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Hello, Forum mates.

Trying to figure out how health coverage for expats in France has changed since the advent of PUMA, Protection Universelle Maladie. Another site (french-property.com) with a very robust section on health care in France, makes these claims:

As with the CMU, the insurance contribution rate [for coverage under PUMA] is 8% of net income, but the income that is taken into consideration is narrower than under the CMU. The only income that is assessed is the 'revenus de patrimoine'. That is to say, investment income, rental income and capital gains.

So if you have no such income you will not be liable for the CSM, as confirmed to us by the French Ministry of Health, who have stated that: "Si vous n'avez pas de revenus du patrimoine, vous n'aurez pas de cotisations à payer au titre de la CSM."

In addition, if the total sum of your revenus de patrimoine is no greater than €9,654, you will also be exempt from payment of the CSM.

Two questions:

1. What are the residency requirements for getting coverage under PUMA? (I've heard conflicting stories about this. Some say three months in France, others say five years.)

2. Is the french-property.com site correct in saying that only revenus de patrimoine count, not all revenues?

Thanks all.

-- Glauco
 

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Uh, I don't know the PUMA law really well, but that is not what patrimoine means in French law, they've given a definition of patrimoine in popular culture.

Your patrimoine in the legal sense includes all of your "actifs" and all of your "passifs" -- all of your incomes and debts. I have an immediate suspicion of this site.
 

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One other thing to keep in mind is that that particular website is oriented toward British expats in France. Those of us from outside the EU often find that our situation may be rather different from what is described there.

Technically speaking, the residence requirement for PUMA is 3 months - however, since you appear to be from the US, you most likely are here on a visa of some sort (unless you are married to an EU national). The initial visa you obtained may very well have an insurance requirement - possibly for the entire first year you are here in France. It may or may not be required for you to show private insurance coverage on renewal of your titre de séjour/ carte de séjour for the first year or two. Those requirements take precedence. And, there is the requirement that you need to have health insurance in place when you apply for coverage under the PUMA scheme (I think - someone will correct me if that is no longer operative).

The "best" proof of your income is your avis d'imposition, because it "proves" (to a certain extent) your residence in France at the same time that it "proves" your income for the prior year. You do have to report your foreign pension income (including US social security) as part of your French tax declaration, even though it is not taxed in France, so I'm pretty sure it's taken into account for the calculation of the annual fee for PUMA.
Cheers,
Bev
 

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Hello, Forum mates.

Trying to figure out how health coverage for expats in France has changed since the advent of PUMA, Protection Universelle Maladie. Another site (french-property.com) with a very robust section on health care in France, makes these claims:


Two questions:

1. What are the residency requirements for getting coverage under PUMA? (I've heard conflicting stories about this. Some say three months in France, others say five years.)

2. Is the french-property.com site correct in saying that only revenus de patrimoine count, not all revenues?

Thanks all.

-- Glauco
1. The residence requirement is 3 months continuous residence, however the documentary evidence of residence would generally mean somewhat longer - it really depends how long it takes you to establish yourself.

2. This is what Previssima says Protection Maladie, universelle mais pas gratuite : parution du décret sur les taux de cotisations - Previssima. And this is from the URSSAF (the agency that bills and collects contributions) site https://www.urssaf.fr/portail/home/espaces-dedies/beneficiaires-de-la-puma-et-de-l/de-la-cmu-de-base-a-la-puma.html

I think perhaps for someone who is inactif (or whose work income falls below the threshold), this from URSSAF is the key (my highlightiing):

Les deux autres composants sont liés à la situation personnelle du bénéficiaire de la PUMa, qui elle aussi est susceptible d'évolution :
A : base de calcul de la cotisation. Elle est constituée de revenus fonciers, de capitaux mobiliers… et de l'ensemble des moyens d'existence et des éléments de train de vie pris en compte (décret à paraitre) ;
R : montant des revenus tirés de l'activité professionnelle exercée en France.
This is the relevant decree on contributions https://www.legifrance.gouv.fr/affichTexte.do;jsessionid=EE9D25EBAE0C8BBB3C6B31E775D8844D.tpdila09v_1?cidTexte=JORFTEXT000032918069&dateTexte=&oldAction=rechJO&categorieLien=id&idJO=JORFCONT000032917974.

