Getting a Carte Vitale


i visited the cpam with my husband who is French last week to get carte vitals. We have moved to France after 23 years together in the UK as papa is poorly. I was told we needed an S1. Having looked before leaving the UK I thought not but returned and phoned Newcastle NI office to request them. I was told these are just for retirees. Newcastle are sending me a letter in English and French which I was told to give them. I returned to the cpam to discuss further but was told I was wasting the woman's time and did I expect to be covered straight away when there are French people waiting... My husband is French but she insisted the same applies to him as he has worked in the UK throughout. We are not yet working and have registered with the pole d'emploi. I was told by the dragon at cpam that neither of us would get medical care unless we were paid by either an employer or chaumage. With the U1 office taking upwards of 6 weeks to send one out I don't expect to get paid chaumage in the near future if at all. As a diabetic I need medical support. Does anyone have any tips on how best to proceed.



Need help getting a Carte Vitale?

Hi Karen,

Well unfortunately it seems that your 'dragon' at the CPAM office is a particularly nasty one who doesn't understand the rules of the system that she is supposed to be operating.

Since 1st Jan 2016, everyone who is resident in France is entitled to join the French State Health care system via PUMa (Protection Universel Maladie). The nationality of the applicant is irrelevant, and all that is necessary is to be able to prove that you are full time resident in France. This normally takes about 3 to 5 months from initial arrival in the country as it is necessary to be able to produce such things as a utility bill, proof of ownership or rental of your place of residence, and evidence of employment if you have it. As you seem to be under UK state pensionable age, and also not working or registered as being unemployed, then you will have to pay the 'cotisation' membership fee from your own pocket. Currently this is set at 8% of the excess of your annual income over 9,600 Euro, and is billed by the URSSAF --- usually in 3 installments per year.

So how to circumnavigate the 'dragon' ? I would suggest that your first port of call should be your local Mairie. Try explaining to them what has happened and see if they can put you in touch with a more helpful person at the CPAM office. Alternatively, try going to a different CPAM office. Here in Vendee there is the main office in the Departementale headquarters town, but also other satellite offices in other parts of the departement.

Another way around your problem would be to download the appropriate Cerfa application form from the internet, and simply send in your application by post together with the necessary supporting documents and photos. No doubt enclosing the letter you will receive from Newcastle will be helpful. Make sure you send the application by Recorded delivery with Return Receipt.

If none of the above works and you are still having trouble, then I would suggest contacting the British Embassy in Paris to see if they can help you establish your lawful right to a Carte Vitale.

In the meantime, if you have only arrived here fairly recently, then you may be able to use a UK issued EHIC card to cover your needs during the application period.

Good luck. Let me know if you need any further clarification.

Best wishes to you both, Robert.

Actually Robert, it is you that is incorrect.

See here:

To join the system on the basis of residence you have to prove that you have lived here in a regular and stable manner for at least three months.

See here:

Stable means you have to prove where you've lived via factures but it's the 'regular' bit that could be the problem here. Regular means you have to prove that you have enough income to be self sufficient and not a burden upon the state (RSA level of income for your family composition) and that you have had complete healthcare cover during the period. Since the only way of doing that in the first three months is to have private health insurance then that seems to be the way to go, at least for that initial period. If you find work or start a business then you will be covered that way and if you have no income, then that is the only way to go.

The 'dragon' is right - you can't just turn up and expect to be given healthcare or any other benefits. A substantial savings pot may be accepted rather than income but I suspect that's a judgement call by whoever processes your application as to whether your pot will last you long enough for you to find work so that you won't become a burden upon the state.

Note also that now that PMU has come in, the 'ayant droit' status is gradually being phased out, so any new entrants would have to join individually and pay cotisations based upon their own income. It's not clear how that works when only one of a couple is working or has income.

