In Brief

• Puma ensures continuous health coverage, even in the event of professional or family changes.
• Every adult is insured personally, without needing to be attached to another insured individual.
• Opening rights requires stable and regular residence in France.
• A financial contribution may be requested from beneficiaries without professional activity according to the funding law for 2026.

What is Universal Health Protection (Puma)?

Universal Health Protection (Puma) aims to guarantee the right to personal and continuous coverage of health expenses throughout life. This system helps avoid interruptions in rights that could previously occur during changes in situation.

Specifically, Puma allows you to remain in the same health insurance scheme, even in cases of:

• Changes in professional situation (e.g., job loss).
• Changes in personal situation (e.g., separation).

Potential periods of interruption in your rights are thus avoided. This means that coverage is assured even in the event of changes in professional, family, or residence situations.

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 differs based on your age.

For Adults

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

You can choose to:

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

For 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 starting at age 16.

This dependent status ends in the year you turn 18.

Conditions Related to Residence in France

To be eligible for Puma, you must meet 2 cumulative conditions related to the regularity and stability of residence.

Regularity of Residence

This condition depends on your nationality:

• Citizen of the European Economic Area (EEA) and Switzerland: You have the right to move and stay freely in France. An identity card or passport is sufficient.
• Citizen of another country: You must have a residence permit and a civil status document.

Stability of Residence

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

If You Are Engaged 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-month waiting period) 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, follow these steps:

1. Complete the Form: First, complete the form "Request for Opening Rights to Health Insurance".
2. Prepare Supporting Documents: Gather the supporting documents listed on page 2 of the form.
3. Send the Application: Return the completed form with the supporting documents to the organization you depend on:
   • 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 exact address of your fund, you can use the online service "Pivot Local" by entering your city or postal code on the service-public.fr website.

Future Financial Contribution (2026 Law)

It is important to note a regulatory change that is expected. The law of December 30, 2025, regarding 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 to specify the amount of this financial contribution. An update of the official page will be made upon the publication of the decree. In the meantime, the information presented on this page remains valid.

Withdrawal of Puma and Departure Abroad

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

To do this:

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

Sanctions for Non-Affiliation

Anyone who deliberately refuses to affiliate or who continues not to engage in the necessary steps for their mandatory affiliation to a Social Security scheme is subject to a 6-month imprisonment and a fine of €15,000 (or only one of these penalties).

Assistance and Contacts

If you have a question or wish to be assisted in your procedures, you can find a contact person via the online service "Pivot Local" by entering your city or postal code.

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

Official Source

The information contained in this guide is extracted exclusively from the official sheet service-public.fr titled "Registering for Health Insurance", verified on October 29, 2024, by the Public Service / Directorate of Legal and Administrative Information (Prime Minister).