(BTW I'm still confused, but I'm not currently being charged contributions, but I was paying for CMU de base. :confused:)
 

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Technically speaking, the residence requirement for PUMA is 3 months - however, since you appear to be from the US, you most likely are here on a visa of some sort (unless you are married to an EU national). The initial visa you obtained may very well have an insurance requirement - possibly for the entire first year you are here in France. It may or may not be required for you to show private insurance coverage on renewal of your titre de séjour/ carte de séjour for the first year or two. Those requirements take precedence. And, there is the requirement that you need to have health insurance in place when you apply for coverage under the PUMA scheme (I think - someone will correct me if that is no longer operative).
The "best" proof of your income is your avis d'imposition, because it "proves" (to a certain extent) your residence in France at the same time that it "proves" your income for the prior year. You do have to report your foreign pension income (including US social security) as part of your French tax declaration, even though it is not taxed in France, so I'm pretty sure it's taken into account for the calculation of the annual fee for PUMA.
So, If I'm understanding correctly, the consulate's requirement of one-year's health insurance will take precedence over any three-month interpretation for PUMA - since my wife and I will be arriving on a one-year long-stay visa as retirees? Is there any sense that, once there, we can apply for insurance through PUMA before the year is up?

Then, if we ever are accepted into PUMA, in terms of trying to assess our required contribution, how is that figured. We'll be living on a combination of savings, my wife's social security, and investments (IRAs, 401(k)). Is some or all of that factored into the calculation?
 

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There is nothing to stop you from applying for PUMA once you've met the 3-month residence requirement. However, the processing of your application will take "a few" months in any event.

The contribution is based on your prior year's income - normally determined according to your French tax assessment, but obviously in your first year, you'd have to provide something roughly equivalent (perhaps copies of your US federal tax returns). As French residents, you are expected to declare your worldwide income - just like in the US. So, figure your wife's social security, plus IRA and 401K withdrawals (both are recognized in the US-France tax treaty as "social security" pensions for French tax purposes) plus interest or other earnings on your savings/investments that aren't considered pensions. So yes, all of that is factored into the calculations.
Cheers,
Bev
 

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Have you learned anything further? Have you had three months of residency and applied for PUMA? My wife and I (as well as another couple), are planning to be in your shoes (retired on a long stay visitor visa, living on income from retirement accounts and eventually social security) in about two years. I'm trying to get a handle on this in our retirement planning. Specifically, I'm interested in what income will be included in the CSM calculation?
 

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Given that they base the charges on your declared income once you're filing French taxes, you can figure on them including your US social security benefits plus withdrawals from your retirement accounts (IRA, 401K, etc.) as these are included in the US-French tax treaty and considered as "government pensions." The US government pensions are taxable only by the US, but you still have to declare the income on your French tax declarations (and then categorize them appropriately for tax relief).
Cheers,
Bev
 

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I don't know if it's accurate, inaccurate, speculation, or what, but I read this on french-property.com:

The only income that is assessed is the 'revenus de patrimoine'. That is to say, investment income, rental income and capital gains.

So if you have no such income you will not be liable for the CSM, as confirmed to us by the French Ministry of Health, who have stated that: "Si vous n'avez pas de revenus du patrimoine, vous n'aurez pas de cotisations à payer au titre de la CSM."

So, I'm wondering if they might NOT consider social security or IRAs etc. (gov't pensions)?
 

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I don't know if it's accurate, inaccurate, speculation, or what, but I read this on french-property.com:

The only income that is assessed is the 'revenus de patrimoine'. That is to say, investment income, rental income and capital gains.

So if you have no such income you will not be liable for the CSM, as confirmed to us by the French Ministry of Health, who have stated that: "Si vous n'avez pas de revenus du patrimoine, vous n'aurez pas de cotisations à payer au titre de la CSM."

