As an Prof'; Lib' AE, can I get a Carte Vitale / health care for my spouse?

I'm sure this is a much asked / responded to question;- I'm an AE on the RSI scheme and have my Carte Vitale. Asking around there are different views / experiences on how to obtain health care / treatment or a Carte Vitale for my non-working wife (50).

We have lived in France since 2011; are assessed for tax in France, and I make my 'social contributions' through the local URSSAF since setting up in business at the beginning of 2014. This is our permanent, and only, home. We have a modest source of property income generated in the UK on which we pay tax to HMRC.

The local CPAM refused to authorise treatment for my lady's cancer which appeared shortly after we arrived here (much anguish and personal difficulties ensued) - happily now signed-off, but we are effectively "uninsurable" (cost / availability) on the market.

Before we throw ourselves on the mercy of the CPAM once more, are there any regulatory / legal or other protocols we can "arm" ourselves with to make a coherent and effective application for her?

Any thoughts and advice gratefully received.

It is not for nothing that the RSI is much maligned, even by the French independent workers who have to put up with its incompetence, overcharging, lack of availability, incorrect information, etc, etc, the list goes on. The RSI and CPAM do not, or very rarely ever, really engage with each other, which makes things incredibly hard for people caught in the middle. Why on earth the RSI was ever created is beyond me - it has now recently been decided by the Court of Appeal of Limoges that the RSI is indeed an obligatory, state-organized, contributory system, so it remains to be seen whether the government will finally do something about merging the two institutions into one big "happy" family (and pigs might fly).

Many thanks to all, once again. "Byzantine" seems hopelessly inadequate to describe the admin'! Situations differ; we left the UK with no clear notion of settling in France, or anywhere for that matter: we went sailing armed with our EHIC cards - which worked very well in Croatia the one time we needed outside assistance.

HI Colin

Various thoughts here..

Since you have been here over 5 years (in fact even if you haven't, but this is a new thing and hard to convince CPAM) and on a low income (you will find relevant income levels online), you can apply for CMU and/or CMUC from CPAM. You can apply direct if you can download or get hold of the forms but it tends to work more easily if the application is put in by a social worker.

If your wife were to set up as an auto entrepreneur, this would solve your problem more easily that the CESU method I think. Depending on exactly when she gave up the micro entreprise, she may have to work in a different field, but you can always find something. If doing that, go for something that is profession liberale or commercial so that it's dealt with by the CFE of URSAFF or the Chambre de Commerce rather than the Chambre de Métiers, because it's very much easier and can all be done online. It may only 'work' for a couple of years, depending on how much income she declares, and goalposts tend to move regularly, but it's probably the quickest way to get cover unless CMU is a possibility.

All that is based on experience, mostly in Dordogne. YMMV.

You are right about different people saying different things. This applies especially to RSI.

Good luck with getting CPAM and RSI to sort it out between themselves!


Hi John, I don't know what has happened in your case. But when you left the UK you should have applied for an E106 from the UK Authorities. This would have given you two years of health cover. You take it to the CPAM and they issue the Carte Vitale. I was also on the understanding that cancer care was free in France. Again I don't know what went wrong.

For us we moved here in 2005. My wife had an E106 but I did not because I was still working for a UK company although resident in France. My wife went to CPAM and was issued with her Carte Vitale. Unfortunately I ended up outside any system because my UK employer refused to register with URSSAF. In 2007 my wife created a micro enterprise. She then had to pay for health cover through Mutuelle de l'Est. The CPAM carte Vitale was taken away and a new one issued by Mutuelle l'Est. It was then that we discovered that I could come under her cover. I have to say that they have been extremely helpful.

