CPAM & Ameli Registration in France: Step-by-Step Guide for Expats (Sécurité Sociale 2026)

CPAM stands for Caisse Primaire d'Assurance Maladie — the local branch of the French public health insurance fund. There are 101 CPAMs in France (one per département + overseas, plus a non-resident centre in Rubelles for non-residents and a CNAM for the national level). The CPAM you register with is determined by your home address, not your nationality, employer, or previous coverage.

PUMA — Protection Universelle Maladie. Since 1 January 2016, PUMA has replaced the older CMU (Couverture Maladie Universelle). Codified in Article L160-1 of the Code de la Sécurité Sociale, it states that any person working in France, or — when not exercising a professional activity — residing in France in a stable and regular manner, is entitled to public health insurance for illness and maternity.

Two critical sub-rules:

• Stable residence = at least 3 consecutive months in France for non-workers (Art. R111-2 CSS). Workers covered through their employer are exempt from this delay.
• Justification of residence = ability to prove 6 months in France over the last 12 months at any time the CPAM asks (typically when renewing your attestation).

PUMA does not mean care is free. It means your CPAM applies the taux de remboursement conventionnel — typically 70% on doctor visits, 80% on hospitalisation, 60% on prescription drugs — and you pay the ticket modérateur (the rest) yourself unless you have a mutuelle complémentaire (covered later).

PUMA is universal, but the administrative path depends on your situation. Pick yours from the five most common scenarios below — your dossier and the form you send are not identical from one to the next.

• Salaried workers (private sector). Your employer declares you to URSSAF on your first payslip via the DSN (déclaration sociale nominative). URSSAF transmits the data to your CPAM, which contacts you for the missing documents (titre de séjour, RIB, birth certificate). You do not need to send S1106 yourself — but you must follow up with the CPAM if 4 weeks pass without contact.
• Self-employed and auto-entrepreneurs. Since 1 January 2020 the SSI (Sécurité Sociale des Indépendants) has been folded into the régime général. You are affiliated to your local CPAM via URSSAF when you register your activity on the guichet unique INPI. Same dossier follow-up as employees.
• Students (EU and non-EU). Since the rentrée 2019, students are no longer in a separate régime étudiant. Enrolment at a French university auto-registers you with the régime général. EU students can use their EHIC for short stays; for stays > 3 months, you create your espace assuré on ameli.fr after the university has transmitted your data.
• Retirees with a foreign EU/EEA pension. If your only income is a pension from another EU member state, your home country issues an S1 form (formerly E121). You file the S1 with your CPAM and remain covered at the expense of your pension country — France just handles the medical paperwork. UK retirees living in France post-Brexit also use an S1 if entitled.
• Inactive residents (no employer, no pension, just savings). This is the path that uses form S1106. You wait until you have proof of 3 months of stable residence, then send the dossier described in the next section. You may later be liable for the cotisation subsidiaire maladie (CSM) if your capital income exceeds 50% of the PASS (€24,030 for 2026).
• Dependents (ayant droit). Spouses, registered partners and children under 16 of an insured person are automatically covered as ayants droit. From 18, each adult must have their own affiliation — but the régime universal means there's no gap as long as residence is stable.

The complete list, verified against ameli.fr and service-public.fr R45084. Send photocopies, never originals — the CPAM will not return them. Originals stay with you for the eventual CPAM appointment.

Mandatory for everyone:

• Form S1106 (Cerfa 15763*02), filled in and signed. Download it from ameli.fr → Formulaires.
• Identity proof. EU/EEA/Swiss citizens: valid passport or national ID. Non-EU: passport + valid titre de séjour or visa long séjour valant titre de séjour (VLS-TS) validated on the administration-etrangers-en-france.interieur.gouv.fr portal.
• Full birth certificate (extrait d'acte de naissance avec filiation) issued within the last 12 months. If not in French, translation by a sworn translator (traducteur assermenté). For non-EU countries without a treaty exemption, the document must carry an apostille or be légalisé by the French consulate in the country of issue.
• Justificatif de domicile. A recent (less than 3 months old) bill in your name from EDF, Engie, Veolia, a French ISP, a landline operator, or a quittance de loyer. If you live with someone, an attestation d'hébergement + the host's ID + the host's own bill.
• RIB (Relevé d'Identité Bancaire) of a French or SEPA bank account in your name (Wise, Revolut, N26 with French IBAN are accepted; foreign IBANs work too if SEPA-compliant).

Required if applicable:

• Attestation employeur + a copy of your latest payslip if employed.
• Marriage certificate / livret de famille (less than 12 months) if registering a spouse as ayant droit.
• Proof of stable residence (3 months) if you have no salaried activity: 3 consecutive bills, or rent receipts, or an attestation d'accueil + host bills.

