How health care support is provided to low-income individuals and families in France

Multidimension desk:

WHAT IS SUPPLEMENTARY HEALTH INSURANCE (CSS)?

Complémentaire santé solidaire (CSS) is a public health policy run by the Social Security office (CPAM) to provide supplementary health insurance to low-income individuals and families in addition to universal health coverage that covers all medical and health expenses including dental prostheses, glasses and hearing devices. It is actually a combination of two separate policies of the past, CMU-C and ACS, to reduce bureaucratic complexity in social life.

The applicant must meet the income limit criteria to benefit from this policy. It is divided in two parts: CSS without financial participation of the beneficiary, i.e., he does not have to make any payment for it, (Ceiling -A) and CSS with financial participation of the beneficiary, i.e., he has to pay a certain amount to get the benefit of this additional insurance, (Ceiling -B).
The eligibility is calculated on the basis of annual income or income over the past 12 months from the date of submission of the application.

Exception: The beneficiary of RSA (minimum income support) are granted supplementary health insurance (CSS) with no financial participation, during the entire period of support.

From April 1, 2022, supplementary health insurance is also granted to people who receive the solidarity allowance for the elderly persons (ASPA).

Annual income ceilings corresponding to the number of family members eligible for CSS (as of 01/07/2022):
(The ceilings indicated in these tables are effective until March 31, 2023)

Those who are in need can apply for the CSS by submitting the application form, Cerfa n°12504*09, with all required documents to the Social Security office (CPAM).

The CPAM offers an online simulator to find out if you are entitled to complementary health insurance. In the event of a positive response, for any request, it is necessary to choose a managing organisation (Social Security office, mutual insurance company, provident institution, etc.).

It can also be applied through an ‘Ameli’ account providing allocation number of the CAF (Family allowance fund). In such a case, the Social Security office will automatically find the last 12 months’ income of an applicant.

WHAT IS STATE MEDICAL ASSISTANCE (AME)?

L’aide médicale de l’Etat (AME) is a system that allows foreigners in an irregular situation to have access to public healthcare at free of cost. It is granted under residence and income conditions. To get it, one must fill out an application form (Cerfa N°11573*09). Once granted, the beneficiary will benefit State Medical assistance for a period of 1 year.

Conditions to be fulfilled to have access to the state medical assistance:
– must have been residing in France for more than 3 months.
– must not have had a residence permit for more than 3 months.
– annual income must not exceed a certain limit
These ceilings are different in Metropolitan France (mainland) and in the DROM (The French Overseas Departments or Regions), i.e. Guadeloupe – Guyana – Martinique – Mayotte – Reunion

Income of the last 12 months from the date of submission of application is taken into consideration.