Assurance Maladie from the first day of work

France’s public scheme is Assurance Maladie. Local primary health insurance funds (CPAM) run it in mainland France, and CGSS funds do so in the overseas departments. Under universal health protection (PUMa), anyone who works in France is covered, as is anyone who has lived there on a stable, regular basis for at least three months.

A person who comes to France to work is covered from the first day of activity, with no waiting period, and finishes registration with the CPAM for the area where they live. People who join through residence alone, or new arrivals not covered through a job, apply to their local fund with form S1106.

The basic scheme leaves part of each bill to the patient. A GP visit within the coordinated care pathway is reimbursed at 70%, and the patient pays the rest, the ticket modérateur, plus small flat charges. That gap is why most people in France also hold complementary cover.

The company mutuelle every employer must offer

Every private-sector employer in France, whether a company or an association, must offer its employees collective complementary health cover, usually called the company mutuelle. The exceptions are few, such as a private person employing a home worker. The employer pays at least 50% of the contribution, and the employee pays the rest.

The mutuelle has to meet a minimum basket of care: the full ticket modérateur on reimbursable care, the hospital daily fee, dental prostheses and orthodontics up to 125% of the official rate, and a flat optical allowance every two years. Dental and optical benefits are therefore a standard part of French employer cover, not optional extras.

Family cover is a choice rather than a duty. The employer, or a sector agreement, may extend the mutuelle to dependants. Decide early, because it changes what a remote hire with a partner or children actually receives.

Hiring in France without a French company

A company with no establishment in France that employs someone there must still put that employee in the French social security system. It declares and pays contributions through Urssaf’s foreign companies service. Urssaf also runs an optional simplified service, the Titre Firmes Etrangères (TFE), which combines the hiring paperwork and lets the employer pay all contributions in one go.

That leaves a US company three broad routes: employ directly through Urssaf, set up a French entity or use an employer of record. On any of them, whoever employs the person in France owes the mutuelle. Our guide to health coverage for EOR and contractors abroad sets out, in general terms, who provides cover under each arrangement.

Short contracts and other opt-outs

Employees may decline the mutuelle in set cases, for example:

they are already covered as a dependant under another compulsory scheme
they hold individual cover, until it ends
they receive the state-funded complementary cover (C2S)
they are on a short fixed-term contract or very short part-time hours

When a short-contract employee opts out, the employer may make a health payment instead. Service Public says that payment is exempt from social security contributions, though it still bears CSG-CRDS and, in firms with 11 or more employees, the forfait social. Alsace-Moselle has its own reference amount for the payment, one of several local rules in that region.

What an international plan can and cannot do in France

Since an employee working in France is compulsorily covered by the French scheme from day one, an international plan cannot replace Assurance Maladie. The mutuelle is a separate legal obligation with its own minimum basket and employer share, and the official guidance we reviewed does not say whether a plan arranged outside France can count toward it.

So treat a global plan as an addition to both French layers. Insurer and broker guides describe international plans in France as a top-up on French cover rather than a substitute; what any given plan covers is the insurer’s decision. None of this is legal or tax advice; check the mutuelle question and the tax side with a local adviser or tax professional before relying on a global plan.

Care pathway, medicines and family members

From age 16, patients name an attending doctor, the médecin traitant. Seeing a specialist directly, without that doctor’s referral, lowers the reimbursement. Some sector 2 doctors may charge more than the official rate, and the basic scheme does not reimburse the difference. Medicines are reimbursed in full or at 65% or 30%, depending on their assessed medical benefit.

Children are covered as dependants of an insured parent until 30 September of the year they turn 18, and parents can ask for a separate carte Vitale for children aged 12 and over. Family members who have lived with the worker in France for more than three months are covered by French health insurance as well.

Getting an introduction for your team in France

Our role on health cover is to make an introduction. Through the quote form on this page, let us know that the employee is based in France, how many people work for you there and elsewhere, and whether dependants should be part of the conversation; we will pass the details to a benefits partner that handles international and remote-team health coverage. From there, the partner and the insurer set eligibility, the plan options and pricing.

For the bigger picture across countries, read the international health insurance overview, and for other benefits questions go to the employee benefits hub.

A few useful answers

Common questions

When is a new employee in France covered by Assurance Maladie?

From the first day of work. A person who comes to France to work has no waiting period and completes registration with the CPAM for the area where they live.

Must a US company with no French office offer the mutuelle?

Service Public applies the duty to every private-sector employer, and the employer of the person in France, whether your company, a French entity or a provider, is the one who offers it.

How much of the mutuelle does the employer pay?

At least 50% of the contribution. The employee pays the rest, and the plan has to meet the legal minimum basket of care.

Can an international plan replace French health insurance?

No. An employee working in France is covered by the French scheme from day one, so a global plan sits on top of Assurance Maladie and the mutuelle.

Does the company mutuelle have to cover the employee’s family?

No. Covering dependants is not compulsory, though the employer or a sector agreement may extend the mutuelle to them.

International Health Insurance for Remote Employees in France