Healthcare information

Hi all,

Has anyone ever discovered a comprehensive guide to French healthcare, in French or in English, that tells you exactly how the system works, which departments things pass through, etc.?

I’m asking because we know roughly how it works but we’re having issues with our mutuelle. They have made a right mess of the paperwork, have my daughter registered twice, are not fully reimbursing my wife (even though we’re paying them 80€/month!) because of some screw-up with who’s social security number they are using, they’re confused because we’re married but have different surnames - it’s a total mess! We can’t work out the flow of things to work out who we need to talk to and no one we do manage to talk to seems able (or in some cases, willing) to tell us anything useful.

What I’m after is some sort of flow diagram. Something that goes from doctor’s appointment through to money arriving back in our bank account, including supplementaire, which departments it passes through, lists of organisations. Has anyone seen anything like this? Or is what happens behind the scenes of the healthcare system France’s best kept secret? =)



We've got a livret de famille but what I still find rather strange is that they insist on leaving the "epoux ou père" page blank and give me a mention only in the lasst line of my daughter's entry "premier enfant" and nothing at all in the "deuxième enfant" entry... It's a fun, so typically French little book to have but I'm relegated to a single line rather than being the "Père de famille" figure I so proudly hold! Still got a carte de séjour somewhere too - I quite liked them, gave you more of a feeling of "having permission" to be here and being part of society - not the same handing over a UK passport for ID, I always hand over my permis de conduire as it avoids hassle!

Yeah, we love our livret de famille, neither of us are French but as we were married here we have the little book and along with our titre de sejours, it just about fulfills all the official paper requirements for family life.

You're right Tracy, there's no such thing as "common law husband/wife" our notaire strongly advised us to pacs or get married "for the kids and simplicity" when we bought the house + the tax benefits. I don't think the concubinage thing carries any weight and I'm not sure it still exists. Having said that I remember having to go to the mairie to declare that I was the father of the unborn child my OH was carrying and I got a certificate to this effect which I needed later on for the livret de famille etc - bit miffed not having my own page in our kids' livret de familles - I'm an also ran as I'm not French - don't have my own livret giving all my "ancestory"!

When I first moved to France, many, many moons ago, it was possible to make a declaration of 'concubinage' at the mairie. This then had to be regularly renewed, seem to think something silly like every year, might be worth checking out.

In France it seems like you have few rights when you are living together but once you get married you are joined at the hip. Friends of mine have been going through various stuff with the notaire to sort their life out and every answer seemed to be 'get married' apparently even PACS will not really help that much.

Am not suggesting that is necessarily the right thing for everyone of course, just saying what it seemed to come down to in the end.

yep CPAM are far quicker and more efficient than the RSI, unfortunately - I went the other way a few years ago!

I finally got the letter to send them the photo for my Carte Vitale. Nearly there! I wonder if that's cos CPAM have taken over from RSI as a result of my change in employment status, so it's finally got done? Probably, from the sounds of it!

When I came to France some years ago I wasn't married nor "paxed" with my French partner. And for that reason not eligible for the Carte Vitale. I had to continue paying private (Dutch) healthcare until I got married, founded my own enterprise and got added to her card.

HI there,

Can anyone help clarify this for me? We have been here since September my partner is working part time and upon receipt of his first pay bulleting and contract we went along to enrol for Carte Vitale. I am not working but am looking to set myllef up as auto entrepreneur as I have just been offered two hours a week teaching english and I intend to advertise for private pupils. My partner has had his piece of paper through saying he is entitled to health care, but I have had nothing. I have now filled in a form stating I am financially dependent on him. We have had a joint french mprtgage for eight years so our long term relationship can be shown. Prior to being here we worked in Italy for eighteen months so have no EU health card from the UK. Does anyone know if I am entitled to be on his carte vitale or am I looking at the prospect of being an ilegal immigrant? Also how does being an autoentreprneur work interms of social charges? Any advice welcome,


Useful info - thanks for posting Karen!

I found CPAM to be very helpful.

On a slightly different note: I worked in a local dental surgery for 18 months and I noticed a few things that may not be obvious to an ex-pat but is something that every frenchperson knows…

  1. If you need anything expensive (dental crowns/glasses etc) then ask for a “devis” to be sent/faxed to your mutuelle so that they can tell you how much of it they will reimburse. No unpleasant surprises after you’ve had the treatment then. Also, it warns the mutuelles that this bill is coming and seems to help speed up payment.
  2. If you have to write a largish cheque for your treatment before you claim the reimbursement, you could ask your doctor/dentist if they will hold the cheque for a month until you’ve been reimbursed, Much better to do this than risk a bounced cheque or to be without food for a month…
  3. If your doctor/dentist says you need to see a specialist, ASK if they can recommend someone. I know it seems obvious but certainly us Brits are used to being told who to see and we may not know that we need to ask.

