The French Social Security System I - Health, maternity, paternity, disability, and death

A - Health, maternity and paternity insurance

Health insurance

France's universal healthcare system (PUMa) guarantees coverage of healthcare expenses for all individuals who:

• are working, or
• have been residing in France (including Guadeloupe, French Guiana, Martinique, Reunion Island, Saint Barthelemy and Saint Martin) on a stable and ongoing basis for at least 3 months.

The following insured persons are liable to a 6.5% alternative health care contribution (cotisation subsidiaire maladie/ CSM):

• those with no employment income or whose income from employment in France amounts to less than 20% of the annual Social Security ceiling^* (i.e. less than €9,420 in 2025),
• AND whose investment or property income (real estate and other property income, investment income, etc.) amounts to more than 50% of the annual social security ceiling (i.e. €23,550 in 2025).

^* Annual Social Security ceiling (PASS) 2025: €47,100.

The annual calculation basis for this contribution is capped at 8 times France's annual social security ceiling, which is €376,800 in 2025. Further information.

The French health insurance system covers health expenses (reimbursement of healthcare costs) for insured persons and their minor dependents, and cash benefits (daily medical leave benefits for temporary incapacity for work) for insured persons.

1 - Healthcare expenses

Scope of application

Healthcare expenses cover medical and paramedical expenses as well as medications, orthopedic appliances, and hospital costs. Such health benefits are provided to both the insured and their underaged beneficiaries.

The status of beneficiary is granted up until 30 September of the year in which an insured's child turns 18. It is rescinded earlier if the child themself becomes an insured through employment.

Minors over the age of 16 can apply to be insured in their own right.

Scope of coverage

a) Physician and outpatient care

From the age of 16, all patients must choose a primary care physician (médecin traitant) who will provide referrals as part of the “coordinated care pathway” system (parcours de soins coordonné).

The primary care physician's role is to keep the patient's personal medical record up to date, prescribe further medical investigations, or refer the patient to hospital services or other health-care professionals (physiotherapists, nurses, etc.). The primary care physician can be either a general practitioner or a specialist. Patients can change their primary care physician by notifying their local health insurance fund.

Medical procedures are reimbursed at the standard rate when carried out or recommended by the primary care physician, given that the patient is following the coordinated care pathway. However, if the patient has not registered with a primary care physician or consults a specialist doctor directly, they will be refunded at a lower rate and pay more out-of-pocket than if they had stayed within the coordinated care pathway.

Patients may see a doctor other than their primary care physician under certain circumstances: in the event of a medical emergency, the absence of the primary care physician or his locum, or if the patient is far from home. Gynecologists, ophthalmologists and psychiatrists may also be consulted directly without a referral from a primary care physician. In such cases the practitioner will indicate the "special circumstances" applying on the medical claim form (feuille de soins).

The patient is generally required to pay part of their medical expenses (ticket modérateur) out of pocket. In special cases however, such as for women more than 6 months pregnant or long-term illnesses, the patient is exempted from this co-payment. A doctor's appointment within the coordinated healthcare pathway system is reimbursed at a rate of 70%.

Reimbursement rates are listed online on Ameli.fr

On top of the co-payment (ticket modérateur), the patient is responsible for a number of other charges: a flat-rate charge for extensive procedures, a €2 charge for visiting a doctor and for examinations and tests and a flat charge for medications, paramedical procedures and travel for medical purposes.

• The flat-rate charge for extensive procedures (forfait actes lourds) is €24 and applies to medical or surgical procedures costing upwards of €120 or with a weighting factor above 60. This charge applies whether the procedure is performed in a doctor's surgery or a hospital. Certain procedures are exempted from this charge as well as persons who, for health reasons, have 100% statutory health insurance coverage [See In-patient care].
• All patients are required to pay a flat-rate €2 charge (participation forfaitaire) for a visit to or procedure performed by a doctor, as well as for X-ray examinations and laboratory tests. Such charges may not exceed €8 per practitioner or laboratory per day, or €50 per person per calendar year. This €2 charge is not due for doctor's appointments for those under the age of 18 or for pregnant women in their 6th month or more of pregnancy.
• A flat charge (franchise médicale) also applies to non-hospital procedures performed by allied health professionals, medications, and travel expenses for medical purposes. This charge is €1 per item of medication and paramedical procedure and €4 per journey, and is capped at €50 per person per year for all procedures, €4 per day for paramedical procedures and €8 per day for travel.

