You cannot start this from the US
Enrolment follows residency. You apply to your local CPAM once you are living in France with a valid visa or residence permit — there is nothing to file before you arrive.
Non-workers generally need three consecutive months of stable residence first. If you are employed or self-employed in France, cover applies with no minimum duration and affiliation usually happens through payroll.
What to file
- Form 736 — “Demande d’affiliation au régime général sur critère de résidence”, from ameli.fr or submitted through your ameli account
- Passport with your visa or residence permit
- Proof of address — a recent utility bill, or three months of statements
- Birth certificate, apostilled and translated if required
- French bank details (RIB)
- Proof of income, or an attestation that you have none
You cannot be covered by another EU or EEA country’s system at the same time.
What the card does once it arrives
The Carte Vitale is a chip card you present at doctors, pharmacies and hospitals. It enables direct billing (tiers payant) and automatic reimbursement — typically 70% of the conventional rate for a GP visit, and more for serious or long-term conditions.
What PUMA costs
Base cover is not means-tested. It is free for anyone meeting the residence conditions, and there is no general income cutoff for basic affiliation.
- Cotisation Subsidiaire Maladie — a sliding contribution from roughly 6.5% down to zero, applying only to non-working residents with low earned income (below about €9,000–9,600 a year) who also have substantial capital or investment income
- For anyone drawing a French salary, standard payroll CSG/CRDS of 9.2% plus 0.5% on 98.25% of gross pay — a general social charge, not a PUMA membership fee
Most salaried workers and retirees on modest pensions pay neither. But the 2026 Social Security Financing Law introduces a new contribution for PUMA beneficiaries who owe no CSG, CRDS or health-insurance contributions under an international agreement — which may catch US retirees covered by the bilateral agreements. The implementing decree setting the amount had not been published as of mid-2026, so watch ameli.fr and service-public.fr.