French VLS-TS visitor visa: health insurance

This article examines health coverage for the French long-stay VLS-TS visitor visa. Learn what PUMA is about and who is eligible for Cotisation Subsidiaire Maladie (CSM).

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Who can get a French VLS-TS visitor visa?

Americans who want to stay in France longer than 3 months without working can get a long-stay visitor visa, called a VLS (visa long séjour) “visiteur” in French. This is the case for Americans who come to France to retire. 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.

Usual recommendations

Most websites (including mafrenchlife up until now), forums for expats and Facebook groups relay the following information:

Anyone can enroll into the French healthcare system after 3 months in France.

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.

  1. Get a private health insurance policy that qualifies for a French VLS-TS visitor visa for the whole duration of the visa.
  2. After three months in France, apply for carte Vitale.
  3. Once you received your carte Vitale, cancel your private health insurance policy.

Random fails

Once in a while, Americans holding a VLS-TS visitor visa (long-stay visa with residency permit) 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 VLS-TS visitor visa

When renewing your carte de séjour (residence permit), the préfecture refuses carte Vitale as proof of health insurance. Instead, the préfecture requires proof of private medical insurance for one year.

But why would you need a private health insurance when you’re already into the French healthcare system?

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 social charges which fund the health coverage system.

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Fail #4- French VLS-TS visitor visa is denied because of non-compliant policy

Some Americans get their visitor visa denied due to insufficient medical insurance policies while others receive a temporary VLS-T visa instead of a VLS-TS visa.

These situations don’t happen very often and they 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. Every one living in France:

  1. can benefit from French healthcare
  2. 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.

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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 VLS-TS 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 VLS-TS 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

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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 visitor 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. If you want to stay in France once the year is up, you have to go back to your home country to apply for another visa.

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 highly controversial subject because most Americans on a long-stay visitor 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 residence permit 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.

Nathalie Nahmani

About Nathalie Nahmani

Nathalie is the creator of ma French Life. She moved back to France after living in Los Angeles for 20 years. She writes practical articles to help expats in France. Nathalie lives with her family in the French Alps near Grenoble.

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16 thoughts on “French VLS-TS visitor visa: health insurance”

  1. I am moving bak to france in march after living 37 years in the US. I have been married to an American spouse for 37 years. We are retiring to France for various reasons, but a more affordable lifestyle is one of them. We will be getting American social security, and I am getting a French invalid hors guerre military pension. Does my wife have to prove that she can sustain herself? As someone who served in the French military, I am surprised that my spouse of 37 years has to show financial assets. We just bought a house in Brittany. Also, I was told that the medical premiums were quite expensive. Also, as a French veteran returning to France, do I have to show I can sustain myself? Hopefully, my wife of 37 years won’t get her visa denied. Yann

    • Hi Yann. First, as a French citizen, you don’t need a visa to come back to France and you don’t need to show that you can sustain yourself.
      For your wife, she should use the assistant from France-visas to see which visa and documents she needs. As a spouse of a French citizen though, I don’t think she has to prove that she can sustain herself. Did you have a “transcription d’acte de mariage” done when you get married? You will need it for your visa.
      Hope this helps!

  2. Nathalie, you suggest that people cancel their private health insurance as soon as they get the Carte Vitale. I would recommend a slight modification to your suggestion: If on a VLS-TS Visiteur visa, DO NOT CANCEL in your first year of private insurance, even if you get the CV during the first year. Why? Because Immigration requires you to purchase insurance for the full year of your renewable 1-yr VLS-TS Visiteur visa. Some prefectures are starting to balk at issuing the first CDS w/o proof of PHI. >> Why? I think there are too many people abusing the system. I hear of so many americans who get the Carte Vitale DURING their 1st year: they then cancel their PHI and ask CPAM for reimbursement instead of the PHI. This is abusive because they should be covered their 1st yr by PHI; AND they should be asking the PHI for reimbursement– NOT THE FRENCH GOVT. I don’t blame the prefectures for doing this. It’s already an unsustainably generous system to immigrants who don’t pay into the system, and then those same immigrants try to scrape every penny out of it, when they should be asking the insurance to pay!

    • You’re totally right Janice and I was suggesting the same but maybe I wasn’t clear enough. I changed the wordage a bit to make it super clear in the “Medical insurance I recommend for a French VLS-TS visitor visa” paragraph. As always, thank you for your highly valuable input Janice!

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