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Still confused about PUMA healthcare entitlement!


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Submerging under contradictory information on healthcare entitlement under the new(ish) PUMA system, and having read everything I can find, I fear I am as confused as ever. It seems from what I read I am not alone. Perhaps someone out there can un-confuse me?

My situation in a nutshell: without any entitlement to an S1 or any other 'open sesame' (I have worked abroad as a Britpat all my life), I started work here as an AE just over two years ago at the age of 66, and have dutifully declared and paid all my 'cotisations' on my modest freelance income every quarter under that scheme. I was told by the organization which arranged my business registration that the AE scheme would run out in three years -- by which time in any case I hope to really retire! But it was also my understanding at the time that fulfilling the three years would 'de facto' secure my Carte Vitale (and thereby that of my non-working partner) in perpetuity once I did actually retire here.

(And just for the record, registering as an AE was never intended solely as a ruse to get the Carte Vitale, as some have pointed out here; I have run a modest freelance business here for more than two years, and getting the CV on its basis was simply an added bonus).

Although like all good residents I submit my annual tax return, sadly my (combined) income has never taken us above the minimum household taxpaying threshold.

So the question to which I've had so many varied answers is this: when I 'retire' from the AE scheme on January 1 next year after the full three years, and then stop declaring and paying the quarterly deductions, will we nevertheless continue to enjoy the fruits of our Carte Vitale (and the top-up insurance we've had with it right from the start)?

Or will we, like the Led Zeppelin song, continue to be Dazed and Confused about the whole complicated business?
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Hi, don't know who told you that your AE status only lasted for 3 years, but I do not believe that this is the case. My wife has been an AE for nearly 5 years now, and there has never been any suggestion made that her status is time limited. It is likely therefore that you do not need to worry about your status in the French healthcare system as long as you continue to declare your AE income and pay cotisations in the normal way. Even if you cease to earn anything, you can continue to submit zero income declarations for 2 years until your AE status lapses.

That is not to say that the incoming French government won't change the rules regarding AE, but the above is the current situation as I understand it.
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I don't know where this "contradictory information "comes from , unless it is from Anglophone websites which are notoriously wrong much of the time.

Remember that in France health cover is paid for by cotisations: those who work or run a business have these continuously topped up,  (This was part of what you paid in charges as an AE.) and those who have a private income pay a % of it to the health service.

Retired French no longer pay cotisations, but they do continue to pay a small% of their pension in contributions.

People who are destitute  can still be covered


However unless you have contributed enough from your AE work to be entitled to a French pension your cover does not continue indefinitely.

I believe it stops after 1 or 2 years, but I am not sure

This is an official French site:


1)As you will see each of you needs to have cover in your own right. There is nomore piggy-backing by one partner based on the rights of the other.

"La suppression progressive du statut d'ayant droit"

To be clear: you will have the right to health cover, but the way it is 'paid for' will have to be sorted out, and each of you will have to do this in your own right.

2) Once you have closed your AE business you will have to justify your cover by one of the other methods above.

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Many thanks to both for the advice. Though it may not only be anglophone websites which lie at the root of any confusion.

One example: the official website NormanH refers to states towards the end:

À noter : si vous êtes vous-même ayant droit majeur d'un assuré, vous continuez à bénéficier de la prise en charge de vos frais de santé sans aucun changement. (Roughly: if you are a major beneficiary of an insured person, you will continue to benefit from the assumption of your health costs without any change.)

.... Which would appear to suggest that one's non-working wife (i.e. beneficiary) would indeed continue to enjoy cover contrary to what you state?

A Brit colleague was recently told by a professional advisor that under the new system, continuing to pay for top-up ('complementaire') insurance is the surest way to guarantee continued entitlement to the healthcare system.

The quest for clarity continues!
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The process is that after you close your AE, your cover continues with RSI for 12 months. After that you need to find a different route to healthcare (RSI will write to you in advance to tell you your cover is about to expire). Whether or not cotisations will be levied for those 12 months with RSI and if so on what basis, I don't know.

