Before you start

A residence permit or validated visa
An employment contract with work exercised in Bas-Rhin, Haut-Rhin or Moselle
Proof of stable residence in France
A French RIB, for reimbursements

Step-by-step

1
Start the social security registration in your first week
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
Confirm on your payslip that the régime local contribution is being taken
Enrolment is automatic for employees working in the three departments and the employer must declare it in payroll. If your employer is headquartered elsewhere in France, its payroll team may simply not know the scheme exists. The line should appear on your payslip — check it rather than assume it.
Via employerWho: You and your employerFirst payslip
3
Buy a mutuelle sized for Alsace-Moselle, not for the rest of France
Local insurers sell reduced complementary policies designed to sit on top of the régime local. A national policy priced to fill the ordinary French gap duplicates cover you already have. Ask your employer explicitly whether its scheme has an Alsace-Moselle version, and compare it against a local policy.
OnlineWho: You
4
Declare a médecin traitant in your first weeks
Naming a family doctor with the fund raises your reimbursement rate and is the gateway to specialists — and it applies on top of the régime local rather than instead of it. Practices close their lists, so start early and ask colleagues rather than working through a directory.
In personWho: YouWeek 1–4
5
Keep every feuille de soins until the card actually works
Until the carte Vitale is functioning you pay in full and receive a paper claim form. Keep them all — once your file is active they are reimbursed retroactively, at the local rate, and people routinely lose several hundred euros by discarding them.
In personWho: You
6
If your employer is German, understand that you are in the German system instead
The régime local follows employment exercised in the three departments. Work for a German employer and your social security is German, with a portable entitlement document registered with the French fund so you can be treated where you live. That is a different arrangement with its own paperwork, and it is not the régime local.
Via employerWho: You and your German employer

Documents you’ll need

Residence permit or validated visa
Birth certificate with a sworn translation, frequently required
Employment contract showing where the work is exercised
Justificatif de domicile
RIB for reimbursements

Things most newcomers don’t know

The régime local is not an optional add-on — it is compulsory, automatic, and better than what the rest of France gets.

Employees working in Bas-Rhin, Haut-Rhin and Moselle are enrolled by operation of law in a supplementary scheme run inside the health insurance system, funded by an extra employee contribution held at 1.30% for 2026. It raises reimbursement to around 90% on medical and dental care where the general regime pays 70% and 60%, covers hospitalisation and the daily hospital charge in full, and covers scheduled transport in full. There is nothing to apply for and no way to opt out.

Source: Régime Local d'Assurance Maladie d'Alsace-Moselle

Buying a national mutuelle here means paying twice for the same cover.

Complementary insurance across France is priced to fill the gap between the state tariff and what you actually pay. In Alsace-Moselle most of that gap is already closed by the régime local, which is why local insurers sell reduced policies at reduced prices. Employers headquartered elsewhere frequently offer a single national scheme without an Alsace-Moselle variant, and employees accept it without asking. Raise it with HR — the difference over a career is substantial.

Source: Régime Local d'Assurance Maladie d'Alsace-Moselle

Alsace-Moselle also gives you full pay from day one of a short absence, with no seniority condition.

Under the local-law provisions of the Code du travail, an employee in the three departments who is prevented from working for a personal reason beyond their control keeps their full remuneration from the first day, with no waiting period and no minimum length of service, less any social security daily allowances. The protection is limited to an absence of what the article itself calls a relatively insignificant duration, which the courts assess case by case — but it is materially stronger than the general French rule, which requires seniority and applies a waiting period.

Source: Code du travail, articles L1226-23 et L1226-24

Not declaring a médecin traitant still costs you, régime local or not.

The local scheme improves the reimbursement rate; it does not exempt you from the coordinated care pathway. Consulting outside it — before you have formally named a family doctor with the fund — is reimbursed at a materially lower rate, and the local top-up is calculated on that lower base. The two rules stack, so skipping the médecin traitant declaration costs you more here rather than less.

Source: l'Assurance Maladie

Common mistakes to avoid

Assuming the régime local is something you have to apply for, and never checking the payslip.
Accepting a national employer mutuelle without asking for the Alsace-Moselle version.
Assuming the régime local follows your address rather than where the work is exercised.
Discarding paper claim forms before your social security file is active.
Leaving the search for a médecin traitant until you are actually ill.

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