The Protection Universelle Maladie (PUMa)
France's PUMa (Protection Universelle Maladie) system guarantees health coverage to anyone legally residing in France. This isn't optional or means-tested — it's a universal right. Whether you're employed, studying, self-employed, or not working, if you're legally in France, you're entitled to health coverage. Your nationality is irrelevant; your legal status in France is what matters.
How registration works depending on your situation
- Employed workers: your employer registers you automatically through URSSAF when they declare your employment. You don't need to do anything — CPAM sends you your details and eventually your carte Vitale.
- Students: register directly with the CPAM of your département using form S1106 (downloaded from ameli.fr).
- Self-employed / auto-entrepreneurs: registration is handled through URSSAF when you create your business.
- Non-working residents: apply directly to your local CPAM using form S1106.
The registration documents
- Form S1106 (Demande d'ouverture de droits à l'assurance maladie) — available at ameli.fr
- Valid titre de séjour or long-stay visa
- Proof of address in France less than 3 months old
- Identity document (passport)
- Proof of regular presence in France (employment contract, university enrolment, etc.)
Processing time and what to do while you wait
CPAM has 30 days to process your registration. In practice, expect 4 to 8 weeks for the registration to be confirmed. Your carte Vitale then arrives 3 to 6 weeks after that — meaning potentially 2 to 3 months from application to card. During this entire period, you can access healthcare using your attestation de droits, downloadable from ameli.fr once your registration is confirmed.
Your social security number
Your numéro de sécurité sociale (NIR) — 15 digits, beginning with 1 or 2 — is assigned when you register with CPAM. For people born abroad, a provisional NIR is assigned first, then a definitive one once your civil status documents are verified. Don't confuse this with your tax number (SPI) — they're completely different.
If your registration is refused
Refusals are uncommon but can happen — usually due to a document issue or a question about your residence status. You have 2 months to appeal to CPAM's Commission de Recours Amiable. Contact La Cimade or a local social rights organisation if you believe you're being wrongly refused.