This article examines the French long-stay visitor visa and health coverage for long-stay visitors. Learn what PUMA is about and who is eligible for Cotisation Subsidiaire Maladie (CSM).
- Who can get a French long-stay visitor visa?
- Usual recommendations
- Random fails
- Do visitors qualify for PUMA?
- Can visitor visa holders get carte Vitale?
- Cotisation subsidiaire maladie (CSM)
- Do you need private health insurance to renew a visitor residency permit?
- Which insurance policy for a French long-stay visitor visa?
- Medical Insurance I recommend for a French VLS-TS visitor visa
- Special case of VLS-T temporary visas
- Why is the subject controversial?
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Who can get a French long-stay visitor visa?
Americans who want to stay in France longer than 3 months without working can get a VLS-TS or VLS-T (temporary) visitor visa. This is the case for Americans who come to retire in France. When you’re at retirement age, health insurance is particularly important. That’s why you need to know what insurance you should get during your stay in France.
Most websites (including mafrenchlife up until now), forums for expats and Facebook groups relay the following information:
There is no mention of which types of visa foreign people are holding. These are the recommendations you usually get to enter France as an American on a long-stay visa.
- Get a health insurance policy that qualifies for a French VLS-TS visitor visa for the whole duration of the visa.
- After 3 months in France, apply for carte Vitale.
- Once you received your carte Vitale, cancel your health insurance policy.
Once in a while, Americans holding a VLS-TS visitor visa report one of the following issues.
Fail #1- CPAM denies American’s carte Vitale application
Out of the blue, Americans on a visitor visa report that their carte Vitale application has been denied. CPAM justifies its decision on the grounds that visitor visas don’t qualify for carte Vitale.
Fail #2- Private insurance is required to renew a French long-stay visitor visa
At your carte de séjour renewal, the préfecture refuses carte Vitale as proof of health insurance. Instead, the préfecture requires proof of private medical insurance for one year.
Fail #3- Americans receive a bill from Urssaf asking to pay CSM
Early December, some Americans living in France receive a (hefty) bill from Urssaf for Cotisation subsidiaire maladie (CSM).
Urssaf is the public collection agency for the social charges which fund the health coverage system.
Fail #4- French VLS-TS visitor visa is denied because of non-compliant policy
Some Americans get their visa denied due to insufficient medical policies, especially for visitor visas. Some other time, they receive a temporary VLS-T visa instead of a VLS-TS visa.
These situations don’t happen very often and seem random, but nonetheless, they do happen.
Whenever people report these issues on expat boards, everybody is quick to reply that:
- CPAM doesn’t know the law (!)
- most foreigners in the exact same situation did obtain their carte Vitale or their visa renewal
Therefore, this is how it should be and you should fight to defend your rights.
This whole situation got me into serious research mode and I’ll share the results of my research with you.
Do visitors qualify for PUMA?
PUMA (protection universelle maladie) covers two concepts in one. (Almost) every one living in France:
- can benefit from French healthcare
- has to participate in funding French healthcare
I’ll start with the first concept. PUMA guarantees that:
Toute personne qui travaille ou réside en France de manière stable et régulière est couverte par l’Assurance maladie.
Any person who works or legally resides in France on a stable basis is covered by Assurance Maladie
Does it mean that everyone with “stable residency” can get a carte Vitale? For visitor visas, we need to look closely at the portion about “staying in France legally on a regular basis”. One way to understand what’s covered by these terms is to turn to the law itself.
Can visitor visa holders get carte Vitale?
Most Americans holding a long-stay visitor visa apply for carte Vitale after 3 months in France and their application is accepted. My point here is to see what the law says because, in some cases, applications are denied.
Article D115-1 from Code de la Sécurité Sociale lists residence permits that qualify to enroll in the French healthcare system. Visitor visas are not part of that list.
A foreigner on a long-stay visitor visa needs to show proofs that he:
- possesses financial ressources for a year (French monthly minimum wage x 12).
- has private medical coverage for his whole stay in France
- won’t work during the duration of his visa
In a way, it does make sense that a visitor can’t enter the French healthcare because he can’t contribute, he is covered by private medical insurance and he has financial means.
Non-visitor visas are different because anyone working in France contributes to the French healthcare system by paying Charges sociales.
Cotisation subsidiaire maladie (CSM)
CSM, also known as “taxe Puma” is the downside of Puma. The principle is that everyone living in France participates in funding the French Healthcare system. French residents pay social charges (“charges sociales”) to Urssaf on every dime they make.