Re the end of the ayant droit statut, the point is simply that under PUMA this is no longer an option so as from the introduction of PUMA ie Jan 2016, adults can no longer be accepted into the system as ayants droits. However, for those who already hold this statut, there is a phasing-out period and they can stay unchanged as "ayant droits" until the cut off date (31 Dec 2019 I believe) or they can change over earlier if they wish.

"A Brit colleague was recently told by a professional advisor that under the new system, continuing to pay for top-up ('complementaire') insurance is the surest way to guarantee continued entitlement to the healthcare system." - this sounds very back-to-front indeed. The state healthcare system has its own entitlement criteria (employment/stable residence/income). Once you are "in" the healthcare system you can, if you wish, take out complementary insurance - that is entirely your decision, the state doesn't care one way or the other. But you can't have complementary cover if you have no state healthcare rights, because what would it be complementary to. So if you lose your entitlement to state healthcare, your mutuelle cover will end as well. You can't just decide to keep paying if the mutuelle can no longer provide you with that kind of cover. Very confusing.
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1) As EuroTrash explains,  an adult  who has been covered by another person will continue for a limited period if they so wish, but will have to eventually change over and may do so as soon as they like.

  • Statut d'ayant droit majeur : Il est

    progressivement supprimé. Une personne majeure peut désormais être

    affiliée en propre, sur critère d'activité professionnelle ou sur

    critère de résidence. Un ayant droit majeur au 31/12/2015 peut demander

    à sa caisse d'assurance maladie d'acquérir le statut d'assuré.

D'ici 2020, ne subsisteront que :  (as from 2020 there will only exist)

  • les ayants droit mineurs rattachés à leurs parents et
  • les assurés affiliés en propre sur critère d'activité? ou de résidence lorsqu'ils sont majeurs.  (adults who have established their own rights by their activities or by the criterion of residence)


That means that an adult will o have his or her own justification, although that could be simply based on residence


2) A Brit colleague was recently told by a professional advisor that under

the new system, continuing to pay for top-up ('complementaire')

insurance is the surest way to guarantee continued entitlement to the

healthcare system."

Is complete BOLLOX .  I would love to challenge the idiot who said this to provide a link to any official French site that states it [:D]

Once again EuroTrash is right. The Mutuelle is an optional way of covering the  % not met by the basic cover provided by the Sécu and has nothing to do with establishing any 'rights'

The 'professional' may have misunderstood this:

Si vous êtes ressortissant de l'EEE/Suisse et que vous êtes « inactif » :

vous êtes dispensé de la production d'un titre ou document de séjour

mais vous devez justifier de ressources suffisantes et d'une assurance

maladie « complète ».
Toutefois, dans certaines situations (perte

imprévisible de revenus, perte de la couverture maladie liée à la perte

d'emploi du conjoint, etc.), votre demande d'affiliation sur critère de

résidence pourra être étudiée par votre caisse d'Assurance Maladie.

I have the feeling that you are asking questions but don't believe the answers.

It takes time to reply with references and links.

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Regarding the phasing out of 'ayants droit majeurs', I read the state published information online when the plans were announced in late 2015. It seemed to me that the switch of an ayant droit to their own personal health cover and reimbursements (administered through CPAM), was mainly designed to modify the system to protect confidentiality of ayants droit, particularly in respect of (mainly) female adults and grown-up children who were piggy-backed onto their husband's or parent's cover. I may have been wrong, but what I read implied that those who would have been ayants droit under the old system would gain health cover in their own right without additional cost. In other words, this change in system is not designed to make more money, but rather to comply with modern approaches to confidentiality and to comply with current data protection legislation.
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My sincere apologies if I appear to be abusing the forum's willingness to seek out chapter and verse on all this -- it is definitely not my intent! It's merely that I have had so much conflicting advice from sources which appear to be authoritative (e.g. the professional French specialist who facilitated my AE registration and insisted it was purely a three-year concessionary scheme, and the aforementioned 'bollocks' passed on from that professional advisor) that I really wanted to be ABSOLUTELY sure that I'm on solid ground.

I will in fact now print out the advice and references which have been given and will take it back to some of the contradictory sources. I do certainly feel that I am now up to speed on what's involved, and my thanks again to you all for taking the time and trouble.
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The idea was yo

Simplifier la vie des assurés, assurer la continuité des droits à la

prise en charge des frais de santé, réduire au strict nécessaire les

démarches administratives, garantir davantage d'autonomie et de

confidentialité à tous les assurés dans la prise en charge de leurs

frais de santé.

