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Health Insurance in France: A Guide for Overseas Employers

When you hire overseas employees, you will find yourself in a new health insurance system, which may be more or less comprehensive than in your home country.  Many countries do offer public universal healthcare coverage, which is funded by taxes or social security contributions.

France has a reputation for offering both excellent medical care and universal coverage that is available to virtually everyone.  As an employer, you will need to understand how to register your employees and make the correct contributions to fund coverage.  This guide will give you the information to get started, but having in-country support may be helpful.

How does the healthcare system in France work?

Healthcare in France is mandatory for all residents, either through a public or private scheme.  The French public health insurance program (PUMA) is available to both citizens and expats who have been in France for at least three consecutive months, and have a principal home and intention to stay at least six months per year. 

Likewise, employees are eligible through their social security contributions, from the very first day of work, and don’t have to meet the residency rules.  Family members of employees are also covered by PUMA right away, and there is no longer a requirement for employees to have contributed a certain amount to qualify.

The PUMA reimburses the individual for medical costs at a rate of 70-80% depending on the healthcare provider, with the remainder as a copay.  If you have a health card you don’t have to make payments upfront, but reimbursements only take five to ten business days. 

Some employers will offer a private health policy to make up the 20-30% difference between full costs and reimbursement amounts (the copay), and collective bargaining agreements in certain industries will make 100% employer-paid coverage mandatory.

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What are the legal health insurance obligations as the employer?

The employer is responsible for registering the employee with PUMA, and then making the required social security contributions that cover health insurance.  Employer contributions are included in a 7% rate that covers insurance for health, maternity, disability, and death.

Employers also must withhold employee contributions in payroll, and that rate is 9.2% as part of a ‘social security surcharge’.  For employees who are not tax residents, they don’t have to pay the entire surcharge but do have to pay 5.5% to cover health insurance only.  Both rates are calculated on 98.25% of gross salary.

Client Case: Adding beneficiaries to health insurance in France

We have a client with an employee in France who wanted to get 100% health insurance coverage for their family members (spouse and children).  While they are all covered by PUMA, it was only up to the 70-80% reimbursement rate.

We let them know that the employer-paid 100% coverage for employees was mandated by a collective bargaining agreement, but that did not extend to family members.  The employee would have to make additional contributions to fund the full coverage for their family or shoulder the copay amount.

Do you need more information about France?

Employers that are new to France may have additional questions, such as:

Are employers required to help employees with upfront medical payments while awaiting reimbursement?

Is employee compensation also covered in the event of medical leave?

Does the employer or employee apply for the health card and how long does it take?

We address questions like these for our clients that hire abroad, to make sure they are in compliance and to avoid any employee dissatisfaction with benefits administration.  We make international employment simple.

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