French residents who don’t earn enough active income but make money from passive income and investments pay CSM. This is why CSM is also referred to as taxe des rentiers (“rentier” is someone who lives off annuities).
Since a visitor visa prevents foreigners from working, they might qualify for CSM to participate to the French healthcare system. People receiving French and European pensions are exempted from paying CSM. The rules to determine who qualifies as well as the formula to calculate CSM is available on the Urssaf website.
CSM is not based on whether or not you are enrolled into the French healthcare system. You might not have a carte Vitale and use a private medical insurance but still have to pay CSM.
Urssaf sends yearly bills at the end of November to people who are eligible for CMS.
Do you need private health insurance to renew a visitor residency permit?
When it’s time to renew a visitor residency permit (carte de séjour), some Americans have already received their carte Vitale. When showing carte Vitale as proof of health insurance, they are sometimes told that carte Vitale is not accepted.
Let’s look at the rules. The official list of documents to renew a visitor visa says (go to point 59 “CST portant la mention visiteur”).
attestation d’une assurance maladie couvrant la durée de votre séjour
proof of health insurance covering the whole duration of your stay
When you look at other sections of the same document, it says instead, in reference to health insurance.
justificatif d’assurance maladie
In that case (non-visitor visa), carte Vitale is indeed valid as proof of health insurance.
More and more préfectures indicate that carte Vitale is no longer a valid proof of health insurance. This is the list of documents from préfecture du Val de Marne for a residency permit visitor renewal:
Justificatif d’assurance‐maladie valable pour une période d’une année : Une attestation d’assurance‐maladie (couverture
médicale universelle (CMU) non recevable). La carte Vitale ne constitue pas un justificatif d’assurance-maladie recevable.
Proof of medical insurance for one year: carte Vitale is not acceptable.
It looks like more préfectures are asking for private medical insurance to renew a visitor visa.
Which insurance policy for a French long-stay visitor visa?
Most Americans coming to France on a long-stay visitor visa get a (cheap) travel policy that covers France-visas requirements. The terms of the travel insurance policy usually include medical-emergencies only in addition to repatriation and costs in the event of death.
Most of the time, visitor visas with a travel insurance are granted. But then, we hear reports of visa applications being refused due to non-compliant policies, especially for visitor visas.
Once again, it’s worth checking the law. Article R-313-3 from CESEDA indicates which policy a foreigner on a visitor visa should get.
Le contrat d’assurance souscrit par l’étranger ou par l’hébergeant pour le compte de celui-ci doit couvrir, à hauteur d’un montant minimum fixé à 30 000 euros, l’ensemble des dépenses médicales et hospitalières, y compris d’aide sociale, susceptibles d’être engagées pendant toute la durée du séjour en France.
Insurance policy must cover up to €30,000 of all medical and hospital expenses for which a foreigner might be liable during the whole duration of his stay in France.
This includes not only emergency-care but also routine check-ups or any medical care you may need in France. It also implies that you can’t have an insurance with a deductible.
Medical insurance I recommend for a French VLS-TS visitor visa
For VLS-TS visitor visas, I recommend that you get a comprehensive private health insurance that covers non-emergency medical care. I don’t recommend cancelling your insurance during the first year because you might need it for your residency permit renewal.
I recommend that you use Fab to get health insurance for your visa. Fab is an English-speaking insurance broker company that specializes in medical coverage for foreigners in France. Fab specializes in getting health insurance policies that are compliant with VLS-TS visas.
Special case of VLS-T temporary visas
VLS-T visas are temporary visas valid for no more than one year. You usually get a temporary visa when you don’t show intentions to stay in France after one year.
CPAM requires a stamp from OFII for long-stay visitor visas in order to accept a carte Vitale application. Since a VLS-T visa does not require a visit to OFII, you can’t get a carte Vitale.
Why is the subject controversial?
This is a controversial matter because most Americans on a visitor long-stay visa in France:
- never received a bill for CMS
- managed to enter the French healthcare system relatively easily
- got their carte Vitale accepted as proof of health insurance for their visa renewal
The controversy comes from the fact that people who’ve been “lucky” are convinced that the law is on their side, which I do understand. CPAMs and préfectures not applying one set of rules makes for a very puzzling situation as well. And then, even the law gives way to interpretation.
I believe that knowing as much as possible on a subject is a good start to make an enlightened decision. I’m not a lawyer so I invite you to read the law yourself and get to the bottom of things.
Get ready for your relocation and check out my Moving to France checklist.