So, I'm wondering if they might NOT consider social security or IRAs etc. (gov't pensions)?
I also don't know whether it's accurate, but the CSM is not PUMA - as far as I can make out it relates to supplementary cover (i.e. via a mutuelle).
 

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e CSM is not PUMA - as far as I can make out it relates to supplementary cover
I guess in this context CSM=cotisations maladie subsidiaires=PUMA cotisations on unearned income.
I believe there is also provision for assets and lifestyle (éléments de train de vie) to be considered, so that asset-rich cash-poor households also make a fair contribution. I think we'll have to wait and see how what it says on paper, is interpreted in practice.
 

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If I understand it, CSM is what you pay for PUMA. It's la cotisation subsidiaire maladie (CSM). And as I understand it, 8% of eligible income (revenus de patrimoine).
 

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I guess in this context CSM=cotisations maladie subsidiaires=PUMA cotisations on unearned income.
I believe there is also provision for assets and lifestyle (éléments de train de vie) to be considered, so that asset-rich cash-poor households also make a fair contribution. I think we'll have to wait and see how what it says on paper, is interpreted in practice.
Ah - thanks for that!

Found this explanation from Le Figaro

Le taux de la cotisation est de 8 % et s’applique sur tous les revenus du capital ou du patrimoine de l’assuré (revenus fonciers, mobiliers, plus-values de cession à titre onéreux de biens ou droits et autres bénéfices non professionnels…) qui dépassent 25 % du*plafond annuel de la Sécurité sociale PASS (soit 9 807 € en 2017).
Protection universelle maladie (Puma) : cotisation 2017 - Santé - Le Particulier

And you're right - train de vie (lifestyle) is taken into account.

However, it's important to note that CSM relates to subsidiary contributions, i.e. (as I understand it) additional contributions that take into account other income that is received during the year the contributions have been made, in essence so that you don't get side income without paying contributions on it. The 8% calculation of income still applies.

Or am I wrong?
 

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My interpretation agrees with yours. Of course, I'm not French, not in the government, and not even residing in France yet.

In essence, I think that to be eligible for PUMA, you mustn't make much earned income (or you'd be in the "regular" system). But, apart from a very small allowance, you have to pay 8% on all other income, excluding pensions or assistance. That is, on rents, capital gains, and the like.

At least, I'm hoping this is the case, as it seems like it would be a pretty good deal for retirees (assuming IRAs, 401ks, etc, and social security are still considered pensions by the government.
 

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Wait a minute - there are a couple different 8% assessments here and I'll admit I'm confused which ones we're talking about.

There is the surtax charge that is part of your French income tax declaration - which is levied against investment income and other income that isn't otherwise subject to "cotisations." Many people refer to this as "social charges" or "cotisations" but it has nothing at all to do with your eligibility for the French healthcare system or PUMA or anything else. (As I understand it, it's a pay down of prior years sécu debt.) Certain types of pension income covered by treaties is specifically excluded from this tax, including US social security and withdrawals from US deferred taxation retirement accounts.

Then there is the 8% that you're charged if you sign up for the French health care system under PUMA because you have no other entitlement (i.e. you aren't working and/or don't have a French pension or an S1 to cover your health care). That's based on income as declared on your French tax declaration (or on your last foreign income tax documents for the first year you are resident in France).

And, of course, even with PUMA, you still need a mutuelle of some variety.
Cheers,
Bev
 

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Wait a minute - there are a couple different 8% assessments here and I'll admit I'm confused which ones we're talking about.

There is the surtax charge that is part of your French income tax declaration - which is levied against investment income and other income that isn't otherwise subject to "cotisations." Many people refer to this as "social charges" or "cotisations" but it has nothing at all to do with your eligibility for the French healthcare system or PUMA or anything else. (As I understand it, it's a pay down of prior years sécu debt.) Certain types of pension income covered by treaties is specifically excluded from this tax, including US social security and withdrawals from US deferred taxation retirement accounts.

