The residence rule

France switched to a residence-based system in 2016 with the creation of PUMa — the Protection Universelle Maladie. Before that, cover was tied to employment or social-contribution status; if your work situation changed, your entitlement wobbled with it. PUMa cut that link. Every person who lives in France de manière stable et régulière — stably and regularly — is entitled to health cover, essentially by virtue of being here.

For EU citizens, stable residence is generally established after three months. For non-EU nationals, a valid residence permit does the job. The key document on both ends is registration with the Assurance Maladie, France's national health insurance body, which issues the carte Vitale — the green chip card that identifies you to the system at every appointment.

2016year PUMa replaced the employment-linked system
70%state reimbursement rate for standard GP consultations
3 monthsminimum residence period required for AME eligibility (undocumented); also threshold for EU citizens establishing stable residence

From when, exactly?

Coverage doesn't start the moment you land. There's an administrative window — typically a few weeks to a couple of months — while the Assurance Maladie processes your dossier and confirms residence. During that gap, care isn't free, but it isn't completely inaccessible either: costs paid out of pocket before the card arrives can sometimes be reimbursed retroactively once registration is confirmed.

Children born in France are registered from birth. People arriving with a valid permit can begin their application immediately, and the Assurance Maladie website lists the required documents by situation. Once the carte Vitale is issued, it activates access to reimbursement at the standard rate — 70% of the tarif de base (the official fee schedule) for most consultations with a general practitioner.

Those in genuine hardship who don't yet qualify for PUMa — or who have no residence permit at all — are not left entirely without recourse. A separate scheme, the Aide Médicale de l'État (AME), covers urgent and necessary care for undocumented people who have been in France for at least three months. It's a narrower safety net, and accessing it requires its own application, but it exists.

What residence doesn't settle

Being covered is not the same as being well connected to care. Registration opens the door to reimbursement, but choosing a registered GP as your médecin traitant is a separate step — one that directly affects how much of each bill the state picks up. Coverage begins with residence; getting the full value of it takes a little more.

Repères — the sequence

  1. Pre-2016cover tied to employment and contribution record
  2. 2016PUMa introduced; residence becomes the sole qualifying criterion