To ensure that the amounts refunded to patients match actual expenditure (including the co-payment) and that the Funds are not required to reimburse medical expenses without any oversight, the health insurance organizations have entered into national agreements with doctors and allied health professionals.

Members of the following groups are exempted from these per-procedure and flat charges:

• Minors (under age 18)
• Women more than 6 months pregnant and up to the 12^th day after the birth,
• Those covered under the Subsidized Supplementary Health Insurance Program (Complémentaire santé solidaire/ CSS) and the State Medical Aide (Aide médicale d'État/ AME) program.

Under this system there are different "secteurs" within which practitioners may choose to work, and which apply different rates of reimbursement of consultation:

• Secteur 1 doctors adhere fully to the national agreement and charge the official rates negotiated with the health insurance system (official rates). When they see patients within the coordinated healthcare pathway, the 70% reimbursement rate is applied to the amount actually charged to the insured (after the flat-rate €2 charge has been deducted),
• Secteur 2 doctors may set higher fees. The amount of their fee that exceeds the official rate is not reimbursed. In addition, the reimbursement basis is the same as for Secteur 1 doctors only if the doctor adheres to the Controlled Pricing Practices Option (Option de pratique tarifaire maîtrisée/ OPTAM). If this is not the case, the 70% rate is not calculated using the official rate but a lesser amount instead.
• Doctors who have adhered to the Controlled Pricing Practices Option (Option de pratique tarifaire maîtrisée/ OPTAM) charge a moderately higher amount than the official fee. The reimbursement basis is the same as for Secteur 1 doctors, along with a rate of 70% for patients following the coordinated healthcare pathway.

Secteur 1 practitioners may also charge higher rates for patients who who have not followed the "healthcare pathway" system or who meet particular requirements (home visits or consultations outside of usual times).

Consultations with a practitioner who does not adhere to the national agreement are not reimbursed based on official rates.

Medications

The social security system covers a portion of the cost of medications included in the positive list of reimbursable pharmaceutical products issued upon prescription. Certain medications are reimbursed on the basis of a reference price determined according to the price of the lowest-priced generic equivalent.

Reimbursement rates vary depending on the medication's recognized medical benefit:

• 100% for medications recognized as costly and irreplaceable;
• 65% for medications with major or significant medical benefit;
• 30% for medications with moderate medical benefit and compound preparations.

There is a €1 flat charge for each item of reimbursable medication. For example, for the purchase of one item of medication priced at €10 and reimbursable at a rate of 65% by the French health care system, l'Assurance Maladie will reimburse €5.50 (€6.50 minus a €1 flat charge).

Upon presentation of a Carte Vitale, pharmacists can use the third-party payment system, meaning that the patient does not need to pay the full charge upfront. The patient must accept any generics that are offered and will only be responsible for the portion of the fees not covered by the national health insurance system.

The emergency room flat fee (forfait patient urgences/ FPU)

Anyone who goes to the emergency room but is not admitted to the hospital will be charged a flat fee of €19.61.

A reduced-rate emergency room fee (€8.49) is payable by:

• Those with a long-term illness (ALD),
• Those drawing benefits in connection with an industrial accident or industrial illness and whose unfitness for work rating is less than two thirds.

Members of the following categories are not charged the emergency room fee (FPU):

• Pregnant women with maternity insurance coverage;
• Disability pension claimants;
• Those drawing benefits in connection with an industrial accident or occupational illness and whose unfitness for work rating is at least two thirds;
• Minor-aged sexual assault victims;
• Newborns less than one month old;
• Organ donors;
• Military disability pension claimants;
• Victims of a terrorist attack;
• Those with State Medical Aide (AME) coverage;
• Incarcerated individuals.

In-patient care

The French social security system contributes to hospital costs incurred by insured persons and their dependents. The system covers all hospital services, including fees for medical and surgical procedures performed during the patient's stay in the hospital, medication, examinations, procedures, etc.

