Complémentaire santé solidaire (CSS)

Complémentaire santé solidaire (CSS) is France's means-tested supplementary health coverage. It is the merger of two earlier schemes — Couverture maladie universelle complémentaire (CMU-C) and Aide au paiement d'une complémentaire santé (ACS) — into a single benefit, in force since 1 November 2019. It is administered by the Caisse primaire d'assurance maladie (CPAM) for residents under the general scheme, by Mutualité Sociale Agricole (MSA) for agricultural workers and self-employed farmers, and by the Caisse Générale de Sécurité Sociale (CGSS) in overseas departments. For self-employed workers under the régime des indépendants, CSS is now also processed by the local CPAM since the 2018 absorption of RSI.

CSS pays the part of healthcare costs that Assurance Maladie does not cover (the ticket modérateur and certain out-of-pocket co-payments) and, depending on income, may also waive the participation forfaitaire of one euro per consultation and the franchises médicales on medicines, paramedical acts and transport. With CSS, the beneficiary does not advance any money for covered care — the tiers payant intégral applies — and providers cannot charge dépassements d'honoraires (overbilling) on conventionné sector 1 acts.

There are two variants. CSS sans participation financière (formerly CMU-C) is free for households below the lower income ceiling. CSS avec participation financière (formerly ACS) requires a modest monthly contribution that varies with the age of each insured person. In 2026, the monthly per-person contribution ranges from €8 for under-29s to €30 for those aged 70 and over. Both variants give the same medical coverage scope, the same direct-billing rights and the same opticien/dentist/audioprosthetist 100% santé baskets.

For migrant communities living in France — including British residents who lost EHIC coverage after Brexit, EU long-term residents, foreign students who exited the Sécurité sociale étudiante and joined the régime général, refugees granted asylum since the entry into force of the loi du 7 mars 2016, and family members of French residents reunited under the regroupement familial procedure — CSS is the single most important supplementary health tool. Without it, the average French household spends about €2,250 a year on a private mutuelle that may still leave gaps for dental prosthetics, hearing aids or progressive lenses.

CSS is open to any person who is regularly resident in France (résidence stable et régulière) and affiliated with the French statutory health insurance (Protection Universelle Maladie — PUMA). "Stable" means living in France for at least three months at the time of the application, and "regular" means holding a valid residence status. Applicants must be enrolled with a Caisse primaire d'assurance maladie and have a numéro de Sécurité sociale (or a numéro provisoire — NIA — issued during the affiliation process).

Eligibility is means-tested. The income ceiling depends on household composition (foyer fiscal at the CSS sense, which is slightly different from the tax foyer because it includes the applicant, spouse or PACS partner, children under 25 who are tax-dependent or live in the household, and any cohabitant whose income is taken into account). For 2026, the annual ceiling for free CSS (sans participation) is approximately €10,166 for a single person, €15,249 for a couple without children, €18,299 for a household of three persons, and €21,348 for a household of four. The ceiling for CSS with monthly contribution sits at 135 % of those amounts: about €13,724 for a single person, €20,586 for a couple. Overseas departments (Guadeloupe, Martinique, Guyane, La Réunion, Mayotte) apply a different scale with slightly higher ceilings.

The 12-month reference period for income runs from the 12 calendar months preceding the application month. All resources count: wages, pensions, unemployment benefit (ARE), RSA, AAH, ASI, ASPA, prime d'activité, rental income, alimony, parental contributions for students, capital income, life-insurance flat-rate (3 % of capital), and the value of in-kind housing if accommodation is provided free of charge. The ten-percent forfaitaire deduction that applies to wages and pensions in income-tax computation is not applied here — the resource declaration uses net catégoriel income.

Some resources are excluded: AAH complément de ressources, prestations familiales (allocations familiales, complément familial, allocation de soutien familial, allocation de rentrée scolaire), bourses scolaires, retraite du combattant, indemnités de stage in many cases, and exceptional grants. Capital placed on a Livret A or Livret bleu is not added to resources but its actual interest is.

For foreign nationals, the regularity-of-stay requirement is met by holding any titre de séjour delivering a right to work or stay (carte de séjour, carte de résident, récépissé de demande, attestation de demandeur d'asile after six months of admission). Asylum seekers fall under the separate Aide médicale de l'État (AME) or Protection universelle maladie depending on procedural stage. Undocumented residents cannot apply for CSS but may apply for AME if they prove three months of presence and meet the AME means test.

