Before you start

A residence permit or validated visa
Proof of stable residence in France
Employment contract or proof of activity, for the fastest route
A French bank RIB, for reimbursements

Step-by-step

1
Start the social security registration immediately
If employed, your employer initiates it, but the process is slow and you should track it yourself. The number is what everything else hangs off. Expect months rather than weeks and do not read the delay as a sign something has gone wrong.
Via employerWho: You and your employerWeek 1
2
Keep every feuille de soins until the card arrives
Until you have a carte Vitale you pay in full and submit a paper claim form the doctor gives you. Keep them all — reimbursements are backdated once you are in the system, and people routinely lose several hundred euros by discarding this paperwork.
In personWho: You
3
Start looking for a médecin traitant in your first weeks
Naming a family doctor raises your reimbursement rate permanently and is the gateway to specialists. Parts of the Gironde have genuine difficulty with GP availability, and lists close. Start early rather than when you first need one, and ask colleagues and neighbours rather than relying on a directory.
In personWho: YouWeek 1–4
4
Get a mutuelle, and check whether your employer provides one
The state reimburses most but not all of a consultation and covers dental and optical care poorly. Employers are generally required to offer a complementary scheme and fund at least half of it, and almost everyone in France has one.
Via employerWho: You
5
Create an Ameli account once you have a number
The online account is where reimbursements, attestations and your card status live. The attestation de droits it produces is another document you will be asked for repeatedly.
OnlineWho: You
6
Keep private or travel cover for the gap period
The months between arriving and having a working carte Vitale are a genuine exposure. Keeping a private policy for that window is a sensible precaution and much cheaper than the alternative.
OnlineWho: You

Documents you’ll need

Residence permit or validated visa
Birth certificate with a sworn translation, frequently required
Employment contract or proof of activity
Justificatif de domicile
RIB for reimbursements

Things most newcomers don’t know

Finding a médecin traitant is harder here than the city's size suggests.

Parts of the Gironde, including areas within the métropole, have real difficulty with general practitioner availability, and practices close their lists. Because the reimbursement rate outside the coordinated care pathway is materially lower, being unable to name a family doctor costs you on every consultation indefinitely. Start asking in your first weeks, and ask colleagues and neighbours rather than working through a directory — a personal referral opens lists that appear closed.

Source: l'Assurance Maladie

Keep every paper claim form from your first months — they are money.

Before the carte Vitale arrives you pay in full and receive a feuille de soins to submit on paper. Once your file is active those claims are reimbursed retroactively. New arrivals throw them away because nothing seems to be happening, and lose several hundred euros they cannot reconstruct.

Source: l'Assurance Maladie

A translated birth certificate is the document that stalls files.

French social security registration frequently requires a full birth certificate, sometimes recent, translated by a court-approved translator. Obtaining one from another country takes weeks and it is the most common reason a file sits unprocessed. Start this before you leave, not once you are asked.

Source: l'Assurance Maladie

Almost everyone has a mutuelle, and going without is a real cost.

The state covers most of a consultation but not all, and covers dental and optical care poorly. Complementary insurance is close to universal in France and employers must offer a scheme and fund at least half. Declining it to save the premium is a false economy for anyone who uses healthcare at all.

Source: service-public.fr

Common mistakes to avoid

Leaving the search for a médecin traitant until you are ill, in a département where lists close.
Discarding paper claim forms before your file is active.
Arriving without a translated birth certificate and stalling registration for weeks.
Declining the employer mutuelle without understanding what the state does not cover.
Letting private or travel cover lapse before the carte Vitale actually works.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.