it might well be that your income is so low that you become eligible for aid…
similarly, serious heath conditions of a family member might give health-care-help…
It’s quite possible we are not in receipt of the full details of your situation…
but, basically… as has been made abundantly clear… in France the S1 only covers a certain amount and the excess has to be paid by the person… one way or another.
You could always shop around for another mutuelle to cover you all, its not compulsory to stick to the same one all the time. Like me, if you have lived and worked in France and paid into health and pension schemes via your work, then you do not get a UK S1 even with a UK state pension payment each month. My case is different to yours in that I get CSS (CMU-C) which also includes a mutuelle of my choice from their list but all this is means tested and awarded due to your monthly income, not an automatic right.
I have the S1 form gathering dust!
The PUMA charge is called the Cotisation Subsidiaire Maladie (CSM) .
The charge has been the subject of legal controversy, which we have covered in several health articles:
As we stated above, the formula was changed significantly for 2019 onwards, substantially reducing the number of households liable, but it remains a complex formula, leaving many households exempt, granting them free affiliation. We question whether such arrangements are sustainable.
One of the most notable characteristics of the charge is that it is applied on an individual basis, not per household, contrary to many other taxes and charges.
Nevertheless, exemptions apply to the whole household where one of them meets the conditions for exemption.
To be liable for the charge three conditions apply:
The law states the income that is liable is:
Cette cotisation est assise sur le montant des revenus fonciers, de capitaux mobiliers, des plus-values de cession à titre onéreux de biens ou de droits de toute nature, des bénéfices industriels et commerciaux non professionnels et des bénéfices des professions non commerciales non professionnels…
In short, the charge is aimed at those who live on their capital income, but who are not of pensionable age. Note that revenus de patrimoine includes capital gains.
In relation to pension income, the regulations make no distinction between State retired pensions and early retirement pensions/annuities. They merely reiterate the clause set out in Article L380-2 of the Code de la sécurité sociale, which states individuals are only liable if:
‘Elles n’ont perçu ni pension de retraite, ni rente, ni aucun montant d’allocation de chômage au cours de l’année considérée. Il en est de même, lorsqu’elles sont mariées ou liées à un partenaire par un pacte civil de solidarité, pour l’autre membre du couple.’
This clause means that a couple would be exempt if only one of them was in receipt of a pension.
In guidance published by the social security agency URSSAF, they make a distinction between French pensions and foreign pensions, stating that whilst pensions from the EEA exempt the person, those from outside of the EEA are not automatically exempt. Only those non-Europeans whose health cover is met by their home country would they be exempt:
‘Pour les pensions de retraite servies par un Etat hors Union européenne ou la Suisse, la perception de cette pension permettra d’exonérer la personne uniquement si la prise en charge de ses frais de santé, ainsi que ceux des membres de sa famille qui résident avec elles, est supportée définitivement par le régime étranger qui sert la pension de retraite.’
The legal basis for this statement is not entirely clear as the legislation makes no distinction between the country of origin of the pension and could well be subject to legal challenge. For most of those on a retirement pension, the question is, however, an academic one, for they are covered by an S1 via their home country. In addition, all the circumstantial evidence we have seen suggests that in practice, no distinction is being made between foreign and French pensions.
The official guidance on the issue also states that those in receipt of an invalidity pension would also be exempt, as would their partner.
The position of early retirees on a pension remains open to some interpretation, but it seems that the law is being interpreted widely and that anyone with a pension is being exempted from the charge. Whether that remains the case is questionable, as such pensions in France are normally referred to as a pension de préretraite, a term that is not used in the legislation.
Those who obtain health cover in France via an S1 certificate of exemption, who are insured for health from their home country are exempt. This mainly affects EEA nationals on a State retirement pension, but it also includes anyone else who holds a S1 certificate;
On the income tests the law states exempt households are:
The formula (Décret n° 2019-349 du 23 avril 2019) means that only those with a professional activity earning below €9,273 pa and capital income higher than €23,184 would be liable for the charge.
The two income tests are cumulative, but even if you were liable under these tests, you would be exempt if you were on a pension or an S1.
For those with professional income the charge rate reduces progressively with an increase in professional income.
In the case of a married couple or those in a civil partnership, the charge will not apply to either of them where one of them has income from a professional activity above the threshold.
This same rule applies in relation to those couples where at least one of them is in receipt of a pension, when they are both them exempt from the charge.
An upper limit to the capital income that gives rise to the charge is also applies, equivalent to €370,004 (2024). So income over this amount will be exempt from the charge.
The position of those who are covered for health through a private health insurance policy is not stated in the regulations, but many expatriates with such policies have received a demand for payment of the health charge. Once again, the issue needs some legal clarity. There are a number of cases pending in the courts. URSSAF state that those with a private health policy are not exempt from the charge.
Contrary to widespread belief, there is no specific social charge for health cover on pension (or other) income. This charge, called the Cotisation d’assurance maladie (CAM), is only payable on the pension income of those in receipt of a French pension living abroad who benefit from French health cover, as well as those in the Alsace-Moselle pension scheme. It is also payable by certain ex employees of specialist pension schemes, eg ex railway workers.
The CAM also needs to be distinguished from the Cotisation Subsidiaire Maladie (CSM), under PUMA.
(There are slightly different rules that apply to frontier workers/business owners with Switzerland.)
For those with no professional activity, the only income on which the CSM is payable is income from capital sources, called revenus de patrimoine. That is to say, investment income, rental income and capital gains.
If your income from such sources is below the minimum threshold above you are also exempt from the charge.
Only those with a low income-earning professional activity (as above) would have this income taken into consideration in the calculation on a progressive basis.
A married couple or those in a civil partnership each benefit from the above exemption threshold. They would need to have revenus de patrimoine of around €41,000 before they were liable, but if they were in receipt of a pension, they would remain exempt.