CSS reimburses the patient share of all care provided under the convention (sector 1) of Assurance Maladie. Concretely:

• General-practitioner consultations — full coverage with no co-payment, no participation forfaitaire of €1, and no advance payment thanks to tiers payant intégral. The patient shows the carte Vitale and the CSS attestation; nothing else is owed.
• Specialist consultations in sector 1 — full coverage. Sector 2 doctors are reimbursed at the sector-1 tarif, and they are not allowed to bill the excess to a CSS beneficiary (Article L. 162-5-13 du code de la Sécurité sociale).
• Hospitalisation — both medical (MCO) and surgical, including the forfait journalier hospitalier (€21.50/day in 2026) which CSS pays entirely, and the participation forfaitaire of €24 for high-cost acts (formerly the forfait acte lourd), now replaced in 2025 by a participation forfaitaire of €25 still fully covered by CSS.
• Prescription medicines on the liste des spécialités remboursables. CSS pays the patient share regardless of the SMR rate (15 %, 30 %, 65 %, 100 %) and waives the €0.50 franchise per box. Tiers payant applies in pharmacy.
• Dental care — fully covered for conservative acts (caries, devitalisation, endodontie). For prosthetics, CSS includes a specific tariff schedule (panier CSS) that fully covers crowns, bridges and removable prostheses listed in the panier 100 % santé. Dentists must propose at least one CSS-compliant prosthetic option per case and cannot bill any supplement above the panier-CSS tariff.
• Optical equipment — one pair of glasses every two years (one per year for minors and adults whose visual correction has changed), with frames at €30 maximum and lenses according to a strict pricing grid. Both single-vision and progressive lenses are included. The opticien who participates in the 100 % santé reform must apply the panier-CSS tariff with no excess.
• Hearing aids — one device per ear every four years, fully covered under the panier 100 % santé. Class-I devices are entirely free for CSS beneficiaries.
• Paramedical care — physiotherapy, nursing care, speech therapy, orthoptics, podiatry (for diabetic patients on prescription) and home nursing. Tiers payant is applied if the practitioner is conventionné.
• Medical transport on prescription (ambulance, VSL, taxi conventionné) without the €2 franchise.
• Mental-health — psychotherapy under the Mon Soutien Psy device is fully covered (up to 12 sessions per calendar year as of 2026), as well as psychiatrist consultations.

CSS does not cover purely aesthetic care (cosmetic dental whitening, esthétique purement cosmétique surgery without medical indication), nor non-reimbursed medicines (specialities not on the liste, homeopathy since 2021, OTC products), nor private rooms (chambre particulière) at hospital. For these, an additional surcomplémentaire would be needed.

If household resources fall between 100 % and 135 % of the CSS ceiling, the beneficiary qualifies for CSS avec participation financière. The monthly contribution is set per person based on age at 1 January of the contribution year. The 2026 schedule is:

• Aged 0 to 29: €8 per month
• Aged 30 to 49: €14 per month
• Aged 50 to 59: €21 per month
• Aged 60 to 69: €25 per month
• Aged 70 and over: €30 per month

The total monthly contribution is the sum of the per-person amounts for all members of the foyer (declarant, spouse, dependants). The contribution is paid by direct debit (prélèvement automatique SEPA) from a French bank account, or — exceptionally and at the CPAM's discretion — by TIP, by check or in cash at the CPAM counter. The first month is generally exempt; the contribution applies from the second month of effective coverage.

Example 1: a single beneficiary aged 45 pays €14/month, or €168 per year. With an average French private mutuelle costing €60-€90/month for an equivalent coverage at that age, the saving is approximately €600-€900 per year.

Example 2: a couple aged 65 and 67 with one tax-dependent child aged 20 pays €25 + €25 + €8 = €58/month, or €696 per year — versus an estimated €2,400 for a comparable private mutuelle couple-plus-dependant package.

Example 3: a family of four with two adults aged 38 and 41 and two children aged 8 and 12 pays €14 + €14 + €8 + €8 = €44/month, or €528 per year. The average family mutuelle at that profile is approximately €1,800-€2,100/year.

Failure to pay the monthly contribution for two consecutive months results in suspension of the CSS rights. The CPAM sends a mise en demeure giving the beneficiary 30 days to regularise the situation. After that delay, the rights are closed. To reopen them, the beneficiary must clear the arrears and file a new attestation, which generally implies a delay of one to two months in coverage. For households in temporary financial difficulty, the CPAM social worker (assistante sociale du service social de la CPAM) can grant a payment plan that preserves coverage continuity.

CSS is requested by filing form Cerfa 12504*09 (Demande de Complémentaire santé solidaire) accompanied by the declaration of resources and the household-composition form. The form is downloadable on ameli.fr and available at every CPAM agency, every PASS (Permanence d'accès aux soins de santé) hospital service, every centre communal d'action sociale (CCAS), and every Point conseil budget.

