International health insurance for expat families in France

You can’t use PUMA until you and your family have lived in France for three consecutive months. You’ll then receive a carte vitale, which is a smart card that lets you use PUMA.³ During this period, you’re legally responsible for 100% of your medical costs.

You must have private health insurance to apply for a visa if you’re from outside the EEA and Switzerland. This covers any healthcare costs during the three month wait to use PUMA.³ Having international health insurance covers both visa requirements and access to healthcare during the first three months of living in France.

If your family is registered with L’Assurance Maladie, the majority of maternity care is covered.⁴

You can register once you and your family have been in the country for three months. Once you’ve registered, you can access France’s maternity care using the public system.

This includes:

• Prenatal tests: all essential tests during pregnancy.
• Ultrasounds: typically, three ultrasounds, with the option to find out the baby's sex.
• Disease screening: tests for conditions like toxoplasmosis to make sure both mother and baby are healthy.
• Birth costs: most expenses related to giving birth at a public hospital are covered.
• Pain management: options such as epidurals are included.
• Newborn screening: tests for the baby after birth, usually within the first 12 days.
• Post-birth care: checks, weighing and measuring the baby to monitor their health.
• Home visits: if you leave the hospital within five days, you can request visits from a midwife at home.⁴

Yes, the French state system typically only reimburses about 70% of standard medical costs.³ A mutuelle is a "top-up" insurance designed to cover the remaining 30%.⁵

However, for expat families, international private health insurance often replaces the need for both the state system and a mutuelle.

If you have access to PUMA then paediatric care is generally affordable as the public healthcare system covers up to 80% of costs.³

However, if you’re not registered with PUMA, you have to pay 100% of the costs upfront, which could become quite expensive, depending on the type and length of care your child needs.

In France, there are two tariff systems:

• Sector 1: standard government rates 
• Sector 2: where medical practitioners are allowed to charge more than the standard rate.⁶

Standard fees for a paediatric care

• Seeing a pediatrician for children under two: €40
• Mandatory paediatric exams: €60
• Paediatric exams for children under two: €50
• New consultant paediatric visit: €60
• Emergency visits: €40- €50 depending on the severity.⁷

However, if your child  receives treatment from a sector 2 medical practitioner, this could cost a lot more, so it’s best to check costs before you go ahead with any treatment.⁶ 

French public healthcare and international private insurance offer access to different treatment facilities and varying reimbursement levels. Many expats choose both to make sure their family's healthcare costs are fully covered.³

French public healthcare

France’s public healthcare system provides access to essential healthcare services, including doctor appointments, hospital treatment, maternity care and specialist services.³

Once eligible and registered, you may receive partial or significant reimbursement for many medical costs.³

For expat families, public healthcare can provide: 

• access to doctors, hospitals and maternity services
• lower healthcare costs compared with paying privately
• long-term access if you live and work in France.³

However, there are some considerations for newly relocating families: 

• Registration and eligibility can take at least three months after moving.
• Some treatments and appointments may involve out-of-pocket costs.
• Reimbursement levels vary depending on treatment type.
• Access to English-speaking practitioners or private facilities may be limited in some regions or cities.³

International private medical insurance

International private medical insurance is designed to provide protection and support for expat families living abroad.

Depending on the type of cover you have, you and your family could benefit from:

• access to private hospitals and clinics
• faster access to specialists and treatment
• international cover across multiple countries
• healthcare access before fully registering with the French healthcare system
• optional benefits such as dental, maternity, mental health or medical evacuation cover.

International cover may be particularly useful for families who: 

• move between countries regularly
• want continuity of care across borders
• prefer access to private healthcare services
• need cover immediately upon arrival. 

The right option depends on your family’s needs, budget and the level of cover you want while living abroad.  

It’s a requirement for you and your family to have private health insurance to obtain your visas if you’re from outside the EEA and Switzerland. Therefore, you must purchase this while you wait to register with France’s social security system — L’Assurance Maladie.

As France’s public healthcare system isn’t 100% free, having private insurance to pay for any remaining costs is a popular choice.³

Cover for children with ongoing medical conditions depends on the type of cover you opt for.

At AXA Global Healthcare, our Comprehensive, Prestige and Prestige Plus cover includes chronic condition cover, which means everyone on your plan is covered for ongoing medical conditions that have started since you took out your health insurance.

If you opt for our Foundation or Standard cover, you or anyone else on your cover won’t be insured for any chronic conditions that begin once you’ve taken out your plan. However, if you include additional outpatient cover, you can be reimbursed for certain services related to your ongoing medical condition for a limited period.

Visit our international health insurance for chronic conditions page for an example of how chronic conditions are covered on our Foundation and Standard plans.*