In 2016, France introduced the Protection Universal Maladie healthcare system, PUMa for short. The goal of the new structure is to improve interaction between the different healthcare entities and streamline procedures. One of the entities that was discontinued was the former CMU or Couverture Universelle Maladie; the organisation that managed the benefits of those that fell outside of the system.

Previously, the spouse of a person covered by the CMU was entitled to benefits as an ayant-droit. Now that ayant-droits have been discontinued by the new PUMa system, spouses are entitled to healthcare in their own right, but as individuals are no longer attached to another’s benefits, it gives rise to the duty to pay into the system. Anyone enrolled in PUMa who doesn’t already pay social security contributions will be required to pay a cotisation subsidiaire maladie of 8% of their income. For more details of the modalities of these contributions and to find out what sources of income will be considered for this calculation, check the updates on the portal.

The healthcare system is also doing away with the upfront payment for a doctor’s visit. Patients would normally present their Carte Vitale and pay the doctor right then and there, namely €23 for a GP, to be reimbursed at 70% by the healthcare system and the rest by their mutuelle complementary insurer provided they had one. In the new system, presenting the card will be enough, and payment will be processed directly to the doctor. The measure is being rolled out gradually, initially for patients with long-term illnesses and those covered by the CMU-C and the AME Aide Medicale de l’État, but by the end of 2017, everyone else will be included. However, at the moment, the refusal of a doctor to adhere to the new system isn’t penalised – they can decide to ignore the rule and request the upfront payment anyway, except for patients within the CMU-C or AME, who have always been protected because of their special need status.

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