Last verified: 4 October 2026, based on the official pages cited at the bottom of the page.

The situation — without French public health insurance (Sécurité sociale), you pay everything yourself

Registration with French public health insurance is free and compulsory for all students in France, whether French or international. It allows you to have part of your health costs covered. For reference: a consultation with a secteur 1 GP in mainland France costs €30 (rate as of 1 January 2026); with a specialist, especially in secteur 2 where fees are unregulated, it can cost more.

Good news: registration is free and mostly done online. Bad news: your university does not handle everything for you — for international students, you must register yourself on a dedicated portal, and this is the classic mistake new arrivals make.

This guide walks you through the procedure in 2026, warns you about the pitfalls, and explains how to get your carte Vitale as soon as your definitive number is certified.

Step 1 — Understanding who is covered by what

In France, your contact for Assurance Maladie is your CPAM (caisse primaire d'assurance maladie). The registration channel depends on your situation:

• International student from outside the EU/EEA/Switzerland (or European without a European Health Insurance Card or provisional certificate): you must register yourself on etudiant-etranger.ameli.fr. There is no automatic registration by the university.
• European with a EHIC (European Health Insurance Card) valid at least until the end of the academic year: you do not need to register, your home organisation continues to reimburse you; in case of illness, you only pay the co-payment by showing the card or its provisional certificate.
• Employee, self-employed or not working: this guide does not detail your procedure. Find out more on ameli.fr or from your CPAM.

Step 2 — Students: your online registration, you have to do it yourself

As soon as you arrive in France and as soon as you have your enrolment certificate from a higher education institution:

1. Go to etudiant-etranger.ameli.fr and apply for your registration. Enter your information (identity, date and country of birth, email, address in France, phone number, and the start date of your rights, meaning the start date of your studies).
2. Upload the required supporting documents:
   • national identity card or passport;
   • residence permit (titre de séjour) (EU/EEA/Swiss nationals without an EHIC should instead complete their file with the S1 form or, if not available, a sworn statement of sufficient resources);
   • enrolment certificate for the current year;
   • IBAN or bank account details (RIB) for your reimbursements;
   • a civil status document to create your social security number: full copy of birth certificate, extract of birth certificate with parentage, family record book or marriage certificate.
3. At the end, the site automatically assigns you a provisional number (it starts with 7 or 8): keep it and download your provisional registration certificate. You can upload any missing or non-compliant documents later in your personal space.
4. With this provisional certificate, you can already declare a primary doctor (médecin traitant) (better reimbursement) and take out top-up health insurance (mutuelle).
5. Once your registration (the certification of your definitive number) is complete: download your definitive certificate, return the form you receive to apply for your carte Vitale, and you can finally open an ameli account.

⚠️ Pitfall #1: thinking the university handles everything. You are the one who registers and uploads your documents. If you couldn't do it online, call 09 74 75 36 46 from France (or 0033 974 75 36 46 from abroad): a helpline advisor can answer you in English.

⚠️ Pitfall #2: trying to open an ameli account with your provisional number. The ameli account is only accessible with a definitive and certified number (starting with 1 or 2), and creating it requires your bank account details and the serial number of your carte Vitale. In the meantime, your personal space on etudiant-etranger.ameli.fr lets you download your provisional certificate and upload any missing or non-compliant documents.

And the processing times? Tip: upload complete documents from the start, that's what limits back-and-forth.

Step 3 — Employees, self-employed, not working

This guide does not detail these procedures: they depend on your status. Two points that apply in all cases:

1. Your ameli account can only be opened with a definitive and certified social security number; on the ameli app or on ameli.fr, you can track your reimbursements and update your information.
2. If you are unsure which is the right channel, contact your CPAM at 3646 or go to the reception desk of the health insurance fund for your place of residence.

Tip: as soon as you have your certificate—even a provisional one—download it and keep it with you until you have your carte Vitale.

Step 4 — From provisional number to definitive number

While your application is being processed, your provisional number (which starts with 7 or 8) and your provisional certificate already allow you to declare a declared primary doctor (médecin traitant) and to sign up for top-up health insurance (mutuelle). Keep the certificate safe: it is useful when you do not have your carte Vitale with you.

When your definitive number is certified (it starts with 1 or 2 and has 13 digits):

1. Download your definitive certificate (certificate of entitlement).
2. Fill in and return the form you received to order your carte Vitale.
3. Open your ameli account (on ameli.fr or the app) with your definitive number, your bank account details (RIB), and the serial number of your carte Vitale. Use it to track your reimbursements, order a CEAM, or update your contact details.

The carte Vitale is updated once a year and whenever your situation changes, at the terminals in health insurance offices or in most pharmacies: an up-to-date card means smooth reimbursement.

Step 5 — Top-up health insurance (mutuelle), almost essential

In the coordinated care pathway, Assurance Maladie reimburses 70% of the standard rate, minus a fixed contribution of €2 deducted from each consultation. In practice (rates as of 1 January 2026):

• Sector 1 general practitioner (your declared primary doctor (médecin traitant)): €30 → €19 reimbursed.
• Sector 1 specialist to whom your declared primary doctor refers you for regular follow-up: €31.50 → €20.05 reimbursed (psychiatrists, neurologists, geriatricians, medical gynaecologists, etc. have their own rates). Watch out for sectors: with a general practitioner or a specialist in this category in sector 2 who has not signed up to the controlled fee agreement, fees are unregulated and the reimbursement base drops to €23 (€14.10 reimbursed).
• The €2 contribution does not apply to those under 18, pregnant women from the 6th month of pregnancy until 12 days after childbirth, or beneficiaries of Complémentaire santé solidaire or State medical aid.
• In some cases (pregnancy over 6 months, beneficiary of CSS), the consultation may be covered at 100%.

