Health System entry (CPAM,PUMA) again

After 1 CPAM local office visit, 3 follow up demands from CRIEC, over 60 documents, and 4 and half months I’ve got the always changing demands for documentation down to the one, namely “end of rights” confirmation.

I know this seems not to be a big deal from the stories here, go to DWP and ask for confirmation, give to French and wait months again.

But this bothers me some. This is the last hurdle I assume but there is no indication that acceptance is guaranteed even at this stage is there? Having notified DWP that I’m here only to find that Nimes decide to refuse entry to the system would be too much I think. Nothing here has been easy.

I think I’m bothered by being back at worse than square one if returning to the UK and having no french health care if they decide after “end of rights” to deny access for whatever reason.

Has anybody failed at this stage? If asked for “end of rights” is there an assumption that you’re good to go?

It’s a vital step. Without the letter you will not be able to join the French health system, without health care you are unable to be resident in France. If or when you return to the UK having had the letter will not prevent you from re-entering the NHS. When you move your residency to another country you do not have to burn bridges but you do have to cross them.


If you meet the criteria then why should you not be accepted? The basic principle is that “Toute personne qui travaille ou réside en France de manière stable et régulière a droit à la prise en charge de ses frais de santé à titre personnel et de manière continue tout au long de sa vie”.

1 Like

I don’t see your point to be honest, it’s not like you have any option. If you are here in Nimes, DWP needs to know, regardless of any dealings with CPAM. You live where you live, and if that is in France you can’t pretend to HMRC, DWP et al that you still live in the UK. Well I suppose you could but it would be fraud.
You say “nothing here has been easy” but if your strategy in dealing with the authorities is to reveal as little information as possible, it never will be easy. Usually there is a clear list of what justificatifs they need, and if you get those together, and throw in a few extra to show willing, and go along with a nice smile, you’ll probably find things a lot easier. 3 follow up demands etc suggests either that CPAM has found it like pulling teeth trying to extract from you the basic documents they need for a full dossier, or alternatively that some lack of information in the original application set off a warning bell that something was being hidden, and therefore they asked for extra justificatifs. That does happen because if information is missing, a keen fonctionnaire will wonder why it’s missing. Don’t forget that they do get dodgy applications, and they need to sift them out, and one indication of a dodgy application is missing information. That’s why you do yourself a favour if you present a full dossier in the first place. Trying to control the process and manipulate it by deciding what information to give to who, doesn’t work; you have to trust the system, otherwise why should it trust you? I hope this little tip will help for the future.


Anna Watson, do you know me?

I take exception to your accusations that somehow I’m fiddling the system!

Do you know what I’ve submitted and when, do you know when I visisted local CPAM and what happened.

No of course not, so stop accusing me of being criminal.

If you have nothing positive and factual to add to the simple questions I’ve posed then take your accusations to another thread.

I hope that you have used your time more productively and have already asked for the letter that you need. Joining the health system is a case of going through a procedure and you have failed to provide a basic requirement and appealed to others to see if this requirement can be by-passed. By your own admission you are not somebody who is willing to stick to the rules. Having valid health cover has more importance than ever now as without proof of healthcare you certainly won’t be eligible for residency. That easy to get bit of paper really is worth getting.

Good grief I didn’t say you were fiddling the system.
I said that some people do, and CPAM need to sift them out.
All I know is that you appear to have submitted an incomplete dossier, and that you are debating the pros and cons of submitting one of the necessary documents. That doesn’t make you dodgy, but it does show inexperience in dealing with the authorities here because it’s the wrong way to go about things. Most of us that have been here for a while have seen it a thousand times - some newcomers find everything difficult and some sail through, and the differentiating factor, 99 times out of 100, is that some have the knack of presenting convincing dossiers and some don’t.
Being defensive and agressive don’t help either.
I have nothing more to add, do things your own way.


to see if this requirement can be by-passed. By your own admission you are not somebody who is willing to stick to the rules

Being defensive and agressive don’t help either.

I’m not sure we’re reading the same thread.

Now you’re both showing your own biased views and stating things which simply have not been said. Your inferences are insulting.

I know it’s difficult here to extract simple answers to simple questions and again that’s evident here.

I’m done.

1 Like

I have re read your initial post and its a bit ambiguous.
Maybe by giving full information of what documents you needed to change, and if you have indeed notified DWP that you are here, may have helped.
Folks can only go so far to help, I can’t see that anyone is suggesting that you may be comitting fraud, be a criminal or are fiddling the system.
It is easy to pose questions here, I have done so many times, and have had positive and helpful replies.
If you don’t like the answers then maybe you could try re wording your question.
If you don’t like the site then ‘au-revoir’ and I hope that you can get the answers that you like, not necessarily the correct ones, on another site !