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Advice please......we are both english, under UK governments retirement age...Husband chose to take early retirement with a pension from Royal Mail. I was intending to seek employment but involved in a car accident here in France, not my fault but Im the one paying out :-( Our first visit to apply for Carte Vital was JULY 2015 in Montlucon, I now feel we have been given the runaround. Every time we go (thinking finally there) they go through eveything and send us away wanting more information. We also have been unsuccessful in obtaining affordable top up insurance. Today we appear to have received a provisional number ......guess what they want four lots of paperwork x2 that they had at first visit and again last! What exactly do they require for this " une attestation papier justificative de vos droits" thank you

Sounds like they're asking for proof of your right to say which basically means proof of where you've been living in a stable manner and proof that you have sufficient income - it's the requirement to have had healthcover that is a bit iffy, as far as I can see. (Under the CMU they'd stopped asking for that and only required proof of stable residence and enough income to be self sufficient but I notice it's come up again on the PMU info page).

How can you get top up insurance if you're not actually in the system? Or do you mean private insurance?

Did you fill out the form requesting to join that used to be available on the ameli site and which was dealt with in Nimes? It's still there on the new page re PMU.

This one

Your comment re top up makes me want clarification. Are you actually in the system but just don't have a carte vitale? In that case, what they are asking for could simply be your paper 'attestation de droits'. You can print that from the ameli site in your personal account. (Seems odd though as so could they).

With respect Debra, in the sentence "Cette réforme garantit à toute personne qui travaille ou réside en France de manière stable et régulière, un droit à la prise en charge de ses frais de santé à titre personnel et de manière continue tout au long de la vie." the words 'manière stable et régulière' are an adjectival grouping which qualify the word 'réside'. These words qualify the fact of the actual residence in France, and should not be construed as being anything to do with the circumstances surrounding such residence.

I agree of course that there is other information regarding income to be given during the application process in order to determine if there is a right to government support with the cotisations for the PUMa membership, or indeed for help with the cost of a 'Mutuelle'.

I am also the first to acknowledge that the French Administration system is notorious for the same rules being interpreted in different ways by different people in different areas of the country. That is why I suggested methods for circumnavigating the particular 'Dragon' refered to by the originator of this discussion. All of these applications of this type are supposed to be sent to the dedicated center in Nimes for processing, and whilst local staff may of course advise on the content of the dossier submitted, they have NO right to refuse the application whatsoever.

Regarding PUMa and the situation where only one of a couple has income, the way to resolve that difficulty is for the person with the income to sign an 'Attestation' to the effect that they undertake to be financially responsible for the other person in the couple.

I agree that the fresh arrival in France must have healthcare cover of some sort. Perhaps I was wrong to assume that such persons arriving from the UK would have done their homework prior to coming here, and would have arrived in possession of either a Form S1 from the DWP, or basic temporary health insurance obtained from a provider either in the UK or in France.

I hope that this helps to clarify the situation.

You can't get a residual S1 from the DWP anymore and other types of S1 would mean they wouldn't need to be worried anyway. One could have stayed working in the UK while the other found work and they could have had an S1 in the meantime that way.

With just as much respect back at you :) the words 'de manière stable et régulière' have always been a qualifying condition of residence for joining the healthcare system, even when it was called the CMU. The only changes that the first of January this year seems to have brought are firstly to treat EU and non EU people under the same rules and secondly to introduce the phasing out of the 'ayant droit' system.

I explained what the quoted words mean and linked to where they are defined. Since you don't seem to have followed the link I guess I can copy and paste from the links I posted too, for the benefit of anyone else who may not follow them:

Quelles sont les conditions à remplir ?

  • Résider en France de manière stable

Pour être affilié au régime général sur critère de résidence, vous devez résider en France de manière stable, c'est-à-dire de manière ininterrompue depuis plus de trois mois.

  • Être en situation régulière

Si vous êtes ressortissant de l'EEE/Suisse et que vous êtes « inactif » : vous êtes dispensé de la production d'un titre ou document de séjour mais vous devez justifier de ressources suffisantes et d'une assurance maladie « complète ».

This part 'et d'une assurance maladie « complète ». ' had previously been taken out of the residence requirements for the CMU and it was confirmed some time ago that it wasn't necessary (I have a letter from NImes which confirms that only stable residence and self sufficiency are required) but the fact that it's been put back in again for the requirements for PMU makes me wonder if they are going to insist that private medical insurance is taken out for those first three months, so that could be another change that they've found easier to re-introduce by renaming the system.

