French News Archive

Healthcare in France

Calculation of PUMA Health Charge

Thursday 07 December 2017

A circular published by the French government has set out the method for calculating the PUMA health insurance charge.

Last month we reported on the news that many thousands of expatriates in France had received a notice concerning the State health insurance contribution for 2017.

The charge for PUMA - Protection Universelle Maladie – is payable by economically inactive households in France, although many are exempt, and expatriates holding an S1 health certificate are not liable.

Despite this exemption, many of you with an S1 have reported to us that you had been given notice of a forthcoming invoice for the charge.

We had been hoping that the circular would set the position straight, but on this point it is silent.

Nevertheless, we remain of the view that the notice from URSSAF does not apply to S1 holders, who can rely on both primary legislation in France and European law for their exemption.

However, for those expatriates who are liable, the circular clarifies the method of determination of the charge they will pay.

Who is Liable?

Those who are liable for the Cotisation subsidiaire Maladie (CSM) are those who fulfill both of the two following conditions:

• That you have no professional activity (business or salaried), or that you have a professional activity, but your income from this activity is no greater than €3,862pa (2016).


• That you are not in receipt of any kind of pension or unemployment benefit.

In relation to pension income, the circular makes no distinction between State retired pensions and early retirement pensions/annuities. It merely reiterates the clause set out in Article L380-2 of the Code de la sécurité sociale, which states individuals are only liable if:

Elles n'ont perçu ni pension de retraite, ni rente, ni aucun montant d'allocation de chômage au cours de l'année considérée. Il en est de même, lorsqu'elles sont mariées ou liées à un partenaire par un pacte civil de solidarité, pour l'autre membre du couple.

This clause would seem to imply that a couple would be exempt if only one of them was in receipt of a pension. There remains legal uncertainty concerning early retirees.

Eligible Income

The only income that is assessed is 'revenus de patrimoine'. That is to say, investment income, rental income and capital gains. Only those with a low income-earning professional activity (as above) would have this income taken into consideration in the calculation.

In addition, if your income from such sources is below a minimum threshold you are also exempt from the charge.

For 2017, if the total net sum of your revenus de patrimoine is no greater than €9,654, you will be exempt.

A married couple or those in a civil partnership each benefit from this exemption threshold, meaning a couple would be exempt if their revenue de patrimoine was no greater than €19,308.

For the purposes of determining the amount payable the authorities can also take into consideration your lifestyle (train de vie). Details of this process have yet to be published.


The insurance contribution rate is 8% of net eligible income.

With the abolition of 'dependant' status (ayants droits) under PUMA, those liable for the CSM will be assessed on the basis of their own eligible income, plus half of the joint revenus de patrimoine they earn with their partner.

As the circular states: 'La cotisation subsidiaire est individuelle : elle est due par chaque assuré à titre personnel sur ses revenus du capital.'

By way of example, an individual with an annual net personal (capital) income of €15,000 and who also enjoys joint net income of €25,000 in revenus de patrimoine with their partner.

In such a case the calculation is:

• €27,500 (€15,000 + €12,500)
• €27,500 - €9,654 = €17,846
• €17,846 x 8% = €1,427
• CSM = €1,427

Their spouse/partner would face the same assessment process, and pay their own charge.

Only if a spouse chooses to retain 'dependant' status is it conceivable would there only be one assessment for the whole household (and only, therefore, one allowance). It is not entirely clear if this would be permitted by the authorities, except for those on an S1, for whom in any event the charge does not apply.


The indications are that households will be invoiced this month.

The charge is payable either in one single payment or in three equal payments over 90 days for each payment, but only on request. If payment is not made within 30 days of the demand, there is a 5% penalty plus 0.4% interest for each month of non-payment.

Challenging the Assessment

If you wish to contest the imposition then you need to write to URSSAF with your documentary evidence.

If they are unwilling to accept your challenge you are entitled to appeal to the Commission de Recours Amiable (CRA) in the agency, and ultimately appeal to a local court, the tribunal des affaires de sécurité sociale (TASS).

We would be most interested to continue to hear from you. You can contact us at

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