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Carte Vitale and healthcare in France – PUMa, médecin traitant, mutuelle and what you pay

Last updated 25 September 2026Rules checked every MondayOfficial sourcesSources & methodology →

Your carte Vitale is the key to French healthcare, but you only get one with a definitive social security number, and what you are reimbursed depends on choices you make early. Here is how PUMa cover, the médecin traitant, a mutuelle and the 2026 changes fit together.

Smiling woman talking to a female doctor holding a clipboard
Photo: Syda Productions/Adobe Stock

The carte Vitale (health card) is how the Assurance Maladie (national health insurance) recognises you at the doctor's or the pharmacy, and with it you are reimbursed in about a week. Behind it sits PUMa, the protection universelle maladie (universal health cover), for anyone who works in France or lives here in a stable and regular way. Several charges changed in 2026, and another change arrives on 1 October.

What is changing in French healthcare in 2026?

DateChange
November 2025The carte Vitale app is available throughout France
1 March 2026A&E visit without admission €23 (was €19.61); hospital stay €23 a day (was €20)
27 June 2026Sick notes from a teleconsultation cover 3 days at most, as a rule
1 September 2026Refuse a biosimilar or hybrid substitute without medical reason and you lose tiers payant (third-party payment), so you pay upfront
1 September 2026A first sick note lasts at most 31 days, each extension 62, unless the doctor justifies more
1 October 2026Annual caps on medical deductibles and on the €2 contributions rise from €50 to €70 each – up to €140 a year in total
Not yet in forceA contribution from inactive residents who pay no CSG under an international convention: voted, but awaiting the decree that sets the amount

Source: Service-Public and the Assurance Maladie, read 23 September 2026.

Who is covered by PUMa, and from when?

If you work, you are covered from your first hour of work: your employer handles the hiring formalities, and you contact the CPAM (local health insurance office) where you live to complete registration with form S1106. Family members living with you for more than three months are covered for care. If you do not work, rights open three months after you arrive – refugees, among others, are exempt from the wait. EEA and Swiss nationals need only an ID card or passport; everyone else needs a titre de séjour (residence permit) or other residence document.

Your situationHow you are covered
EmployeeEmployer starts the affiliation; you complete it with your CPAM
Passeport Talent – salarié visa, foreign model, language assistant or au pairFormalities go directly to the Paris CPAM – a Paris rule
Posted worker, normally up to 24 monthsStay in your home scheme; register in France with form S1
EU/EEA pensionerForm S1 from your pension fund, also for accompanying family
Inactive EU/EEA/Swiss citizenAfter 3 months of stable residence, if household resources reach RSA/ASPA (minimum income) levels
Non-EU studentRegister free with the Assurance Maladie online service for foreign students
No regular residenceNo PUMa, but possibly AME (aide médicale d'État, State medical aid)

Source: Service-Public, the Assurance Maladie and Campus France, read 23 September 2026.

The EHIC (European Health Insurance Card) covers unforeseen care on a visit, but not planned treatment or private care; once you live here, form S1 counts, not the EHIC.

How do you get your carte Vitale in France?

Born abroad, you first need a social security number. Send form S1106 with your ID or residence document and a civil-status document, such as a full birth certificate – translated into French unless it comes from the EEA or Switzerland or a treaty exempts it. You first get a temporary number, the NIA: it lets you be reimbursed for up to nine months, but gives no carte Vitale and no ameli account. If documents are missing, rights are suspended at six months and removed at nine. Part 3 covers the number.

StepWhat happensTime
1Form S1106 and documents to your CPAMAs soon as you arrive, or your employer starts it
2Temporary number (NIA): reimbursement, but no cardValid up to 9 months
3Definitive social security numberThe Assurance Maladie gives 9 months as its processing time
4Order the free carte Vitale in your ameli accountAbout 2 weeks online, about 3 by post
5Declare your médecin traitantOnce a doctor agrees

Source: the Assurance Maladie and Service-Public, read 23 September 2026.