Certain extras such as a private room, a telephone, or a television are not covered by the public health insurance system. However, these expenses may be fully or partially covered by the patient's supplementary health insurance provider or mutuelle.

Hospital stays in public hospitals or private clinics operating within the social security framework, hospital costs are covered at a rate of 80%. Patients are required to pay 20% of their hospital expenses, plus a €20 daily fee not covered by the French health insurance system.

In some cases or for certain insured individuals patients receive 100% coverage:

• from the 31st day of hospitalization,
• pregnant women needing hospitalization during the final 4 months of pregnancy,
• hospitalization resulting from an industrial accident or illness,
• hospitalization for a long-term illness,
• those with Subsidized Supplementary Health Insurance (CSS) or State Medical Aid (AME) coverage, etc.

In these situations, they are still required to pay the €20 flat fee (or €15 in a psychiatric ward) as well as the €24 flat-rate charge for extensive procedures. This flat-rate charge is payable only once during any hospital stay even if several such procedures are performed. However, some patients may be exempted from paying either or both of these two charges (those with CSS coverage, patients with a long-term illness, a work-related illness, or an occupational accident injury, women 6 or more months pregnant, children hospitalized within their first 30 days of life, etc.).

When the insured is admitted to a hospital, an application for coverage is submitted to the health care fund to which they belong. The third-party payment system then applies. The Fund pays the amounts owed directly to the health care institution while the insured is responsible only for the co-payment, the daily fee and the flat-rate charge for extensive procedures.

C) Transportation expenses

Transportation expenses for medical services can be covered on the basis of a medical prescription:

A prescription is necessary in order to be reimbursed for the following:

• Transportation in connection with a hospitalization,
• Transportation in connection with a long-term illness (ALD) if the person's state of health does not allow him/her to travel independently,
• Transportation in connection with an industrial accident or illness,
• Ambulance transportation when the person's state of health requires him/her to lie flat,
• Long-distance transportation, or more than 150 km one way,
• Frequent transportation (at least 4 trips of over 50 km one way over a 2-month period for the same treatment),
• Transportation in connection with care or treatment for children / adolescents attending early-intervention medical-social centers (centres d'action médico-sociale précoce/ CAMSP) and medical-psycho-pedagogical centers (centres médico-psycho-pédagogiques/ CMPP).

Even when they have been prescribed by a doctor, the last 3 types of transportation listed above require prior authorization from the French health insurance system (Assurance maladie)'s medical team. This is also true for commercial airline or boat transportation.

Transportation expenses are generally reimbursed at a rate of 55%. The patient pays the remaining 45% out of pocket, plus the minimum charge of €4 per journey up to a maximum €8 in any one day.

Patients who meet the usual requirements for coverage can be reimbursed by the French health insurance system at a rate of 100% under certain circumstances (e.g. transportation in connection with an ALD or for treatment and testing in connection with an industrial accident or illness, transportation for women in their 6th month of pregnancy or more, those with Subsidized Supplementary Health Insurance Program [CSS] or State Medical Aide [AME] coverage, for urgent-care purposes, etc.).

Supplementary health insurance

Supplementary insurance covers healthcare expenses that are not covered by the compulsory basic scheme or services for which that scheme provides no coverage at all.

If insured persons do not have group supplementary insurance through their employment, they can take out supplementary insurance with a mutual fund, provident fund or insurance company.

 Subsidized supplementary health insurance program (C2S) is available to insured persons:

• who are entitled to health care coverage on the basis of their employment or legal ongoing residence in France, and
• whose income is below an amount that is determined by their household makeup. Income taken into account is that of the 12 months prior to their application.

Subsidized supplementary health insurance (CSS) is awarded automatically and free of charge to new active-solidarity income (RSA) recipients.

CSS members' health insurance expenses are covered by their health insurance funds and by the delegated supplementary insurer (organisme gestionnaire) which they have chosen.

To learn more about France's Subsidized Supplementary Health Insurance Program (Complémentaire santé solidaire/ CSS).

2 - Cash benefits

a) Daily cash benefits

To qualify for daily benefits when prescribed medical leave for a period of less than 6 months, the claimant must have worked at least 150 hours in the 3-month period before being prescribed medical leave or paid contributions on earnings amounting to at least 1,015 times the hourly SMIC in the previous 6-month period.