Address, not email. The dossier goes by post (registered mail with receipt is recommended) to the CPAM of your home département. Find the correct one on ameli.fr → "Adresses et contacts" by typing your postal code.

Two scenarios: you have a numéro de sécurité sociale provisoire (assigned by URSSAF when an employer declared you), or you have nothing yet (inactive new arrival).

Step 1 — Find your CPAM. Go to ameli.fr → "Adresses et contacts" → enter your postal code. Note the postal address. Do not send your file to the wrong département — it will be returned 6-8 weeks later.

Step 2 — Fill in form S1106. Page 1 = identity (use the names exactly as written on your birth certificate, not your French preferred name). Page 2 = situation (employed / self-employed / inactive / pensioner). Page 3 = address and dependents. Pay attention to the date d'arrivée en France — that's what the CPAM uses to count the 3-month delay.

Step 3 — Compile the dossier. Use the document list above. Add a short cover letter in French stating your situation in 4-5 lines ("je sollicite l'ouverture de mes droits à l'Assurance Maladie au titre de la PUMA"). A clean, ordered dossier processes faster.

Step 4 — Send by post. Recommended: lettre recommandée avec accusé de réception. Cost ~5 €. Keep the AR slip — it is your only proof if the dossier is lost.

Step 5 — Wait for the numéro de Sécurité Sociale. Once received and validated by the CPAM, you receive a definitive 13-digit numéro de Sécurité Sociale (replacing any provisional one) by post. Average delay: 2 to 12 weeks depending on the département. Paris CPAMs are notoriously slower; rural CPAMs faster.

Step 6 — Create your espace assuré on ameli.fr. Click "Créer un compte". You'll need the 13-digit number, your date of birth, your postal code, and the code provisoire sent on a separate letter. This is where you see your reimbursements, upload documents, request a carte vitale, and message the CPAM. The 2024 redesign of the espace assuré made this step considerably faster — but you still need the activation code, which is sent only by post.

Once your dossier is validated and you have your numéro definitif, you can request the carte vitale. This green chip card is what pharmacies and doctors swipe to bill the CPAM directly (third-party payment, tiers payant) — without it, you pay upfront and wait weeks for reimbursement.

Timeline. The card is issued in 2 to 3 weeks after the CPAM validates the file (source: ameli.fr, service-public.fr F265). Online request via the espace assuré is typically the fastest path; postal request can extend to 3-4 weeks. If 4 weeks pass without delivery, log in to ameli.fr → "Mes démarches" → "Suivre ma demande de carte vitale" or call 3646 (free from a French line, Mon-Fri 08:30-17:30).

The photo. Since 2017 the carte vitale carries your photo. You can upload it directly from your espace assuré or send a passport-format photo by post. Common rejection reasons (we've seen all of them):

• Photo is too dark, too small, or has a coloured background — must be neutral white/light grey.
• Smile / mouth open / glasses with reflections — same rules as a passport photo.
• Wearing a hat / headphones / hood — refused unless religious exemption with documentation.

While you wait — the attestation provisoire de droits. Downloadable from the espace assuré once your file is validated. It is a one-page A4 document showing your name, numéro de Sécurité Sociale, and rights status. Doctors and pharmacies accept it for tiers payant exactly like a carte vitale, but the reimbursement is processed manually and is therefore slower (2-3 weeks vs same-day with the card).

If you lose your carte vitale. Declare it via the espace assuré or by calling 3646. A replacement is dispatched in 2-3 weeks. The lost card is not blocked — it could still be used by a third party until expiry — but reimbursements are processed only against the new one.

The médecin traitant is your designated reference doctor — usually a médecin généraliste, occasionally a specialist for specific conditions. Declaring one is mandatory from age 16 under the parcours de soins coordonnés introduced by the 13 August 2004 reform. The mechanism: when you are referred by your médecin traitant to a specialist, the specialist's reimbursement stays at the conventional rate (70%). When you go directly to a specialist without referral, the reimbursement drops to 30% — a 40-percentage-point penalty, and dépassements d'honoraires (overcharges) are no longer reimbursable by your mutuelle.

The declaration form. Use **Cerfa 12485*03 (also called S3704)** — Déclaration de choix du médecin traitant. It is co-signed by you and the doctor, then sent to your CPAM. The doctor often submits it electronically via Sesam-Vitale during your first appointment; if not, mail it yourself. Verify the latest version on ameli.fr.