There are some exceptions which I've left out as I can't see that they would be relevant but that last bit about losing income because of circumstances beyond your control:

Toutefois, dans certaines situations (perte imprévisible de revenus, perte de la couverture maladie liée à la perte d'emploi du conjoint, etc.), votre demande d'affiliation sur critère de résidence pourra être étudiée par votre caisse d'Assurance Maladie)

could be relevant if they are able to claim that they had to come to France to look after 'papa'. I'm not sure both of them coming at once would be considered necessary, though, but it's worth a try.

The stable and regular part is an EU rule and applies to all EU countries and whether they need to allow EU residents to enter their systems. France did try to get out of it for a couple of years but have now been brought into line (even before the changes this year). I doubt they're going to go beyond what is required of them - especially when they've defined the conditions so clearly. The UK has the same definition on the NHS website but they don't have the mechanisms for enforcing it in place (they're trying). France has always had the mechanisms in place and don't have any problems enforcing it.

What would have been better for the OP to do would have been to make sure they were eligible to claim jobseeker's allowance before they came and bring it with them but I'm not sure whether this would have entitled them to healthcare cover for the initial three months that it's payable for, or not.

This from the Europa site suggests that healthcare cover would be there if you're in receipt of unemployment benefit, maybe via an EHIC if not by an S1 because during the first three months nobody considers you to be a permanent resident and therefore use of the EHIC should still be acceptable:

Receiving unemployment benefit?

If you're receiving unemployment benefit from the EU country

In this case, the 28 EU member states + Iceland, Norway, Liechtenstein and Switzerland

where you became unemployed, going abroad to look for work won't affect your (or your family's) rights to health cover, family allowance, invalidity or old age pension rights, etc.

To ensure that you and your family have health cover during a temporary stay abroad, don't forget to get a European Health Insurance Card


Robert, the British Embassy is not interested in individual cases.

I would look at the appropriate source on the French internet.

We applied around the same time as you and finally received our provisional number in Feb. With that they also required yet more information that we had already sent, so we we sent it off along with a lot that they hadn't asked for. It was a large dossier! We also sent them a letter detailing everything we had previously sent and the dates they were sent. It must have tipped them over the edge as almost by return of post we were asked to send photos for the Carte Vitale and shortly afterwards we were in!

Perseverance is the key......You will succeed.

I can only go by my own experience. I am under the UK retirement age, as is my wife. I retired through injuries. When i arrived in France 3 years ago, my bank manager told me to go to CPAM immiediatly to register and apply for a Carte Vitale. She then started the process for a mutual assurance to compliment the health cover. This cannot be completed until you have the attestation for the Carte Vitale. Unfortunately, i met your dragons sister. I did not realise that she had not registered my visit on the computer, despite her copying all my legal documents, and disability certificate. (Not severe disablilty) After 3 visits, one with a different lady who was very different and tried to help. She was younger, and junior to the dragon sister. I realised that i was actually getting nowhere fast. That none of my visits had been recorded from June 2013 until February 2014, despite them copying all my papers on each occasion. I spoke to my French GP, and to the Marie, and i wrote a 'robust' letter of complaint to CPAM. As a result, i was seen by a senior social worker, (Different department) at which point everything changed. She could do nothing about the non recorded visits, and had to start the process again, but i recieved my Carte Vitale attestation a few weeks later. She all but agreed the staff had lied, but she was in an unenviable position, where she was unable to prove it. My mutual assurance was activated the same week and we have been covered ever since.

As to cost. I make 3 payments of 250 euros a year to CPAM via URSSAF, and 71.38 euros per month Mutual assurance. I consider that to be excellent value for money for two people.

Record every visit you make, and get them to sign it, or prove they have recorded your visit on computer. If they take copies of all your papers, obtain a reciept. I did not, so i cannot prove they had 3 complete copies, and they deny ever having them. Next apply to see a social worker and explain the situation. Back up your story with a letter from your doctor as to your medical condition, and from the Marie, proving your residency. Do not take no for an answer. If you back down they will ignore you. It appears that once they realise other professionals are involved, their attitude changes somewhat. In addition, the social worker arranged for my wife and i, to be registered disabled with the MDPH. We had no idea that she had done this, until we recieved an appointment for assessment. After the assessment, we were registered very quickly. We had no intention of applying for this, but are very grateful.