To continue receiving cash benefits after 6 months of leave, the claimant must have worked at least 600 hours in the previous 12-month period or have paid contributions on at least 2,030 times the hourly SMIC. The claimant must also have been registered with the health insurance scheme for at least one year.

In the event of incapacity for work, medical leave must be prescribed by a doctor. The insured must submit the medical leave form to their local health insurance fund (CPAM) within 48 hours. Daily cash benefits are only payable as from the 4th day of absence from work (3-day waiting period). This waiting period does not apply:

• in case of extension of the initial leave or after resumption of work for a maximum period of 48 hours between the end of the initial leave and the start of the extension leave,
• in case of medical leave for workplace accident or occupational disease,
• in case of medical leave following miscarriage,
• with a registered long-term illness (ALD) who are prescribed medical leave as a result of that illness. In this case, the waiting period is applied only for the first medical leave (valid over a period of 3 years).

Daily benefits amount to 50% of the member's basic daily wage. This is calculated based on an average of the insured's gross salaries (subject to contributions) for the 3 months prior to going on medical leave, or for the 12 months prior to the leave period if their employment is seasonal or periodic, with a cap of 1.4¹ times the applicable gross monthly minimum wage or Smic* (€2,522.52 gross as from April 1st, 2025). Even with a salary above €2,522.52, gross daily benefits cannot exceed €41.47.

¹ Since April 1^st, 2025.

A maximum of 360 daily benefits can be paid over any 3-year period. For long-term illnesses, the daily benefit can be paid for a maximum period of three years from beginning to end date for each illness.

Daily cash benefits are subject to income tax as well as to social security withholdings:

• 0.5% for the social debt repayment contribution (CRDS);
• 6.2% for the general social contribution (CSG).

b) Daily compassionate care leave allowance

This allowance is paid to persons who have been granted compassionate leave (congé de solidarité familiale) to look after a terminally ill family member (ascendant, descendant, sibling) or trusted person (personne de confiance), or who have used their compassionate leave to cut back to part-time work for that purpose.

If the claimant stops work completely the allowance is payable for a maximum of 21 days at a rate of €64.41 per day from 1st April 2025. If the recipient reduces the number of hours worked to part time, it is payable for 42 days at half the full-time rate, or €32.21.

Maternity and paternity insurance

Maternity and paternity insurance covers:

• pregnancy and delivery-related costs,
• cash benefits during the mother's pre- and post-natal leave,
• the mother's and/or father's adoption leave,
• and the father's paternity leave.

1 - Maternity-related healthcare

To be entitled to cover under France's maternity insurance system, the pregnancy must be declared to the health insurance fund before the end of the 3rd month. The practitioner or midwife performing the 1^st prenatal examination may make this declaration. Once the declaration is made, the insured can update their Carte Vitale.

Entitlement to benefits is determined using the same criteria as for health insurance. It is determined at the estimated date of conception, or if the patient is not eligible at that date, at the date of prenatal leave.

All compulsory pre-natal examinations (compulsory prenatal appointments, birth preparation classes, and complementary laboratory tests), are covered at a rate of 100%. Moreover, between the sixth month of pregnancy and the twelfth day following birth, all medical expenses are covered at a rate of 100%, whether or not they are pregnancy-related. The mother is exempted from the €2 charge and the flat charge for medications, paramedical services and travel.

The third-party payment system applies to all medical care that is covered by the maternity insurance system at a rate of 100% and provided by non-hospital-based health professionals. This means that the patient does not pay for any care upfront as Assurance Maladie pays the healthcare professional directly for the appointment or procedures performed.

2 - Daily maternity and paternity benefits

Daily benefits are paid when the eligible person stops working. They are awarded during maternity leave, and for paternity leave. For adoptions, daily benefits may be shared between both parents. The insured person must have paid the requisite amounts in contributions or worked the requisite number of hours, and must also have been registered with the social security system at least 6 months* prior to the expected date of delivery or the child's date of arrival in the household.

The length of maternity leave is determined by the number of children the insured is expecting and her other dependent children.

