French News Archive

Healthcare in France

French Health Insurance Contribution for 2016/17

Monday 27 November 2017

Many thousands of expatriates have incorrectly been sent a notice for the payment of the PUMA health contribution, when they are not liable to pay the charge.

Last year the French government abolished the basic Couverture Universelle Maladie (CMU de base), a branch of the health system that covered inactive households.

It was replaced by Protection Universelle Maladie (PUMA), a more universal, automatic, continuous system of affiliation.

As part of the change, the method of determining the health insurance contribution payable for affiliation was also reshaped.

Under the CMU, the level of the contribution was 8% of all income above a minimum threshold, which in recent years has been around €9,500, revised annually.

The new contribution is called the Cotisation Subsidiaire maladie (CSM). This charge is unconnected with the social charges CSG etc, which are imposed on most income and capital gains.

Although the percentage contribution and the minimum floor has been maintained under PUMA, the only income that is taken into account is investment and rental income and capital gains, called 'revenus de patrimoine',

Pension income is excluded, a definition which would seem to include early retirement pensions, as only capital based income is taken into account, although this point remains to be confirmed.

The Ministry of Health in France have stated to us that if a household has no revenus de patrimoine above the current minimum threshold of €9,654, they would not be liable for the health contribution.

Others who are not liable for the CSM are those who hold an EU S1 (health) certificate of exemption, as their health care is paid for by their country of origin. This group includes State retired pensioners, those in receipt of a long-term disability benefit and cross-border workers.

In addition, those covered for health via a private insurance policy are also exempt, as they are not affiliated to the French health system.

Despite these exemptions, we have received many mails from those of you who have heard from URSSAF, the social security contributions collection agency, stating that you are liable for the CSM and notifying you that you will receive an invoice for payment in due course. The letter states, inter alia:

''Selon les informations dont nous disposons, vous releviez de l'assurance maladie française en 2016 du fait de la stabilité de votre résidence en France, sans avoir néanmoins été amené à cotiser à la sécurité sociale au titre d‘une activité professionnelle ou à percevoir une pension de retraite au titre d’une telle activité passée. Par conséquent, selon Ie niveau de vos revenus, vous serez susceptible d’être redevable d’une «cotisation subsidiaire maladie»''

We have seen several copies of these letters, which all appear to be the same, despite being sent from different parts of the country.

We have spoken to URSSAF about the notice, who have confirmed to us that it is genuine, but that some households who are not liable for the charge may well have received it. The notice has been sent out on the basis of information provided to URSSAF by the French tax authority. It may well be that there has simply been a general sweep of ressortissants européens inactifs.

According to the agency, the notices have been sent out without prior filtering of some potentially exempt household categories due to incomplete records held by them. There are also likely to be coding errors in household records held by the agency. This would include those holding an S1 certificate.

The new system has not modified international agreements already in place concerning attachment of certain categories of persons to the social security system of their country of origin, as is stated in an internal circular we have seen from the French health department: 'La Puma ne modifie pas les dispositions règlementaires existantes applicable aux migrants qu’ils soient permanents ou du passage pour UE/EEE ou Suisse ou non-EEA.'

Strictly speaking, therefore, those households with an S1 are not affiliated to PUMA. Article 160-6 of the Code de la sécurité sociale states that amongst those excluded are:

"Les personnes titulaires d'une pension étrangère qui ne bénéficient pas par ailleurs d'un avantage viager d'un régime obligatoire de sécurité sociale français lorsque, en application d'un règlement européen ou d'un accord international, la prise en charge de leurs frais de santé ainsi que de ceux des membres de leur famille qui résident avec elles relève du régime étranger qui sert la pension."


'Les travailleurs détachés temporairement en France pour y exercer une activité professionnelle et exemptés d'affiliation au régime français de sécurité sociale en application d'une convention internationale de sécurité sociale ou d'un règlement européen, les membres de leur famille qui les accompagnent ou toute autre personne relevant de la législation de sécurité sociale d'un autre Etat en raison de son activité professionnelle, ainsi que les membres de la famille de cette personne qui résident avec elle de manière stable et régulière en France.'

Those who hold an S1 certificate of exemption are only nominally affiliated to PUMA (for the purposes of administration), as European laws grant them and their family members an entitlement to health cover from their home country via the certificate.

Should you consider you are exempt due to an S1 certificate, or you are below the income threshold making you liable for the charge, you need to make contact with your URSSAF office. You would be best advised to await receipt of the actual invoice before you contest the imposition.

Similarly, even if you are liable for the charge, but that pension income has been included in the calculation, you should make a claim for a reduction in or abolition of the charge if your other income is below the threshold that requires you pay it. Indeed, if you are in receipt of a pension (of whatever kind), the regulations suggest you would be exempt!

Thank you to those of you who have written to us on this matter. We would be most interested to continue to hear from you. You can contact us at You should also see an update at Calculation of PUMA Charge.

Related Reading:

Thank you for showing an interest in our News section.

Our News section is no longer being published although our catalogue of articles remains in place.

If you found our News useful, please have a look at France Insider, our subscription based News service with in-depth analysis, or our authoritative Guides to France.

If you require advice and assistance with the purchase of French property and moving to France, then take a look at the France Insider Property Clinic.