The health system in France is one in which the State is responsible for only a proportion of your health treatment costs; a complementary insurance system sits alongside it to pick up those charges not met by the State.
The complementary system is not compulsory, so if you do not have a policy you need to pay the additional charges directly.
There are some important exceptions, for certain major illnesses are fully covered by the State and those on a low income are also entitled to 100% cover.
In addition, those of modest means are entitled to get assistance towards the costs of complementary 'top-up' health insurance policy.
The scheme is called the Complémentaire Santé Solidaire (CSS).
Under the scheme, if your income is below a certain threshold you can obtain free health treatment. If your income is around 35% higher than the threshold, you will only need to make a contribution of up to €1 per person/day towards a complementary 'top-up' policy. In effect, the State itself offers a complementary policy, although the voluntary insurers will remain administrators.
Who is Entitled?
In order to be eligible your income must be below a threshold. The income thresholds this year (to 1st April 2023) for each element of the scheme are as follows:
Household Size | 'Sans Participation' | 'Avec Participation Financière' |
One Person | <€8,810 | <€11,894 |
Two Persons | <€13,215 | <€17,841 |
Three Persons | <€15,858 | <€21,409 |
Four Persons | <€18,501 | <€24,997 |
Five Persons | <€22,026 | <€29,735 |
Unfortunately, the test of resources is not entirely that simple, for if you are an owner-occupier without a mortgage your income will be increased by a fixed sum (forfait) per month; single persons are subject to a forfait of €67.17 a month and couples €111.55, with increases for larger households.
Accordingly, a couple with an income of €15,000 per year without a mortgage will be assessed as having an income of €16,338.
How Much do You Pay?
If your income is around 35% above the threshold, you can still obtain access to the CSS but you will need to pay a monthly charge based on your age and the household size.
A household composed of two people, one 67 years and the other 72 years, would pay €55 per month, i.e. €25 for the 67 year old and €30 for the 72 year old.
If you already have a voluntary health policy, and your application is successful, you will transfer to the CSS and pay less in premiums. In a small number of cases the scope of your cover may be lower. You can retain your existing insurer to administer the CSS, or have it administered through your local health authority, the CPAM.
How to Apply
You need to apply direct to your local health authority, completing the application form (Demande de Complémentaire santé solidaire) and send it to them or visit their offices. Alternatively, you can do it using your on-line 'Ameli' account.
You can also approach your voluntary (top-up) health insurance provider to assist you with the application. They are administrators of the complémentaire santé solidaire avec participation financière, although not all insurers are participants.
The health authority have two months to consider your application. If successful it is backdated to the date of your application, although it is possible to apply it retrospectively in the event of hospitalisation.
Advice
You can discuss your health insurance requirements with our English language speaking health insurance partner, who is able to offer competitive policies for both private health and 'top-up' cover, as well as battle tested, competitively priced policies for visa applications.
Related Reading:
