Obtain complementary health insurance

Obtain complementary health insurance

In short
Last update11 août 2022

What is it?

Supplementary health insurance is a complementary health insurance, i.e. a mutual insurance that is free or payable depending on your income. It allows you to have your health expenses and those of the members of your household fully reimbursed.

You are entitled to complementary health insurance if your income is modest. The complementary health insurance is useful to avoid paying for visits to the doctor and the hospital or for buying medicines, glasses, dental prostheses, etc.

Good to know:

You can check with this site if you are eligible for the complementary health insurance.

To obtain the free complementary health insurance, you must:

  • Have a national insurance number, i.e. be covered by health insurance => see section 1: "how to do it?"
  • Have resources that do not exceed a limit set annually. For example, to benefit from the complementary health insurance free of charge, a single person must have earned less than 9041 € during the 12 months preceding the application.

The complementary health insurance is automatically granted to RSA beneficiaries without any steps to be taken, unless they object. The application for complementary health insurance is also made easier for recipients of the ASPA (solidarity allowance for the elderly): they do not need to fill in a declaration of resources.

Good to know:

If you have the free complementary health insurance and you live in the Ile-de-France region, you can pay €18 instead of €72 for your Navigo pass.

There is also a supplementary health insurance scheme for which a fee is charged (€1 per day). Single people who earned between 9041€ and 12205€ during the year preceding the application can benefit from this, for example.

Good to know:

For families, the annual income limits are higher (for more information: https://www.service-public.fr/particuliers/vosdroits/F10027)

Who is it for?

Location

France entière

What to do?

1

Register for health insurance

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You cannot apply for supplementary solidarity health insurance before being registered for health insurance, because you do not yet have a social security number.

Good to know: If you already have a social security number, go directly to the next step.

If you have never registered for Health Insurance, you must do so by filling out this form: CERFA N ° 15763 * 02

Health Insurance will then send you a certificate of entitlement with your provisional social security number (13 digits that start with 7 or 8).

2

Apply for complementary solidarity health insurance

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To apply for complementary health insurance, you must send or submit this completed form (CERFA n° 52269#04) with the supporting documents requested to your Caisse Primaire d'Assurance Maladie (CPAM).

Here is how to complete the form:

  • Page 1: Indicate the composition of your household and specify the information relating to your family as well as any assistance you receive.
  • Page 2: If you are not concerned by the RSA, you must indicate here the resources of your household (that is to say all the money which enters your bank account).
  • Page 3: Choose the organization that will manage your complementary health insurance: your health insurance fund (CPAM) or a complementary organization.

Good to know: If you do not know which box to tick, we advise you to tick the CPAM and then sign your form on page 4.

  • Page 4: The top of the page is only to be completed if you have chosen a complementary organization (other than the CPAM) on page 3.
    Otherwise, you only need to complete the end of the document with your signature, the city where you are and the date.
3

Provide the requested documents

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In addition to the form, you must include certain documents in your envelope to be sent or deposited at your CPAM:

  • A tax notice or a tax declaration situation (ASDIR) if you have one;
  • A notice of property tax and local housing tax if you have any;
  • A certificate from CAF if you receive benefits (RSA, APL ...);

Good to know: If you have resided abroad during the previous 12 months, you must provide the supporting documents for the country (ies) concerned.

If you have applied for the RSA and/or if one of your household members is over 18 and under 25 and has applied for a young RSA or youth RSA benefit, you must provide the resource certificates issued by the CAF or MSA.

4

Send or submit the form to the CPAM

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You can now send your file or deposit it in your CPAM. To know the address, you must:

  • Go to the ameli.fr website,
  • Fill in the postal code of the city where you live,
  • Click on the right of the screen on “Addresses and Contacts”,
  • Click on “Assistance for complementary health insurance”,
  • Click on “Renew your Complementary health solidarity” file: you will then see the address to send the mail.

Good to know: Remember to add 1 or 2 stamps depending on the weight of the letter on your envelope if you are sending it by mail.

And after?

If your request is accepted

You will have to wait between 20 days and 2 months to receive a response from your health insurance organization by mail.

  • If your request is accepted for free complementary health insurance, you will receive a certificate of rights for 1 year.
  • If your request is accepted for paid complementary health insurance, you will be informed of this right as well as the amount of financial contributions due for each member of your household.

If your request is refused

If your request is refused, you will receive an email explaining the reason. You can challenge this decision.

The information necessary to contest the decision is on this link: https://www.ameli.fr/paris/assure/droits-demarches/reclamation-mediation-voies-de-recours/contester-decision

Annual renewal of the complementary health insurance

Aid for complementary health insurance is granted for one year and its renewal is not automatic.

You must send your Health Insurance Fund a new request:

  • by mail by completing the same form (CERFA n° 52269#04) , to be sent with the supporting documents requested no later than 2 months before the end of your rights for complementary health insurance. (See steps 2, 3 and 4 above)
  • on the internet or on the AMELI mobile application with your account, in the "My steps" section, click on "Make a request for complementary health insurance" and on "I start my request".
    Please note that you must have an electronic version of these documents:
    - A tax notice or a tax declaration notice (ASDIR) if you have one,
    - A notice of property tax and local housing tax if you have any,
    - A certificate from the CAF if you receive allowances (RSA, APL, etc.)
    - supporting documents if you have lived abroad during the previous 12 months.

> See the file on Refugees. info "How to scan a document".

Good to know: If you receive the RSA, the renewal is automatic, you have nothing to do.

If you need help making your request

You can ask for help with your application:

  • at your Primary Health Insurance Fund;
  • at the municipal center for social action (CCAS) in your city;
  • health and social services (for example, accommodation and social reintegration centers and all personal assistance services);
  • with your social worker.
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