights you can print an attestation de droits from Ameli and use it as proof, paying upfront and reclaiming in the gap. Nobody is asking you to go uninsured for six months.

Reimbursement, the médecin traitant, and the mutuelle

Once you're in, it's worth understanding what "covered" actually means, because it isn't 100%. Under PUMA the state reimburses roughly 70% of a standard GP visit, around 80% of hospital costs, and about 60% of most prescription medicines. The balance — the ticket modérateur — falls to you, along with a small daily hospital forfait and any specialists' overcharges. This is precisely why a top-up mutuelle is close to universal in France; fewer than one resident in twenty goes without one, and lower-income households can access the subsidised Complémentaire Santé Solidaire instead.

One more piece of housekeeping pays for itself many times over: declaring a médecin traitant, your registered reference GP. France's coordinated-care system rewards having one — full reimbursement rates — and penalises not having one, dropping your reimbursement on specialists you reach directly to around 30%. Choose a GP, declare them (a quick form or a click in Ameli), and you protect your rate. It's the cheapest insurance policy you'll ever take out, because it's free.

None of this is beyond anyone; it just rewards doing it in order and front-loading the slow bits — the residence evidence, the sworn translation, the French bank account. Do that, choose the right form, send it to the right office with your real arrival date, and CPAM does the rest. The green card, when it finally lands, is really just confirmation of a decision made weeks earlier at a desk you'll probably never see.

Eligibility rules, forms, timelines and reimbursement rates here are drawn from official and specialist sources and are current at the time of writing, but the health system's rules and figures change and vary by CPAM. Note in particular that a 2026 healthcare contribution for some non-working residents was legislated but its exact figure was still being finalised at the time of writing. Pimpernel are not medical, insurance or legal advisers. Confirm the current position on ameli.fr and take advice suited to your situation before acting. This guide is general information.