In Brief

• Puma ensures personal and continuous coverage of health expenses.
• It applies even in case of changes in professional, family, or residence situations.
• Adults are insured individually upon reaching adulthood, without needing to be attached to another insured person.
• A financial contribution may be implemented for certain beneficiaries according to the law of December 30, 2025.

What is Universal Health Protection (Puma)?

Universal health protection (Puma) aims to guarantee a right to coverage of health expenses, personally and continuously throughout life. This system helps avoid potential gaps in your rights, especially during changes in situation.

Unlike previous systems, Puma allows you to remain in the same health insurance scheme, even in case of:

• Changes in professional situation (for example: job loss)
• Changes in personal situation (for example: separation)

To be eligible for Puma, you must work or reside in France in a stable and regular manner. This affiliation is mandatory.

Who is Affected by Puma?

You are affected by Puma if you work or reside in France in a stable and regular manner. The status varies according to your age.

Adults

If you are an adult, there is no need to be attached to an insured person. An adult can no longer be a dependent since the implementation of Puma. You are insured individually upon reaching adulthood.

As an individually insured person, you can choose to:

• Receive reimbursements in your own bank account
• Get your own reimbursement statement
• Have your own Ameli account

Minors

If you are a minor, you continue to have the status of a dependent. In practice, you are attached to one of your parents. However, it is possible to request to benefit from Puma personally from the age of 16.

This dependent status ends in the year of your 18th birthday.

Conditions Related to Residence in France

You must meet 2 conditions related to the regularity and stability of residence. These 2 conditions are cumulative.

Regularity of Residence

• If you are a citizen of the European Economic Area or Switzerland: you have the right to move and stay freely in France. An identity card or passport is sufficient.
• If you are a citizen of another country: you must have a residence permit and a civil status document.

Stability of Residence

This criterion depends on whether you are engaged in professional activity or not.

Engaging in Professional Activity

If you are engaged in professional activity and your Puma application is accepted, you are immediately affiliated with health insurance.

Without Engaging in Professional Activity

Once in France, you must wait 3 months before your rights are opened. These rights remain open if you live in France for at least 6 months of the year.

Note: This condition of stability of residence (3 months) is met without delay for certain individuals. For example:

• Refugees
• Individuals returning to France after international volunteering abroad
• Individuals receiving RSA or the adult disability allowance (AAH)

Steps to Obtain Puma

To apply for your rights, you must follow these steps:

1. Complete the form "Request for Opening Rights to Health Insurance."
2. Return this completed form with the supporting documents presented on page 2 of the form.

The recipient organization depends on your scheme:

• To the Primary Health Insurance Fund (CPAM) if you are under the general scheme.
• To the Agricultural Social Mutuality (MSA) if you are under the agricultural scheme.

To find the address of your fund, you can use the online service "Local Pivot" available on service-public.fr by entering your city or postal code.

Sanctions in Case of Refusal of Affiliation

Anyone who deliberately refuses to affiliate or who continues not to engage in the procedures for their mandatory affiliation to a social security scheme is punishable by 6 months imprisonment and a fine of €15,000 (or only one of these penalties).

Withdrawal of Puma

Puma can be withdrawn if you no longer meet the conditions of stability of residence or regularity of stay. Thus, you must spontaneously declare your departure abroad.

To do this, you must:

1. Complete the form "Declaration of Transfer of Residence Outside France."
2. Return this form to the CPAM (general scheme) or to the MSA (agricultural scheme).

Future Development: Financial Contribution

The law of December 30, 2025, on the financing of social security for 2026 provides for the establishment of a financial contribution for Puma beneficiaries who meet 3 conditions:

1. Reside in France in a stable and regular manner.
2. Be without professional activity.
3. Not be liable for CSG, CRDS, and health insurance contributions under an international agreement.

A decree is expected regarding the amount of this financial contribution. An update of this page will be made upon the publication of the decree. In the meantime, the information presented on this page remains valid.

Help and Support

If you have a question or wish to be assisted in your procedures, you can contact your health insurance fund:

• If you are under the general scheme: Primary Health Insurance Fund (CPAM)
• If you are under the agricultural scheme: Agricultural Social Mutuality (MSA)

Official Source

The information contained in this guide comes exclusively from the official sheet "What is Universal Health Protection (Puma)?" published on service-public.fr, verified on October 29, 2024, by the Directorate of Legal and Administrative Information (Prime Minister).