If the level of your revenus de patrimoine in the form of rental income was such that it your were required to become a professional landlord (LMP) you would not pay the CSM, although you would pay social security contributions.
For the purposes of determining the amount payable the authorities can also take into consideration your lifestyle (train de vie), an assessment that will particularly affect those households living on their capital resources. Details of this process have yet to be published.
In your first year in France, without any previous tax returns having been made, the authorities will assess your contribution level on the basis of your tax return and income in your previous country of residence. If your income has reduced significantly since this time (often the case) then you need to make clear this is the case and provide appropriate and clear evidence. The charge is applied on a pro-rata basis for those not in PUMA for a full year.
The insurance contribution rate is 6.5% of net eligible income although disgressive reducing to 0% when professional income is above €11,592 (2024).
With the abolition of ‘dependant’ status (ayants droits) under PUMA, those liable for the CSM will be assessed on the basis of their own eligible income, plus half of the joint revenus de patrimoine they earn with their spouse/civil partner.
As the regulations state: ‘La cotisation subsidiaire est individuelle : elle est due par chaque assuré à titre personnel sur ses revenus du capital.’
The charge is levied in November each year, payable in arrears. So the payment for 2024 is due in November 2025.
It is payable either in one single payment or in three equal payments over 90 days for each payment, but only on request. If payment is not made within 30 days of the demand, there is a 5% penalty plus 0.4% interest for each month of non-payment.
Although the regulations are not explicit on the point, there is no reason for not supposing that the PUMA charge is a deductible expense for the purposes of determining liability to income tax and social charges. We would be interested to hear from your own experience (editor@french-property.com).
If you wish to contest the imposition then you need to write to URSSAF with your documentary evidence.
If they are unwilling to accept your challenge you are entitled to appeal to the Commission de Recours Amiable (CRA) in the agency, which you need to do so within two months of receipt of the bill, and ultimately appeal to a local court, the Tribunal des Affaires de Sécurité Sociale (TASS).
If you pay the CSM the question arises as to whether it is tax deductible.
In our view, the contributions constitute a social security contribution under the terms of article l’article 156, II 4°of the Code des Impots.
Accordingly, you should enter in Box 6DD of your tax form F2042.
It’s just a gamble… as with house insurance, car insurance etc etc…
One pays but hopes never to need it…
However, I can confirm from experience… that there’s nothing so comforting as good insurance cover when disaster strikes.
But I understand that from what you’ve said you are not eligible for an S1! If you hand it to CPAM they will check your record and find you have been paying cotisations here as part of your AE, so will most likely reject it. If the last place you worked was France then France is your competent State, not the UK.
You can continue to be covered by PUMa once you close your AE as every resident in France has the right. And you will get reimbursements as every other French person. But depending on your other income you may have to pay a small charge for the cotisation subsidiaire if you are not in receipt of a pension. This is not the same as a mutuelle which is a choice, although if you income is very low there is a free and nearly free option.
You are quoting large chunks of text, but are misunderstanding some fundamental points so are interpreting it at a slight tangent.
For example, did you tell this person in the UK that you have been working in France for 8 years and contributing to social security here?
Hello Jane
FYI - I am over 66 as of June last year.
I cancelled being an AE from the end of September last year.
I am in receipt of a UK basic state pension from June last year.
I received S1 forms fully completed from the UK for me, my wife and daughter (3).
My wife is not of pensionable age yet, my daughter is severely disabled. We currently receive money from the French for her care as payment to my wife as she is registered as her full time carer.
So all this aside I understand we should still be able to claim exemption from paying and any further Puma payments.
The odd thing is that last year the puma bill was higher for my wife than for me…?
It will be interesting to see whether CPAM accept your S1. In theory they shouldn’t. However having a state pension does open the door to similar benefits and exemptions so maybe they will let it go through.
Not sure what a PUMa bill is, as presumably last year your AE was active so you were paying regular cotisations to URSAFF. Who was your wife paying and for what?
I think the hardest is getting the UK to issue an S1. I was certainly grilled by the UK for mine. After all, that’s basically the UK agreeing to accept charges for you.
I’ll bet CPAM will just take the S1.
I suppose though it’s just possible something might come up later that causes France to join the dots and query why you have an S1. If they do, good chance they let things lie - after all they are getting paid.
One thing - apparently after they accept your S1 and tell you they accept it, as part of the acceptance process CPAM “registers” the S1 and sends confirmation of your S1 having been registered by them, to the UK. Make sure the UK processes this. CPAM registered mine, sent conf to the UK, 2 years later when I got round to asking the UK for an EHIC the UK refused saying I was ineligible as CPAM had not registered my S1.
Of course CPAM had sent confirmation that they had registered my S1 to the UK at the correct time so long ago and could prove it. More bungling by the UK - in other words no one there processed it when received. So I’d advise you to give it 3 months after CPAM advise you your S1 has been accepted and you’re now registered here, and then contact Newcastle Overseas Health to make sure the UK has actually processed that registration confirmation CPAM sent them.
He has one, as was issued to him last year when he hit retirement age.
Yes, they sent me one last year (I didn’t even ask for it)
I was not sent anything last year after starting to receive UK state pension payments, but then I have been away for over 30+ years and worked here in France where I paid my cotisations as did my OH so we are probably not anywhere on their radar now apart from details given when applying for said pension end of 2022.
Why? What good is that doing?
If you have an S1 (assuming you are entitled to it), you should have registered it as per the instructions that came with the form.
You cannot expect the system to work correctly if you leave important documents lying around gathering dust instead of getting them processed.
PS If you want to refer to a website, it is a lot easier for other people if you give the link to the page, and limit your quote the particular sentence or paragraph that you feel is relevant.
Exactly.