The out-of-pocket amount is what you have to pay after reimbursement by Assurance Maladie; top-up health insurance is used to reduce it. Three options:

• Complémentaire Santé Solidaire (CSS) — the best option if your resources are modest. In mainland France, since 1 April 2026, it is free of charge for a one-person household whose resources do not exceed €10,421/year, and with a contribution between this ceiling and €14,069/year (in the overseas départements: €11,599 and €15,659)—the contribution does not exceed €1 per day (between €8 and €30 per month depending on age). If you are under 25 and considered dependent on your parents (attached to their tax household, or living under the same roof, or receiving maintenance payments from them that are deducted from their taxes), your entitlement is assessed based on their household. An individual application is still possible if you meet all three of these conditions: you do not live under the same roof as them at the time of application; you have filed a separate tax return, or you undertake on your honour to do so next year; you do not receive maintenance payments that give rise to a tax deduction, or you undertake on your honour not to receive them for the coming year. Simulation at mesdroitssociaux.gouv.fr.
• Private top-up health insurance — Tip: compare the cover (excess fees, dental, optical) rather than just the price.
• Company top-up health insurance — if you are an employee, your company may have a compulsory group policy; if you are entitled to CSS, you can request an exemption from joining this policy for the duration of your entitlement.

💡 Without top-up health insurance, the out-of-pocket amount is yours to pay. Tip: if you are a student with no income, first check your entitlement to CSS.

Step 6 — Common pitfalls

🚨 Thinking student registration is automatic No. The university does not register you with Assurance Maladie: it is your own responsibility on etudiant-etranger.ameli.fr, with your documents. As long as the application is not submitted, there is no certificate, so no coverage.

🚨 Letting your documents drag on You can upload missing supporting documents later in your personal space. Tip: as soon as you arrive, prepare your passport, your residence permit (titre de séjour), your enrolment certificate, your bank account details (RIB), and your birth certificate.

🚨 Opening an ameli account too early With a provisional number (7 or 8), it is impossible: you have to wait for the definitive number (1 or 2), then create the account with your bank account details (RIB) and the serial number of your carte Vitale.

🚨 Not declaring a declared primary doctor (médecin traitant) From age 16, choose a declared primary doctor and make the declaration with them to send to your health insurance fund. Otherwise, your reimbursements are reduced: for a sector 1 general practitioner at €30, you are reimbursed €8.40 instead of €19 (70% minus a €10.60 penalty, minus €2 contribution). Exceptions: children under 16, emergencies, consultations far from home, dental surgeons, and, if you have a long-term illness, the specialists listed on your care protocol. Special case: you can consult directly, without going through your declared primary doctor, a gynaecologist, an ophthalmologist, or a stomatologist for certain specific procedures, and a psychiatrist or neuropsychiatrist if you are between 16 and 25. You are then reimbursed as normal, provided you have declared a declared primary doctor.

🚨 Paying for a 'student Sécu' Your affiliation to French public health insurance is free and compulsory. Tip: if an organisation offers you a paid "student insurance", check what you are buying — a top-up health insurance (mutuelle) can be useful, but it does not replace this affiliation.

🚨 Confusing secteur 1 and secteur 2 "Secteur 2" does not mean "better doctor", but "fees are not regulated". A secteur 2 specialist can charge much more than the reimbursement base: ask for the fee before making an appointment.

Step 7 — Teleconsultation, emergencies, keeping your carte Vitale up to date

Some useful practices to know as soon as you are registered:

• Teleconsultation: a teleconsultation with a GP (your declared primary doctor (médecin traitant), secteur 1) costs 25 € and is reimbursed 15.50 € — the same rate as an in-person visit (rates applicable since 22 December 2024). In a teleconsultation, your declared primary doctor can prescribe or renew a sick leave for more than 3 days; for another doctor, this duration is limited.
• Emergency or being far from home: in an emergency, or if you see a doctor far from home, the doctor ticks "Emergency" or "Out of residence" and you are reimbursed as normal. An emergency is a situation that was not foreseeable more than eight hours in advance, for a condition that endangers life or the integrity of the body and requires the doctor's rapid intervention.
• Keeping your carte Vitale up to date: update it once a year and whenever your situation changes (at the terminals in the health insurance office or most pharmacies). Your certificate of entitlement (attestation de droits) helps you out when you do not have the card with you.

Step 8 — Official resources

Official pages used to fact-check this guide:

• “You are an international student coming to study in France” (Assurance Maladie)
• “Health coverage for international students” (etudiant.gouv.fr)
• “Creating your ameli account and logging in: user guide” (Assurance Maladie)
• “Consultations in mainland France: your reimbursements” (Assurance Maladie)
• “The role of the declared primary doctor (médecin traitant) and the coordinated care pathway” (Assurance Maladie)
• “Who can benefit from the Complémentaire santé solidaire (top-up health insurance)?” (Assurance Maladie)

Keep these handy: ameli.fr, etudiant-etranger.ameli.fr, and 3646 (free service + cost of the call) for any problem.

And what about Pionra?

Pionra does not replace the CPAM. It is the place where newcomers share information: how it really went, in which city, and how long it took.

Have you just completed this process? Share your experience in a comment or in a note — this will help those who come after you the most.