Length of maternity leave

Family circumstances	Length of prenatal leave	Length of postnatal leave	Total length of maternity leave
1 child expected and fewer than 2 dependent children or children born viable	6 weeks	10 weeks	16 weeks
1 child expected and already 2 dependent children on a permanent and ongoing basis	8 weeks	18 weeks	26 weeks
Twins expected	12 weeks	22 weeks	34 weeks
Triplets (or more) expected	24 weeks	22 weeks	46 weeks

With the approval of her doctor, an employee can take part of her prenatal leave after delivery.

In the event of premature delivery (fewer than 6 weeks before the expected date of delivery) the member's total maternity leave period is not shortened: the portion of prenatal leave not taken will be automatically added on to the postpartum leave entitlement.

In the event of late delivery, the length of the postpartum leave entitlement will remain the same.

Paternity leave

Paternity and childcare leave must be taken within 6 months of the child's birth. Its duration is set at 25 days, or 32 days in the event of a multiple birth. It is broken down into 2 periods:

• one mandatory period of 4 days taken immediately after the birth leave (3 days specified by the French Labour Code and paid by the employer);
• And another of 21 days (birth of one child) or 28 days (birth of multiple children).

Adoption leave is 16 weeks, or 22 weeks for the adoption of more than one child. If the adopted child is at least the 3rd child in the household, the leave period is extended to 18 weeks.

If the spouses decide to share their adoption leave, the leave period will be extended by 25 to 32 days as determined by how many children are being adopted and how many dependent children are already in the household. In this case, the parents will need to split their leave into 2 separate periods, the shorter of which must be at least 25 days (or 32 days if adopting more than one child). These 2 periods can be taken either one after the other or at the same time.

The amount of the daily maternity, adoption or paternity benefit payment is equal to the average daily wage of the 3-month period preceding pre-natal leave up to the monthly social security ceiling (€3,925 as of January 1st, 2025) after a flat-rate 21% withholding of the employee's share of statutory and contractual social contributions and taxes (including CSG and CRDS). As of January 1st, 2025, the daily payment cannot exceed €101.94.

Daily maternity and paternity benefits are paid every 14 days from the 1st day of entitlement (with no waiting period).

B - Disability insurance

1 - Disability pension

Disability insurance is an outgrowth of health insurance and is intended to compensate disabled persons for the loss of earnings resulting from a decreased ability to work or earn a living.

A disability pension is awarded to an insured individual whose disability was not caused by an industrial accident or illness and who:

• has not reached the statutory retirement age;
• has suffered at least a 2/3rds reduction in earning capacity or capacity for work;
• had been insured for at least 12 months at the time s/he was prescribed disability leave;
• had worked for at least 600 hours or paid contributions on a salary equivalent to 2,030 times the hourly minimum wage (SMIC) over the 12-month period prior to the date s/he stopped working.

Pension calculation

There are three categories of pension, depending on the member's remaining capacity for work:

• The 1st category applies to disabled persons who are still able to perform some form of gainful employment. The pension amounts to 30% of the SAM* (salaire annuel moyen: Average Annual Earnings). The maximum monthly amount is equal to 30% of the social security ceiling (€1,177.50).
• The 2nd category applies to those with a disability who are unable to engage in any form of gainful employment. This pension amounts to 50% of the SAM*. The maximum monthly amount is equal to 50% of the social security ceiling (€1,962.50).
• The 3rd category applies to those who are unable to perform any gainful employment and need a caregiver in order to perform the ordinary activities of daily living. The pension amounts to 50% of the SAM increased by 40%. This increase cannot be lower than an annual minimum amount which is re-evaluated on April 1st of each year (€1,288.13 per month as of April 1st, 2025). The maximum monthly amount of the third category disability pension is €3,250.63 (€1,962.50 + €1,288.13).

*The SAM represents the earnings accrued and credited to the insured person's old-age account during their ten highest-earning years (salaries liable to contributions, up to the annual social security ceiling).

Minimum: the disability pension cannot be lower than €335.29 per month.

Entitlement to a disability pension can be revised or suspended at any time according to the claimant's circumstances (a change in health status resulting in a change of category, resuming employment, or reaching statutory retirement age).

In the case of an insured receiving a disability allowance and practicing a professional activity, the payment of the disability allowance may be reduced or suspended if the resources (allowance + professional income or equivalent over 12 calendar months) exceed a certain threshold called the comparison threshold.