As a result of CPAM's incompetence, i had to pay a bill for one night in hospital for my wife. The hospital said that as my application was in i was covered. At the time we did not realise that the visits to CPAM had not been recorded. Result, a facture for over 1400 euros. I appealed and fought the facture for 18 months, but without the proof that i had registered with CPAM before the hospital visit, it was a waste of time. On the upside. We have had fantasatic medical treatment ever since. Last year i had several major operations for health problems i did not know i had. My wife had an accident and had both knees replaced. The treatment and after care, have been the best i have ever experienced.

Finally, the fact that your husband is French, just backs up exactly what my neighbours have said. (They are all French), and that is, that foreigners do not get treated any differently. The French go through the same bureaucratic nonsense that we do. The notion that we are treated any differently, is just not true. What does make a difference is not backing down, and trying to learn the language, or using an interpreter until you have at least a woking knowledge. Not needed in your case.

I'm not sure that this information will be of any use to you, but maybe it will serve as a warning to others. I hope everything gets sorted out as soon as possible for both of you.


Glad it was sorted eventually, Stephen. However, that's your experience when you have the requisite home and income. Imagine the trouble if you don't? They'll probably find work and be covered that way before CPAM let them in.

I rent a a small cottage and have one pension, Debra. I appreciate what you are saying though. Very difficult for some unfortunately. I don't think i would move abroad, if i was not certain i had sufficient income to live and be sure of medical cover etc. Your situation is different, in that your husband is French. I would have moved without hesitation under the same circumstances, and not have expected the problems you have experienced. Maybe your local politician could intervene on your behalf as well. Hopefully it will be resolved quickly for you both.

Not me but the OP but yes, I know what you mean. I've heard that the UK are doing the same now though, with returning British citizens. Some say you have to be there for six months before being allowed back in the system. I don't know if it's true because I'm sure I've read that if you're a British citizen and you have a stable home back there you can be classed as ordinarily resident immediately. All the EU countries will probably get the hang of what they're obliged to do under EU law and what they want to do - and then the UK might leave (hope not) and in that case we'll all be in limbo again.

Th situation with Brits returning to UK is exactly as you have outlined. 6 month wait to get back into the system. I've heard the same from several people who have returned. I'm not too worried about a Brexit. France has been host to hundreds, if not thousands of British for a very long time, and vice versa. It will almost certainly mean jumping through a few more bureaucratic hoops, but i can't see them expelling anyone, especially if they are paying their way and contributing to the countries system. In fact i believe the majority of French people would be appalled at the thought, and make their feelings known. Then there is the property situation. There are many thousands of empty French properties in an already depressed market. Hollande is threatening to tax second and subsequent homes heavily, and many French people have inherited property. They will all come onto the market as well, further depressing the market. If all the British leave as well, they'll have to pay people to own the houses instead of selling them. Or give them away. The increasing number of homes coming onto the market very cheaply because they have elderly sitting tenants is, i believe, evidence of this. Of couse there is also a threat of France and several other countries leaving the EU as well. As for EU law. I can't see how anyone can possibly know the law in the EU. There's 127 laws regarding pillows ! How anyone can be expected to find their way through the maze is anyones guess. The whole EU needs a complete overhaul. The financial waste is staggering.

Stephen, there have been recent changes and if you are in receipt of an S1 if you return to live permanently you no longer have to wait for six months.

Holders of an S1 also have the new right to NHS treatment without getting the agreement of the French health authorities.

You should contact the Health Authority in the in which you will be seeking treatment for their policy.

Thank you Jane. Unfortunately, an S1 is something i have never had. Or the previous health document. I was refused every time. That is despite the fact, i still pay my tax in the UK even now, as i have done all my life. But i get absolutely nothing for it. I was under the impression that the S1 was only valid for two years, but as you say things have changed. I have no intention of returning to the UK anyway, and no desire to. My only interest in the UK, is for the sake of my children, grand children and friends. In two years time, i will apply for a French passport and be done with it. I've been treated far better in France, than i ever have been in the UK. But then who knows what the future holds.