The Sécurité sociale and the carte Vitale
The general scheme covers most of the cost of consultations: 70% of a doctor's visit, with the remainder paid by the patient or their mutuelle. When you hire an employee, the company automatically affiliates them through the DPAE (the prior declaration of employment), and coverage starts from the first day of work.
The worker receives their social security number and, in about two to four months, the carte Vitale, the card that allows automatic reimbursement. While it arrives, the certificate of rights downloadable from ameli.fr serves as proof.
PUMA: coverage for residents without a job
The Protection Universelle Maladie guarantees coverage for anyone residing in France stably and legally, whether employed or not. An inactive resident with a residence permit must prove three months of stable residence; workers are covered from the first day, with no waiting period.
A detail that often goes unnoticed: since 2016, the inactive spouse does not have automatic coverage through the worker. They must open their own rights with the PUMA, and if inactive, wait their three months.
The mutuelle: mandatory in the company
Since 2016, every employer must offer a company mutuelle (complementary insurance) and pay at least 50% of the premium of the cheapest contract. The typical cost for the worker ranges between 15 and 40 euros per month, and covers the ticket modérateur, the hospital forfait and part of optical and dental according to the contract.
For employees with low incomes, there is the Complémentaire Santé Solidaire (CSS), the free or reduced-cost public mutuelle: free up to 10,421 euros annual income, and between 8 and 30 euros per month between 10,422 and 14,069 euros.
Self-employed and micro-entrepreneurs
The self-employed in France affiliate through the URSSAF and pay their own contributions: in the micro-entrepreneur scheme, total contributions are 12.3% of turnover for sales and 21.2% for services, and these fund sickness coverage, among other branches.
The company mutuelle does not exist for the self-employed who have no employees: they need an individual mutuelle, which costs between 20 and 80 euros per month depending on coverage, or they access the CSS if their income is below the threshold.
What usually goes wrong in practice
Affiliation with the CPAM is a process with known pitfalls. They require a full birth certificate, translated by a sworn translator and apostilled: a simple extract or a non-sworn translation delays the file for weeks. The provisional number (NIA) expires after nine months if identity is not certified, and a one-letter difference in the name can block registration for months.
And a note: the European Health Insurance Card only covers temporary stays, not residence. If an employee arrives in France with their family, it is advisable to start the affiliation from day one and not wait until they have a contract: PUMA does not require employment.