It was to simplify things as each person would have a personal account

Aid in keeping continuity when people switch from one job(and so a particular régime) to another

Reduce adminsitration

Create more autonomy and confidentiality  ( as you say particularly for married women)

Sometimes women who had their health cover provided by theit husbands found them selves in difficulties because they had  nothing in their own name.

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Another aim of PUMA was to even out the contributions, so that what people pay is more closely related with their financial ability to pay. Not necessarily to rake in more money, but to make it fairer. URSSAF and the tax office now share information.

Re AE and the three year limit, this was an idea that was floated very briefly, discussed and quickly rejected and forgotten about. Any "advisor" who told you this as a fact, I would be very cautious of believing anything else he told you.
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 Why don't you just go and see the CPAM with all your paperwork and see what is what, and ask for all the information to be sent to you in writing.

This is a message board, that is all. The good people on here have given you links, but me, I like to speak to someone, go and see someone, and keep on going to see them until I understand. That is how I succeeded in France, and I did succeed.

Our mutualist(s) (we got through a few over the years) would not have kept us on if we had lost our french state medical cover. (No idea if it is still the same, but that is how it was).

AND IF we lose our french state pensions for any reason...... then the private ones, well private, a la francaise will stop too.

Some things are very different in France.

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  • 4 weeks later...
I'm confused too OP. We usually pay our 8% to CPAm/URSSAF as we are not on S1 cover. I don't work, only my OH does.

We paid no cotisations last year, or to date this year and I'm getting a bit worried about a huge bill to come for back payments.

We've heard nothing from PUMA/CPAM or URSSAF.

I'm sure they will be in touch soon but as I normally claim the URSSAF payment on our tax return (box 6DD) this year I assume I can't put anything as we didn't actually pay anything last year.

It's just a bit worrying. I've tried to go through our local CPAM but they don't know either.
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Nobody paid cotisations last year because the system was being changed over and PUMA cotisations are based on the previous year's tax return. It was a free year.

The first bills for PUMA will be sent out at the end of this year.

"La CMU de base étant supprimée au 1er janvier 2016, aucun appel à cotisation ne sera adressé pour l'année 2016....

Les cotisations seront automatiquement calculées suite à la déclaration de revenus grâce aux informations transmises par l’administration fiscale.

Les revenus pris en compte sont ceux de l'année précédant l'année au cours de laquelle la cotisation est recouvrée. La contribution PUMa due au titre des revenus 2016 sera à payer en fin d'année 2017."

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Which means it is not a free year but a delayed payment. I asked about this when i recently gave CPAM my new pensioner's S1. They said I would be billed in Sept based on 2016 revenue as this was the charge for 2016 before my S1, which only applies from Jan 2017.

Rarely does any administration give free gifts so not surprised!


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Just a couple of quick question on this subject, if not directly related to the OP's initial query. I have worked out by looking at various online resources, that assuming no professional activites are undertaken, it is only property income and investment income that is taken into account to calculate the PUMa cotisations. It is also widely stated that those in receipt of a retirement pension are fully exempt from PUMa cotisations.

What I have not found by searching online are answers to the following:

1. Is UK property income included in the calculations?

(This income is taxed in the UK, and although declared in France, is then under the dual tax treaty subject to a rebate of French tax equal to the income's proportion of the whole income for the foyer, and a 100% rebate of social charges).

2. Would my early retiree NHS pension, which is both taxed and subject to social charges in France, qualify me for exemption from PUMa cotisations?

(None of the resources I looked at specify the type of retirement pension qualifying for the exemption, nor any minimum age limit - it seems the information to calculate the cotisations is simply taken from the previous year's tax returns, in which my NHS pension is of course declared as such).

Thanks to anyone who has any insights or thoughts
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  • 2 months later...
Just bumping this discussion again in the hope that the information is more clear to someone.

Please could someone confirm if the PUMA system is automatic if already "in the system" with cotisations, or is it necessary to submit all documents and re apply.

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