Before you start

Stable, regular residence in France expected to last 3+ months (proven by lease, utility bills, tax notice); non-EU/EEA nationals also need a valid titre de séjour or long-stay visa (VLS-TS validated)
A French RIB (bank account details) for reimbursements, plus an état civil document (birth certificate, often translated by a sworn traducteur assermenté) for the social security number

Step-by-step

1
Bridge the gap before you're covered
Non-EU newcomers must hold private health insurance from arrival — it's a long-stay visa requirement and there's no public cover until PUMA opens. EU/EEA citizens use their EHIC/CEAM for necessary care during the first months. Employees are the exception: you're affiliated through your employer from day 1, so prioritise getting your numéro provisoire from HR.
OnlineWho: Private insurer (for the visa) or your home-country EHIC issuer; employees via HRArrange before arrival; coverage active day 1 for employeesPrivate expat insurance ~€30-100/mo; EHIC free; employer cover free to you
2
Register with CPAM for the social security number
Submit the PUMA affiliation file (Cerfa n°15763, 'Demande d'ouverture des droits à l'assurance maladie') to your local CPAM — the Paris fund is CPAM de Paris — with proof of stable residence and identity. Employees are registered by their employer instead. You receive a numéro de sécurité sociale (permanent 15-digit NIR), which unlocks reimbursements even before the physical card arrives.
In personWho: CPAM de Paris (in person at an accueil, or by post)Often 2-6 months for a permanent number; provisional number soonerFree
3
Create your ameli account and order the Carte Vitale
Once you have your number, open an account on ameli.fr (or the ameli app) — your portal for tracking reimbursements, downloading attestations de droits, and messaging CPAM. Order the Carte Vitale by uploading an ID photo and identity proof; the green chip card is presented at every doctor/pharmacy so reimbursement is automatic (no paper claims).
Mobile appWho: You, via ameli.fr / ameli appCard arrives ~2-3 weeks after the request is validatedFree
4
Declare a médecin traitant and take out a mutuelle
Pick a GP and file the 'déclaration de médecin traitant' (the doctor can do it digitally). This puts you in the parcours de soins coordonnés so you're reimbursed at the full 70% — going outside it cuts reimbursement sharply. Then take a mutuelle (complémentaire santé) to cover the remaining ~30% ticket modérateur and hospital day-charge: employees must be offered an employer plan covering ≥50% of the premium; everyone else buys individually.
Via employerWho: You + your GP; employer HR for the company mutuelle, or an insurer directlySame day to declare GP; mutuelle effective within daysIndividual mutuelle ~€20-80/mo; employer mutuelle ≥50% paid by employer

Documents you’ll need

Passport + valid titre de séjour / long-stay visa (non-EU); national ID or EHIC (EU/EEA)
Birth certificate / état civil proof (often a sworn/certified translation)
Proof of stable residence — lease, EDF/utility bill, or avis d'imposition
RIB (French bank account details) for reimbursements
Cerfa n°15763 PUMA affiliation form; passport photo + ID for the Carte Vitale request
Employment contract / bulletin de salaire (employees, for employer affiliation)

Things most newcomers don’t know

Always declare a médecin traitant and stay in the parcours de soins — skipping it doesn't just cost convenience, it drops your reimbursement well below 70% on most visits.

The full conventional reimbursement rate (70% of the €30 GP tariff) is conditional on going through your declared GP; consulting off-path is penalised, leaving a much larger reste à charge that your mutuelle may not fully cover.

Source: ameli.fr — Le rôle du médecin traitant et le parcours de soins coordonnés

A GP visit is €30 (raised from €26.50 on 22 Dec 2024); the state reimburses 70% minus a €2 participation forfaitaire — so ~€19 comes back and your mutuelle tops up the rest, but that €2 always stays on you.

The participation forfaitaire (raised to €2 in 2024, capped at €50/year) is legally non-reimbursable even by a mutuelle, so 'fully covered' care still leaves small unavoidable charges — useful to know before assuming zero out-of-pocket.

Source: ameli.fr — Convention médicale, ce qui change en 2025

Don't wait for the plastic Carte Vitale to start being reimbursed — once you have your numéro de sécurité sociale and an ameli account, reimbursements flow to your bank; the card just automates it at the point of care.

The social security number is the real key to cover; the permanent number can take months for non-employees, but reimbursements work in the meantime, so people who 'wait for the card' overpay needlessly.

Source: service-public.fr — Protection universelle maladie (PUMa)

Common mistakes to avoid

Assuming public cover starts on arrival — non-employees only qualify for PUMA after ~3 months of stable residence, so a gap without private insurance (a visa requirement for non-EU) leaves you fully exposed
Skipping the mutuelle: Sécu reimburses only ~70%, so the ~30% ticket modérateur, hospital daily charge (forfait journalier), and dental/optical extras hit your wallet without complementary cover
Letting your titre de séjour lapse — non-EU public cover is tied to a valid residence permit, so a late renewal can suspend your Assurance Maladie rights
Treating non-life-threatening problems as ER cases — call 15 (SAMU), 112 (EU), or 114 (deaf/hard-of-hearing); for English-speaking private care many use the American Hospital of Paris in Neuilly, while routine public care runs through the AP-HP network

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