Then there is the 8% that you're charged if you sign up for the French health care system under PUMA because you have no other entitlement (i.e. you aren't working and/or don't have a French pension or an S1 to cover your health care). That's based on income as declared on your French tax declaration (or on your last foreign income tax documents for the first year you are resident in France).

And, of course, even with PUMA, you still need a mutuelle of some variety.
Cheers,
Bev
But it's also subsequently adjusted by URSAAF to pick up other income - they have put some technology in place that automatically picks up other amounts. Granted, this mostly impacts those who are paying cotisations through employment or self-employment etc. Chances are the OP wouldn't be affected.
 

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The official explanation, which makes sense to me, is that everybody who is entitled to healthcare in France is in PUMA - as the name says, it is universal healthcare, ie for everyone. There aren't different systems according to how you pay your cotisations, there's one healthcare system that people access via different routes according to status. If you work, you pay cotisations on earned income. If you have no earned income, or very little earned income, then you pay cotisations on unearned income. Certain categories are exempt from contributing, eg people who have very little income or assets of any kind - pensioners - chômeurs.

"La protection universelle maladie (Puma) garantit à toute personne qui travaille ou réside en France de manière stable et régulière, un droit à la prise en charge de ses frais de santé à titre personnel et de manière continue tout au long de la vie."

Seems simple enough...
 

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The official explanation, which makes sense to me, is that everybody who is entitled to healthcare in France is in PUMA - as the name says, it is universal healthcare, ie for everyone. There aren't different systems according to how you pay your cotisations, there's one healthcare system that people access via different routes according to status. If you work, you pay cotisations on earned income. If you have no earned income, or very little earned income, then you pay cotisations on unearned income. Certain categories are exempt from contributing, eg people who have very little income or assets of any kind - pensioners - chômeurs.

"La protection universelle maladie (Puma) garantit à toute personne qui travaille ou réside en France de manière stable et régulière, un droit à la prise en charge de ses frais de santé à titre personnel et de manière continue tout au long de la vie."

Seems simple enough...
It is indeed universal, although the system is not commonly referred to as PUMA by the French - heck it seems to me that most French people wouldn't even know what PUMA is :D But it's also that sheer universality and the supporting joined-up technology that is now enabling the govt to ensure that people pay their contributions based on all of their income (subject to the range of exclusions). So, that little trick of setting up as an AE that produces minimal turnover in order to access the system on the cheap doesn't work any more - and a good thing too, IMO.
 

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Just to throw another thing into the mix-If you have an occupational pension then it would appear that no cotisations are being levied whereas before we had to pay the 8%
 

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PUMa and income

There is nothing to stop you from applying for PUMA once you've met the 3-month residence requirement. However, the processing of your application will take "a few" months in any event.

The contribution is based on your prior year's income - normally determined according to your French tax assessment, but obviously in your first year, you'd have to provide something roughly equivalent (perhaps copies of your US federal tax returns). As French residents, you are expected to declare your worldwide income - just like in the US. So, figure your wife's social security, plus IRA and 401K withdrawals (both are recognized in the US-France tax treaty as "social security" pensions for French tax purposes) plus interest or other earnings on your savings/investments that aren't considered pensions. So yes, all of that is factored into the calculations.
Cheers,
Bev
We have our first year's coverage - long-stay visitors visa, retirees - which turned out to be about as expensive a proposition as it is back in the US. In attending a seminar to find out more about PUMa and mutuelles and other related information, one person, who did not speak from personal experience, but had "heard" something about the PUMa application process, said that in considering an application, the government looks back as far as two years to determine one's (or a couple's) income, and then sets the contribution at 8 percent of that income, and that sets the annual contribution at that rate for all time. IF TRUE, that tells me that applying for PUMa as soon as we are eligible, which is in a few weeks, may not be a very good deal as two years ago, both my wife and I were working in good-paying jobs, such that 8 percent of that income would exceed what we are paying in premiums for our current insurance.

Can anybody shed some light on this? As of today, we live on only our investment income and my wife's social security disbursements, an income significantly less than in our working days.
 
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