Switching médecin traitant. No formal procedure — simply fill in a new Cerfa 12485*03 with the new doctor and send it in. The previous declaration is automatically superseded. There is no waiting period; the new declaration takes effect immediately.

Specialists you can see directly without referral. Even within the parcours de soins, four categories of specialists are en accès direct without losing the conventional rate: ophthalmologists, gynaecologists, paediatricians (for under-16s), and stomatologists / dental surgeons.

Without a médecin traitant. First-year expats who haven't yet found one are not immediately penalised — the CPAM tolerates a transitional period. But the longer you wait, the more out-of-pocket spending accumulates that you'll never recover. Practical advice: pick a généraliste in walking distance of home or work, even temporarily. You can switch later in 5 minutes.

PUMA covers the tarif de convention, but rarely 100%. The remaining cost — ticket modérateur + participations forfaitaires + dépassements d'honoraires — falls on you unless you have a mutuelle complémentaire santé. In 2026, fewer than 5% of French residents are without one.

What a mutuelle covers.

• Ticket modérateur — the part of the tarif de convention not reimbursed by the CPAM (e.g. the 30% on a généraliste consultation).
• Forfait journalier hospitalier — €20/day during hospitalisation, not covered by PUMA.
• Dépassements d'honoraires — overcharges by sector-2 doctors (frequent in Paris, Lyon, Lille). Coverage depends on your formula: 100% TC, 200% TC, 300% TC.
• 100% Santé. Since 2021, dental crowns, optical (frames + lenses), and hearing aids are reimbursed in full by CPAM + mutuelle for products in the panier 100% Santé. Outside that basket, normal co-payment rules apply.

Employer obligation. Since 1 January 2016 (loi ANI 2013, codified in Art. L911-7 of the Code du Travail), every private-sector employer must offer and partially fund a mutuelle d'entreprise covering the employee. Spouses can usually be added at extra cost. Public-sector employees were progressively covered from 2024 under the protection sociale complémentaire reform.

Choosing a mutuelle as an expat. Online comparators (LesFurets, LeLynx, Hyperassur) work, but always check three things: the actual reimbursement table per category (TC%, real €), the délai de carence (waiting period) for hospitalisation and dental, and whether your country of origin's residual coverage is recognised — some mutuelles refuse to cover the first 3 months for new arrivals from non-EU countries.

CSS — Complémentaire Santé Solidaire. If your household revenue is below the eligibility threshold (~€10,166/year for a single person in 2026), you qualify for free or low-cost (€8-30/month per person depending on age) public-mutuelle coverage. Apply via your espace assuré → "Démarches" → "Demander la CSS".

Five mistakes account for the overwhelming majority of avoidable problems we see in the expat population:

1. Sending the dossier to the wrong CPAM. Each département has one. If you live in Versailles, your CPAM is the CPAM des Yvelines — not the Paris CPAM, even if your French address is your employer's office. Returned dossiers cost 6-8 weeks. Verify on ameli.fr → Adresses et contacts.
2. Unclear or expired titre de séjour. Non-EU expats often send a récépissé (receipt of application) instead of the actual titre de séjour. CPAMs accept récépissés but only if dated within the last 3 months. If yours is older, request a new one at your prefecture before submitting.
3. Forgetting to declare a médecin traitant. As covered above — the cost is silent: you simply receive smaller reimbursements for months. Set a calendar reminder for week 4 after registration to find a généraliste.
4. Moving without notifying the CPAM. A new postal address inside the same département: update via the espace assuré (5 minutes). A new département: you must request a transfert de dossier via your old CPAM, which forwards everything to the new one. Carte vitale stays the same; reimbursements may pause for 2-4 weeks during the transfer.
5. Language confusion on form S1106. The form's wording is dense legal French. The line "Activité professionnelle salariée actuelle" is asking whether you are currently employed, not whether you have ever been. The "date d'arrivée en France" is your physical arrival, not the date of your visa. Misfilling these fields delays the dossier by weeks while the CPAM clarifies.

Where AdminLanding fits. The whole CPAM workflow — finding your CPAM, filling S1106, declaring a médecin traitant, handling a département change, requesting CSS — happens on ameli.fr. Guide: Démarches en France is a Chrome extension and Android app that sits on top of ameli.fr and annotates every field, in English or French, in real time. It explains what each S1106 box means in plain English, flags which document is missing from your dossier, walks through the médecin traitant declaration, and never sends your data to a server (annotations are rendered locally). You can grab it as a Chrome extension or a mobile app on Google Play or App Store, or read the full feature page at adminlanding.com/guide-ia. For frontaliers comparing French and Swiss systems, see also our LAMal vs CMU guide; for a broader European overview, the European healthcare overview covers the cross-country picture.