You know the one document that is required but you don’t seem prepared to provide it. How does that describe somebody who is prepared to follow the rules? If getting a CV is important to you you would not have written your original post you would have acquired and sent in the paperwork required, just like everybody else who has gone through the system has had to do. There is no way to avoid this step.

1 Like

I think us Brits forget how lucky we are to gain access to health care in the UK. I read on another site a lady who had been relieved to get her carte vitale after 5 months and said luckily they are healthy. My immediate thought was what about car accidents? We have just paid over €900 so when we arrive in France in January we will have healthcare. I will still worry about all the hoops but at least I have a year to jump through them.

@Teresaship. Healthcare is always provided in an emergency, so really don’t worry about that. It is not like scare stories about other countries where you are asked for your credit card before you are treated.


:thinking::wink: but, unlike UK… you will certainly have to pay whatever is owing… afterwards…


We have been following various threads and government websites to establish Madame Wood’s healthcare status when we Brexit. She is French but lived and worked in the UK for over 30 years. She has a state pension and a form E121 which covers her healthcare.

Our research, surprisingly appears to confirm that post Brexit and after any rights extension we should both be covered by the Protection Universelle Maladie - PUMA system here in France. The cotisation for this, under current legislation, will not be charged as our only income derives from Pensions and NOT capital income.

This has come as a tremendous relief as we had been led to believe we would be liable to a 6.5% tariff on revenue over a certain amount which would have made healthcare costs almost prohibitive.

I do know that other pensioners who are wholly reliant on Pension income, and hostage to the diminishing exchange rate, have been very concerned, so l hope this might ease some of the anxiety.

If anyone else can confirm or has reason to challenge this info please jump in.

1 Like

Yes, I too understand that if our health cover via form S1 (formerly form E121) is revoked then we can receive health cover via PUMA as long as we are legally resident in France. This link may make things a little clearer. PUMA

1 Like

Thank you Joyce - Prior to 2007 we paid a cotisation of 8% for 6 years on our revenue above a certain amount, which was all Pension, although Private and Government and NOT State pensions. I am now wondering if that large sum of money was collected by URSAF from us in error. If it was then, knowing the bureaucracy here, reclaiming it is a potential nightmare.

As far as post Brexit goes this from your link appears to confirm our view that we will not pay anything more for our healthcare than we currently do with Mutuelle and the Assurance Maladie.

I seem to recall that there was a change in 2015 that meant that the URSAFF contributions were no longer levied on pensions. And I think we got them refunded for 2016 after complaining…but the key point was that one of us had a state pension in 2016. In 2015 we had a work pension that didn’t count.

I don’t have your confidence that Brexit will not change the amount we pay. My reading of it is that if the S1 scheme goes phut then we will be back to paying cotisations over the threshold income, no matter what it is made up of. Sure we can join PUMA (or rejoin it!) but it will cost us.

Hi Jane, this is exactly what has been causing us stress, and it’s for that reason l have reactivated this subject, hopefully to find out exactly what the rules are. One of the most informative things l read, in English, from French Property News is an excellent article which explains what will happen. Pension income only = No Cotisations. So rent from a Gite here or property in the UK or part time employment counts as Capital income, perhaps this applies to you Jane.

I don’t know the definitive answer on all this but what happened on 1st Jan 2016 wasn’t so much changes, as the scrapping of the old CMU system and introduction of the new PUMA system. There are similarities of course but there are major differences. One is that PUMA has exemptions from cotisations for pensioners and CMU had no exemptions for pensioners. Another is that PUMA charges supplementary cotisations to households with low earned income but high unearned income, which CMU didn’t, and related to this is the change that URSSAF now shares info with the fisc and calculates cotisations from your tax return rather than sending you a separate form to fill in, and you are charged in arrears instead of upfront. Another change was the ending of ayant droit rights for adults. Etc etc etc. There are winners and losers but on balance PUMA is probably fairer in how it shares the burden, which is what the changeover aimed to achieve.
However it’s worth bearing in mind that PUMA is still a very new system and is likely to be tweaked several more times. Bills were sent out for the first time in 2017 and there were plenty of hiccups and complaints which were addressed in 2018. I haven’t seen any announcement yet about any changes for 2019 but it’s possible there are more adjustments and refinements to come.

1 Like

I have worked through the details, but my gut feeling is that those who have a small income won’t pay and those who have a larger capital income above the 20,000 will be able to afford to pay the 6.5% above that threshold. That’s 65 euros on every 1,000 of extra income which should be manageable for most?

We managed to pay cotisations before we got our S1’s, so whilst we will be angry if the UK pulls it I’m not seeing it as make or break.

The one that is causing me stress if the thought of pensions being frozen!

1 Like