If the amount of aggregated resources (allowance + professional income) is less than the comparison threshold, the allowance is not reduced. If the amount of the aggregated resources is greater than the comparison threshold, the excess observed is divided by 12 to obtain the amount of the monthly excess. The monthly allowance paid is then reduced by half of the excess recorded.

Those drawing a disability pension are entitled to health/maternity benefits that are covered at a rate of 100%. They must, however, pay flat charges (medical or paramedical procedures, medications and transport) but are exempted of the €24 charge on major medical procedures.

If the recipient is not in employment, the disability pension is automatically converted into an old-age pension for incapacity for work at 62 years of age. If they do work, they must apply for their retirement pension. when they stop working, and, at the latest, at 67 years of age.

2 - The additional disability allowance (Allocation supplémentaire d'invalidité/ ASI)

The additional disability allowance (ASI) is awarded as a supplement to a disability or disabled widow(er)'s pension to claimants whose monthly income is below a cap of (amounts as at April 1st, 2024):

• €914.85 per month for claimants living alone or with a spouse not claiming ASI;
• €1,530.60 per month when both spouses are claiming ASI (as of 1st April 2024).

The additional disability allowance is calculated on a means-tested basis and is equal to the cap from which the claimant's income is subtracted.

Thus, a claimant living alone with a monthly income of €500 will be awarded: €914.85 – €500, which comes to €414.85.

If only one of the spouses is eligible for ASI, the amount received cannot exceed the difference between €914.85 and the minimum disability pension (€335.29), for a maximum of €579.56 per month.

3 - Widow's or widower's disability pension

The widow's or widower's disability pension (pension d'invalidité de veuve ou de veuf) is awarded by the French health insurance system (l'Assurance maladie) to the surviving spouse of a person who had been in receipt of, or who had been entitled to receive, a disability pension or an old-age pension.

To qualify, the surviving spouse must be under 55 years of age and suffer from a permanent disability reducing their ability to work or earn a living by at least two thirds.

The amount of the pension is equal to 54% of the (disability or old-age) pension that had or would have been awarded to the deceased spouse. A 10% increase is granted to recipients who have had at least 3 dependent children.

A 10% increase is granted to recipients who have had at least 3 dependent children.

From age 55, the widow's or widower's disability pension is replaced by a widow's or widower's old-age pension, which is paid by their retirement pension fund.

This pension cannot be paid at the same time as a survivor's pension.

C - Death insurance

The death grant (capital décès) is paid to the relatives of the deceased person by the local Health Insurance Fund (in the case of Metropolitan France) or the General Social Security Fund (in the case of the Overseas Departments).

This payment is not liable to CSG or CRDS withholdings, social security contributions, or inheritance tax.

In terms of entitlement, priority is given to those persons who at the time of death were effective, total and permanent dependents of the insured person. If the deceased person had several dependents, the order of priority regarding payment of dependents is as follows:

• a surviving spouse or a partner with whom the deceased had entered into a civil union (PACS),
• the children of the deceased,
• the ascendants of the deceased.

Prior to their death, the insured person must have been either:

• in salaried employment;
• or drawing unemployment benefits;
• or a disability pensioner;
• or in receipt of industrial injury benefits with a disability rating at or above two-thirds.

The death grant is paid as a lump sum of €3,977 (as at April 1st, 2025).

D - Death of a child

Parents can apply for bereavement leave (congé de deuil parental) following the death of a child or dependent who was under the age of 25. This is an 8-day entitlement (which can be divided into 2 periods).

This period of leave must be taken over the course of the year following the child's or dependent's death and entitles claimants to daily benefits from the French health insurance system (l'Assurance maladie).

Daily benefits are calculated on the basis of the claimant's wages for the 3 months prior to the period of leave, or for the 12 previous months for those with seasonal or non-continuous employment, minus a flat-rate deduction to take account of employee's contributions.

Wages taken into account are capped at France's monthly Social Security ceiling (i.e. €3,925 for 2025). The maximum daily benefit award that can be paid during this bereavement leave is €101.94 per day after the flat-rate deduction.

More information on the Ameli website.