You can also order the app version in the ameli app, with a selfie and a photo of your ID. The Assurance Maladie line is 3646, Monday to Friday, generally at least 8:30–17:30, though hours vary by département; from abroad, call +33 1 84 90 36 46.

Why declare a médecin traitant – and what does a visit cost?

Everyone aged 16 or over should declare a médecin traitant (regular doctor), a GP or specialist of your choice who must agree. The doctor declares it online with your carte Vitale, or you both sign form S3704 for your CPAM. If you cannot find one, contact an organisation coordonnée territoriale (local coordinated care organisation) and, failing that, your CPAM. Gynaecologists, ophthalmologists, stomatologists and, for ages 16 to 25, psychiatrists can be seen directly and are reimbursed at 70 per cent.

GP visit at €30 (sector 1)Assurance Maladie paysYou pay
With a declared médecin traitant€19 (70 per cent minus the €2 flat contribution)€11, or €2 with a mutuelle
Without one€8.40The rest

Source: the Assurance Maladie and Service-Public, read 23 September 2026.

On top come the participation forfaitaire (flat contribution) of €2 per consultation, lab test or X-ray, and the franchises médicales (medical deductibles): €1 per box of medicine, €1 per paramedical act and €4 per medical transport. Under-18s, people on the C2S or AME and pregnant women from the sixth month until 12 days after the birth are exempt. Medicines are reimbursed at 100, 65, 30 or 15 per cent; homeopathy no longer is. Sector 2 doctors outside the OPTAM scheme set their own fees, but you are reimbursed on a €23 basis whatever you pay.

What does a mutuelle cover – and do you need one?

A mutuelle (top-up health insurance) pays what the Assurance Maladie does not. A responsible contract must cover the ticket modérateur (co-payment) on doctors' fees and the whole daily hospital charge, though not the €2 contributions or deductibles, and top-up insurance repays the A&E fee in full. Private-sector employers must offer all employees a collective mutuelle and pay at least half the premium; in some cases you can opt out.

On a low income, the Complémentaire santé solidaire (C2S, solidarity top-up cover) is free or costs a monthly contribution. As a foreign national you need a valid residence permit and more than three months of uninterrupted residence, although workers and students may qualify sooner.

HouseholdC2S free if annual resources do not exceed
1 person€10,421 (with a contribution: up to €14,069)
2 people€15,632
3 people€18,758
4 people€21,885
Each extra person+€4,169

Source: Service-Public, read 23 September 2026.

Which numbers do you call in an emergency?

NumberFor
15SAMU (medical emergency); also the Service d'accès aux soins when your own doctor is unavailable
17Police
18Fire brigade – fire, accidents, danger
112European emergency number, answered in French or English
114Deaf, hard-of-hearing or speech-impaired people, by SMS, app or video
3624SOS Médecins, doctor home visits around the clock
0 800 112 112The number emergency services call you back from – not spam

Source: Service-Public and Campus France, read 23 September 2026.

Emergency calls are free and work from any phone with a SIM card, even when your credit has run out. For non-urgent care at night, at weekends or on public holidays, your mairie (town hall) can give you the list of on-call doctors and pharmacies.

What to do now

StepWhatWhen
1Send form S1106 with ID, residence document and birth certificate to your CPAMFirst weeks, unless your employer starts it
2If you do not work, count on cover from 3 months after arrivalFrom arrival
3Order your carte Vitale in your ameli accountOnce you have the definitive number
4Find a médecin traitant and declare themAs soon as a doctor agrees
5Join your employer's mutuelle, or check whether you qualify for the C2SWhen you start work, or after 3 months
6Save 15, 112 and 0 800 112 112 in your phoneToday

Source: the Assurance Maladie and Service-Public, read 23 September 2026.

Official sources

The official pages this guide is based on, read 23 September 2026. Links open the authority’s own website.

Relocate in Europe provides general information, not legal or financial advice for your individual situation. Check with the authority named above before you act – rules change, and your case may differ.