3. Protection Universelle Maladie (PUMA)

  1. What is PUMA?
  2. How Much do You Pay?
  3. How to Apply for PUMA

3.3. How to Apply for PUMA

To obtain health cover through the PUMA you need to register with your local health authority, the Caisse Primaire d’Assurance Maladie (CPAM).

There are numerous CPAM offices throughout each department of France. The location of your local office can be found in the telephone directory, on-line, or ask at your mairie.

To apply you need to complete the application Form 736 Demande d'affiliation au régime général sur critère de résidence. Print it off, complete it, and include all the necessary documentation with it.

Early retirees from the EEA are also sometimes asked by their local CPAM to complete a separate Form 710 Questionnaire "recherche de droits" Ressortissants Européens Inactifs.

You will need to produce evidence of your income, your passport, marriage certificate, birth certificate and proof of residence, e.g. electricity or telephone bill.

You will also need to supply your French bank account details as reimbursements for health treatment will be paid directly into your bank account.

If you are seeking admission on medical grounds or other 'accident of life' provisions under French law, then you will similarly need to produce appropriate evidence.

In particular, those seeking admission on medical grounds will need to produce evidence of a refusal of private health insurance cover, or insurance premium payments that are excessive in relation to your income.

Processing of your application may take several months. Indeed, we are aware of applicants who have waited more than a year for a decision. Applications from EEA early retirees are referred to the Nimes CPAM, where the assessment process and registration takes place, although some CPAMs process such applications locally, contrary to the agreed arrangements.

If you consider your application is not being processed with due alacrity you are entitled to invoke a conciliation procedure, which you can do by writing to the Conciliateur at the CPAM, although it would only be appropriate to use this process if previously remonstrations to the CPAM have been fruitless. Some evidence in writing would be required.

Once accepted into the system, until you are issued with a plastic health insurance card, called a carte vitale, you will be provided with a formal notice (attestation), which you will need to use to pay and then reclaim each time you use the health service.

When your carte vitale arrives it will include with it a new attestation that you are in the health system. This formal notice is sometimes required to be presented when you need hospital or specialist treatment, so it is useful to keep both handy at all times.


If you are refused access you are entitled to write to the appeal body of the CPAM, called the Commission de recours amiable (CRA), application to which is time-limited to two months after you receive the letter of refusal. You are entitled to a letter of refusal.

These appeal bodies operate in a rather opaque manner, but they include lay assessors on them, and so are not necessarily dominated by an official mind-set.

Next: Voluntary/Complementary Health Insurance

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