Health, maternity, paternity, disability and death
All employees are covered by this insurance in the event of illness, maternity, paternity, disability and death.
This is on condition that they are registered for French Social Security. Registered employees are classed as insurees under the General Social Security System.
Read our fact sheet “Registering for Social Security”.
Who to contact? The Primary Health Insurance Fund (CPAM) of the insuree’s place of residence
Coverage of healthcare expenses
Universal health coverage (protection universelle maladie – PUMA) ensures that any individual who works for one or more employer will have their medical expenses covered from the day they start working. The insuree’s family can also benefit from this coverage.
The medical expenses covered in full or in part include:
- Medical and paramedical costs (medical consultations, etc.).
- Pharmacy expenses in the case of medicines supplied on prescription.
- Hospital expenses (fees, medical examinations, surgery, etc.).
- Transport costs when covered by a prescription.
PUMA is also accessible to all individuals, even the unemployed, who have been stable and regular residents in France for at least three months. Citizens of non-European Union states, non-European Economic Area countries and Switzerland must be able to prove that their presence in the country has been regular.
When applying for social security rights, these individuals must provide a copy of their residence permit or a copy of a valid long-stay visa equating to a residence permit.
To find out more about the coverage of medical expenses, please visit the Center of European and International Liaisons for Social Security (CLEISS) website.
Reimbursement rates are available at the website Ameli.fr
Compensation in the event of medical leave
Should an employee be unable to work due to illness, their doctor may prescribe them a period of medical leave.
In such cases, the public health insurance fund will pay the employee compensation as of the fourth day on which they are unable to work. This compensation is referred to as the “indemnité journalière de sécurité sociale” (“daily social security compensation”) or IJSS.
This daily compensation is equal to 50% of the employee’s daily salary calculated over the three months preceding the period of medical leave, up to a maximum ceiling set by the public health insurance fund.
To receive compensation when partially or totally unable to work due to illness, an employee must have worked at least 150 hours in the three months preceding the period of leave.
In the case of long-term leave (more than six months), they must have worked at least 600 hours over the preceding year.
Maternity and paternity insurance
Medical expenses relating to a pregnancy declared to the CPAM, as well as the resulting birth, are covered by the public health insurance system.
Both the insuree and their spouse may be reimbursed for any medical expenses incurred during the pregnancy, including the full cost of mandatory examinations.
Parental leave is awarded and compensated for births and adoptions alike. Its duration and the amount of compensation paid vary according to the number of children to be born and the number already in the family. Incapacity to work due to paternity or maternity will lead to the payment of daily compensation, on condition that the individual will have been registered for more than 10 months on the date the baby is due.
To find out more, please visit the CLEISS website
When an insuree becomes totally or partially unable to work due to a disability that is unrelated to their occupation, they may apply for disability allowance to compensate for loss of wages.
They must be able to prove that they have been registered under the General Social Security System for at least 12 months and have worked at least 600 hours.
The allowance amount will vary according to their capacity to work.
Medical expenses, mandatory examinations and any medicines a doctor has prescribed to an insuree with a disability will be fully covered in the event of illness or pregnancy, up to the maximum Social Security threshold.
Helpful tip: The Ile de France regional health insurance fund (CRAMIF) is the authority responsible for awarding disability allowances in the Paris region. In other regions, this role is performed by the CPAM.
The families of insurees are covered by the General Social Security System’s death insurance provisions. They may therefore receive compensation in the event of the insuree’s passing, if certain criteria are fulfilled.
To find out more, please visit the website Ameli.fr