3. Protection Universelle Maladie (PUMA)

  1. What is the PUMA?
  2. Application Process for PUMA
  3. Free Health Insurance (CMU-C)
  4. Assistance with Voluntary Insurance

3.3. Free Health Insurance - CMU Protection Complémentaire

The CMU Protection Complémentaire (CMU–C) provides free health insurance cover for those on a low income, whether unemployed, employed, or self-employed.

'Inactive' expats under the age of retirement are entitled to access the CMU-C, provided they have first obtained affiliation to PUMA.

We do sometimes hear reports of expats being denied access to the CMU-C, even though they are clearly entitled, so if you are refused access then get advice and challenge the decision.

If you are in employment or run a small business you would also be entitled to access to the CMU-C, provided you meet the income criteria.

The CMU Protection Complémentaire should not be confused with assurance complémentaire. The latter is voluntary ('top up') health insurance.

If you are in receipt of CMU Complémentaire then, as a general rule, all medical and dental costs are fully covered and you will have no costs to pay, provided you always pass through your family doctor for medical services.

Unlike many other health service users, those in receipt of CMU-C do not pay for their treatment and then seek reimbursement. The treatment is provided free of charge at the point of delivery and it is the doctors and chemists who themselves then recover their fees and charges from the health service.

Doctors and specialists who treat you are required by the government to only charge the basic, official fee. That is to say exempt from supplementary charges often imposed by consultants, called dépassement d'honoraires.

There is evidence that some specialists do not always honour this rule, and that some CMU-C patients are being asked to pay additional fees, or simply refused treatment. In either case this practice is not permitted and should be reported to your local Caisse.

The current annual income thresholds for entitlement to CMU–C are not generous. The level depends on the size of your household, as follows:

CMU-C Income Thresholds - April 2019-April 2020

Household Annual Income
One Person €8,951
Two People €13,427
Three People €16,112
Four People €18,797

For each person in excess of this number, the income threshold is increased by €3,580.

These income thresholds are per 'fiscal household'. That is to say, the income of all those living in the property is taken into account, provided all appear on the same income tax return. This would include children under 25 years and in employment, but who had elected to be part of the same household for tax purposes.

The reference period for determining your income is the previous twelve months. So for a demand in Oct 25 2019, it is the year ending 30th September 2019 that is the reference period.

If you do not have a mortgage on your property an additional sum is added to your income to calculate your entitlement to CMU-C. This sum is called the forfait logement.

For 2018 the level of this figure is €793 per year for a single person; for a couple it amounts to €1,388 per year; for a family of three or four persons it is €1,666 per year.

Accordingly, as an owner-occupied couple without a mortgage, if your income in the reference year was €10,000, the authorities would assess your notional income as being €11,388, simply because you have no accommodation charge to pay.

If your application for CMU-C is successful you will be granted entitlement for a full year, irrespective of any change in your circumstances during this period. At the end of twelve months there will be a review of your entitlement, when you will be asked to complete a new test of resources.

Application can be made to your local Caisse (normally the Caisse Primaire d’Assurance Maladie or RSI) to whom you should provide proof of your income.

You can download the Application for CMU-C.

If your income is too high to obtain entitlement to the CMU-C, you may still be entitled to assistance with your voluntary health insurance costs.

There are changes planned in the CMC-C from Nov 2019, which you can read about at Help with French Health Costs. We shall be updating this page in due course.

Next: Assistance with Voluntary Insurance

Back: Application Process into PUMA

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