Medical insurance for Ukrainians: obtaining Carte Vitale

To obtain health insurance for Ukrainians in France, an APS holder simply needs to register with CPAM — the physical Carte Vitale card will arrive later, and treatment is available from the moment rights are opened.

International Law Firm "Zahist" has a representative office in France and helps clients complete registration in the health insurance system without unnecessary delays. Our experience shows that applicants who immediately submit a birth certificate translation by a sworn translator receive a permanent social security number significantly faster than those whose documents CPAM returns for revision.

PUMa: basic health insurance for temporary protection holders

Protection universelle maladie (PUMa) is the main compulsory health insurance system, covering approximately 70% of the cost of medical services.

Unlike ordinary residents of France, who must have lived in the country for at least three months, temporary protection holders gain access to PUMa immediately after registration of the APS application, by analogy with asylum seekers.

Five steps to obtaining a Carte Vitale

The health insurance registration procedure consists of several consecutive stages, each with its own indicative timeframe.

1. Obtain a valid APS — without it, registration in the social security system is impossible.
2. Gather the documents: APS, a translated birth certificate, proof of address, and bank details (RIB).
3. Submit the file to CPAM via ameli.fr (the “Devenir assuré” section) or in person at an agency.
4. Receive a temporary social security number (NIA) within two to six weeks.
5. Receive the Carte Vitale by post after assignment of the final number (NIR), usually within two to four months.

Temporary number (NIA) and final number (NIR)

At different stages of the process, the applicant receives two different social security numbers, each with its own capabilities.

Documents for registration with CPAM

The set of documents for CPAM must be complete and correctly prepared; otherwise, the review of the case will be delayed by several weeks or months.

1. A valid APS bearing a mark of temporary protection.
2. A full birth certificate with a translation by a sworn translator.
3. Proof of residential address in France.
4. Bank details (RIB) for the transfer of reimbursements.

Depending on the country of origin of the document, the birth certificate may additionally require an apostille or consular legalization, so this requirement should be clarified in advance.

Specifics of registration for employed and self-employed persons

If a temporary protection holder becomes formally employed, the employer is obliged to file a prior declaration of hire, which automatically initiates the affiliation process with CPAM.

In this case, the applicant does not need to initiate registration independently — a letter from CPAM usually arrives within two to four weeks after the start of employment.

Self-employed persons who open their own business submit documents to CPAM themselves, as they have no employer to file this declaration on their behalf.

Can one receive treatment before obtaining the physical card

The physical Carte Vitale arrives only after several months; however, this does not mean that treatment is unavailable until it is received.

Immediately after rights are opened, a PDF certificate of entitlement becomes available in the personal account on ameli.fr, which is sufficient to apply third-party payment (tiers payant) at a doctor’s office or pharmacy.

Our experience shows that postponing necessary treatment due to the absence of a physical card is a common but entirely avoidable mistake.

Complémentaire Santé Solidaire (CSS): covering the remaining 30%

CSS is free or reduced-cost supplementary insurance that covers the remaining 30% of service costs, the hospital co-payment, as well as part of dental and optical expenses.

Entitlement to free CSS depends on the household’s income over the past twelve months and on the composition of the household.

What happens to insurance when the APS is renewed

Renewal of the APS does not update data at CPAM automatically, so the status holder must independently send a copy of the new permit to their fund.

If this is not done before the previous APS expires, insurance rights may be temporarily suspended, including ongoing reimbursements for services already provided.

Our experience shows that sending the new APS by email or through the personal account immediately after receiving the document makes it possible to avoid any interruption in coverage.

Common mistakes when arranging insurance

The most frequent mistake is sending a birth certificate without a translation by a sworn translator, as a result of which CPAM automatically rejects the document.

Another common problem is failure to notify CPAM of APS renewal: without fresh confirmation of status, insurance rights may be temporarily suspended.

Our experience shows that applicants who, immediately after a change of address or renewal of status, update their data in the personal account on ameli.fr maintain continuity of rights far more often than those who postpone this until later.

Insurance for children and other family members

Minor children are registered as dependants of one of the parents and receive the same health insurance without the need to submit a separate file to CPAM.

For children, insurance documents are usually processed faster, as the three-month residence requirement does not apply to them even under the general PUMa rules.

A spouse who has reunited in France may obtain dependant status for one of the partners if the other is already insured and has a stable income or formal employment.

What to do if a case at CPAM is stalled

If registration with CPAM is delayed for several months without explanation, one should act systematically rather than simply await a response.

1. Check the “Documents to provide” section in the personal account on ameli.fr — a letter requesting additional documents may simply have been lost.
2. Send a registered letter with acknowledgment of receipt to your fund requesting a response within fifteen days.
3. Book an in-person appointment at a CPAM agency to clarify the status of the case review.
4. If there is no response after two approaches, file a complaint with the Health Insurance System Mediator via ameli.fr.

As a final step, if the problem remains unresolved, one may turn to the Defender of Rights, who can intervene directly with CPAM management.

Dentistry and optics: what additional costs to expect

Basic PUMa coverage partially reimburses dental and optical services; however, the amount of reimbursement is often significantly lower than the actual cost of treatment or glasses.

That is why arranging CSS is especially important for families with children who regularly need dental check-ups or vision correction.

Our experience shows that combining PUMa and CSS makes it possible to substantially reduce the actual costs of such services compared with paying the full price without additional coverage.

Expert view: how to speed up the application process

An analysis of our cases shows that the greatest delays are linked specifically to birth documents—incorrect translation, missing apostille, or an illegible original.

Another important factor is timely notification of CPAM of any changes: address, extension of APS, or a change in marital status.

We recommend preparing a complete set of documents in advance, before submitting the application, in order to avoid a repeated review cycle due to the absence of a single certificate.

Obtaining medicines at a pharmacy with a temporary number

Even with only a temporary NIA number, it is possible to obtain medicines at a pharmacy on a doctor’s prescription by presenting the statement of services provided instead of the electronic card.

The pharmacy records the data manually, and partial reimbursement of the cost takes place after the documents are processed by CPAM, so it is advisable to keep all receipts and statements of services provided until the Carte Vitale is received.

International Law Firm "Zahist" has a presence in France and helps clients complete registration with CPAM without delays caused by incorrectly prepared documents.

An individual consultation helps accurately arrange medical insurance for Ukrainians in light of the specific situation—from the first application to CPAM through to receipt of the physical Carte Vitale.

Every case has its own particularities—the country of origin of the documents, family composition, and employment status—so detailed preparation together with a specialist remains the most reliable way to avoid lengthy delays.

The earlier an applicant who needs medical insurance for Ukrainians submits a complete and correctly translated set of documents, the sooner they obtain real access to treatment.