At the beginning of last year the URSSAF charges made it impossible for my wife to continue. My wife was at an age when she could retire with a very small pension. The Mutuelle l'Est gave us one year to change back to CPAM. We asked CPAM for advice and were told that she could work CESU and that she only had to work 60hrs over a three year period to come under CPAM. We asked twice to confirm that this was the case. Our cover runs out at the end of March and so we went to CPAM in the middle of January. We were then told that it had nothing to do with them and we were to go to the RSI. We went to the RSI who directed us back to CPAM. CPAM again insisted that it was nothing to do with them. In desperation we went back to Mutuelle l'Est and we were told to write to the RSI side of their organisation. We then received a letter telling us that we had the right to cover under a certain article by CPAM. We took the letter to CPAM who still said that it was nothing to do with them. They also stated that what we were told in that very office was not true and that for cover you had to work 60hrs a month. They stayed that what was in the letter was not true and that someone was misinformed. We have been like a ball bouncing backwards and forwards. In the end we stood firm and told them to sort this out directly with the RSI. So we await the outcome with fingers crossed.

I think what I am trying to say is. Do not trust anything anyone says. No two people in the same office say the same things. Get everything in writing.

Finally if you are working for yourself and paying a Mutuelle then you should be able to have cover for your wife.

Many thanks Heather. I've sent you a 'friend request' with a short note of my personal email address (limited to 200 characters), so please excuse the brevity! I've found dealing with French admin a bit of a challenge, but the human elements seem perpetually helpful and sympathetic when approached with patience and good humour - having a decent level of fluency also helps and occasionally provides some levity to the proceedings...... John

When I set up my AE at the end of 2013 I applied for my carte vitale & added my husband as dependent on the application. It all went smoothly & we got our attestations quickly, & the cards shortly after that. Everything has worked beautifully from the beginning.Once we had the attestations we signed up for a mutuelle & the process is seamless whenever we use it. Fingers & toes crossed that it will continue that way. Hope you get it sorted quickly.


Even if you fill dependents in perfectly on the AE application it doesn't always work. I have a standard letters asking for 'rattachement' of spouse or children. If you message me or google and contact me via my website, I'll email you a 'fill in the blanks' copy. Basically you need to contact your caisse in writing (whichever one you chose on your own AE application), giving your own and your wife's details and then they should add her. You should get an attestation fairly quickly but you'll have to wait a while and it might need some chasing to get her a carte vitale, unless they add her on to yours.

You should also be able to find a standard letter by googling something like modèle lettre rattachement conjoint

Good luck


Many thanks to you all. I'll need to check whether I included my wife when filling out the registration forms - it was a bit of a blur using the on-line system with so many administrative "vehicles" and regimes to select in order to start in business.

We found it difficult to understand that the CPAM would allow my wife to "die in the street";- I exaggerate, of course, but that's what it felt like at the time. I suspect the matter of giving expensive health care to newly-arrived / non-working immigrants, even from within the EU, is a bit of a political hot-potato (no comment!).

My thanks once again.


Yes, your wife should be on your carte vitale, I don't understand why she isn't.

The fact that they didn't accept her treatment in 2010 could be connected with your too recent arrival in France at the time, and the fact that a few months before you were based in England in terms of health insurance and hadn't made the necessary transfers in time. I'm a bit surprised that it didn't work out though, usually it isn't a good idea to believe what they write to you, just call, or go there in person and explain the situation. Have you called the organisation which deals with RSI? I don't know which one it is in your area, but I just went to mine (Mutuelles du Soleil) and added my husband on to my scheme. They, of course, made plenty of mistakes, but that's always the case….

Hi John,

I also registered as an AE with my wife included on my Carte Vitale. So far we have had no problems with Medical, Dental and Optical treatments for her and we always get the refunds promptly. Hope this helps.

Hi John,

When registering as an A/E in 2010, there was the option to add my husband (as 'ayant droit') re: healthcare so that the carte vitale covered us both. My experience was not straightforward, there were errors with our attestation, trying telephone calls to RSI - though I managed to get someone's email which made correspondence much easier - and mistakes on the first carte vitale issued to me. That said, everything now works fine!

Perhaps another network member can confirm whether you can apply for this retrospectively. If so, be prepared for the usual request for translation of birth certificate and various letters between yourselves and RSI. Good luck.