Dentists certainly have to pay a small fee now for a feuille de soins being processed, which obviously they don’t like to do. Please remember to take your carte vitale if you have one(!!).


The cpam are faster from experience but it still takes a few months from memory. I went the other way CPAM to RSI and that took over a year to change my carte - no worries as i continued using the old one no problem :wink: but 2 years… that’s got to be a record Suzanne!

Hi Grec. Actually the system is very straightforward.I asume that you have your green “Carte Vital” with all the data concerning you and your family-mebers up-to-date.

If you call upon ordinary medical services like GP’s, medication from a pharmacy, dentist, chiropractic etc. you pay the bill and are, normally within the month reimbursed from both the carte vital (Cpam) and your mutuelle. Reimbursement are not always 100% of the costs. Higher costs are paid directly by the CPAm and the mutuelle and you have to pay your own risc afterwards to those organisations.

But getting everything right with both the CPAM and the mutuelle can be a nightmare. As I’m Dutch I have no idea if there are special forms etc that you need when you leave the UK and its Healthcare system and enter into the French one. I struggled for almost 6 months to get things right but what finally solved the issues was taking an appointment at both the CPAM and the mutuelle (in that order) bringing all my papers, even if I thought they had nothing to do withthe issue, and went through everything step-by-step with the lady.

Hang in there!

Yep, RSI - we’re still waiting for our’s 2 years down the line…
Good luck I hear CPAM are much better.

You should get your carte vitale from the cpam once you’re salaried AND more quickly from the RSI (or other caisse depending who you were with/what activity) if that’s any help

Courage !

good luck with all the changes!

Auto entrepreneur = RSI? They’ve mucked up royally in the last couple of years and are well known for it. If your’re going to be salaried, I’ve found CPAM much better than RSI so you should get your carte vitale now.

Have you gone to your mairie and asked for help from the “assistante sociale”? Their job is to help out in situations like this. they can check that you’re getting all the benefits from CAF etc that you’re entitled to as well.

good luck!

Firstly, thanks everyone for the replies.

Andrew, I’d need a Carte Vitale first! I’ve only been waiting two and a half years. We’ve given up asking about it. :wink:

I’m changing job, from auto-entrepreneur to normal salaried, so will be changing caisse. That will cause pandemonium, huh? Well you never know - it might kick-start things again with my Carte Vitale again. Or not. Ho hum.

Anyway, Karen, that’s really helpful! Thanks. It’s probably that the mutuelle are only watching for CPAM payments made under my number, because obviously my wife doesn’t have a life of her own or anything daft like that. :wink:

Greg, I haven’t seen a flow-chart either unfortunately!

However, last year I noticed that our mutuelle hadn’t paid for a couple of (large) items so I called them and asked what the problem was. In the course of the discussion, the very nice woman explained the system to me very simply and in doing so, realised that the non-payment was due to their oversight!
Give Carte Vitale
Pay doctor
Feuille de soins issued or transmitted electronically to cpam/rsi and mutuelle
Cpam authorise payment to your bank account of their portion of bill
Mutuelle see payment is made by Cpam and then pay their part.

If I’ve understood you correctly -
you and your wife have separate secu numbers - should you? Are you both working? Check with cpam (rsi…)Check the details on her Carte Vitale (the one she uses)
The mutuelle is reimbursing at least some of the money so they have her on the account. Remember that not all treatments/prescriptions are reimbursed, as a general rule, if its reimbursed by the secu then it’s covered by mutuelle. There are limits though depending on your coverage. Anything that is not reimbursed by secu should be checked with your mutuelle (ie some dental care) because they may not cover it either. Also, if you haven’t followed the “parcours de soins” (ie referred by your gp) you may not be reimbursed everything. Have you registered with your GP - (medecin traitant)?

It’s useful to register online at so that you can see what payments have been made and a print out of this can be given to the mutuelle as proof (attestation) that they should pay-up!



no it’s a huge mystery to the French too and just wait to see what happens if you change caisse d’assurance as I did :open_mouth:

Depends who you’re with too - go straight to your caisse (cpam, msa, rsi etc) for the state’s part and your mutuelle should be able to give you the rest of the details for the top up. stick your carte vitale into a terminal at your local cpam to check the info on it - if wrong it’ll be screwing the whole system up. if it is wrong write to your caisse with the necessary docs - livret de famille, certificate de naissance, de mariage etc.

good luck and don’t expect anything to happen quickly !

Sorry, I haven’t seen anything like this, but agree that it would be very useful. I am convinced that a huge part of this total obscurity is to keep people in jobs that would not otherwise exist. You must know why France is such a wooded country, to provide the paper for the fonctionnaires et al.