The complete file contains:

• The signed Cerfa 12504*09 form with the contact details, the household composition and the choice of CSS gestionnaire (CPAM by default, or a participating mutuelle/insurance company chosen from the published list)
• Identity document for each adult — passport, French national identity card, residence permit (titre de séjour) or récépissé
• Birth certificates for any children, or livret de famille
• For non-French adults: proof of regular residence (titre de séjour or proof of EU citizenship and registration if relevant)
• Proof of residence in France for at least three months — recent rental contract, EDF bill, attestation d'hébergement plus identity document of the host, certificate of domicile from a CCAS for persons in administrative homelessness situation
• Tax notice (avis d'imposition) of the previous year, or a non-imposition certificate for households below the tax threshold
• Bank statements covering the last three months for each adult member
• Pay slips or attestation Pôle emploi for the last three months for each adult who is employed or unemployed
• Pension certificates for retired members
• Receipts of any maintenance payments received or paid (pension alimentaire)
• RIB (relevé d'identité bancaire) for the automatic debit setup if applying for CSS avec participation

The application can be filed in three ways. First, on the online compte ameli (the most-used route): logged-in beneficiaries access "Mes démarches" → "Faire une demande" → "Complémentaire santé solidaire" and upload scanned documents. The processing time is two months legal maximum but typically four to six weeks. Second, by mail to the CPAM of residence — the full file with originals or certified copies. Third, in person at the CPAM agency on appointment booked via the 36 46 line or directly via ameli.fr. PASS hospital social workers, the assistante sociale of the school for student applicants, and the CCAS social worker can also help compile and transmit the file at no cost.

For applicants whose tax notice was not yet issued (newly arrived in France, recently emancipated young adults, recently separated spouses), the resource declaration must be completed manually for the last 12 months with supporting documents. The CPAM may request additional proof during the instruction phase.

The CPAM has two months from the date of receipt of a complete file to issue a decision. In practice, simple files are decided in three to six weeks. The decision letter (notification de décision) is sent by post and is also visible on the compte ameli. It states whether CSS is granted, the exact start date, the duration (one year, renewable), the precise scope (with or without monthly contribution), the list of beneficiaries, and the chosen gestionnaire (CPAM or mutuelle).

If the decision is favourable, the CPAM sends an attestation de droits and, if applicable, the RIB-mandat for the monthly direct debit. The carte Vitale of each beneficiary is updated automatically on the next pharmacy or doctor visit via the carte Vitale terminal, or manually via the bornes installed in CPAM agencies. The attestation must be kept and shown together with the carte Vitale at each healthcare encounter, in particular for tiers payant in pharmacies and at opticien/dentist establishments where carte Vitale alone may not yet display CSS status.

If the decision is unfavourable (refus), the CPAM letter must state the legal basis and the appeal route. There are two appeal levels. First, an internal recours amiable in front of the Commission de recours amiable (CRA) of the CPAM, to be filed within two months of the notification. The CRA examines the file and issues a new decision within one month (silent rejection beyond that). Second, if the CRA confirms the refusal or stays silent, the applicant can refer the matter to the Tribunal judiciaire — Pôle social, within two months of the CRA decision. Free legal aid (aide juridictionnelle) is widely available for CSS-related disputes.

Common reasons for refusal include: missing documents (most frequent — answerable by sending the missing items within the prolongation delay), exceeded resource ceiling for at least one beneficiary, lack of regular residence proof, or fraud detection (false declaration of household composition or hidden resources). In the case of fraud, in addition to refusal, the CPAM can apply a pénalité financière (administrative fine) and, in serious cases, transmit the file to the procureur for criminal prosecution under Article L. 114-13 du code de la Sécurité sociale.

CSS is granted for one year. The CPAM sends a renewal reminder two months before the expiry date, with a pre-filled form (formulaire de renouvellement) listing the household composition and the previously declared resources for the user to update. The renewal must be filed at the latest two months before the expiry date to avoid any interruption of coverage.

Households on RSA socle, who automatically benefit from the resource presumption clause, see their CSS renewed automatically as long as they keep their RSA rights and they have not signalled a change in household composition. Households not on RSA must actively update resources. The 12-month reference period is the 12 months preceding the renewal month.

If the renewal is filed late (within the three months following the expiry date), the CPAM grants a retroactive opening to the date of expiry, provided that the file is complete and the resource ceiling is still met. After three months of lateness, the CPAM treats the file as a new application, and the start date is the date of file receipt — meaning that any healthcare costs in the gap period are not covered by CSS.

The renewal also offers the opportunity to switch gestionnaire (from CPAM to a mutuelle or vice versa) without any continuity-of-coverage gap. The list of participating mutuelles is published yearly at ameli.fr and includes both national groups (Harmonie Mutuelle, MGEN, Mutuelles de France, Macif Mutualité, AESIO) and regional mutualité bodies. The medical scope is identical regardless of the chosen gestionnaire — only the customer service and online portal differ.

British citizens settled in France before 31 December 2020 are protected by the Withdrawal Agreement and remain affiliated with the French social-security system on the same terms as French residents. They are eligible for CSS subject to the same means test as French nationals. Their carte de séjour mentionnant "Accord de retrait du Royaume-Uni de l'UE" (the "WARP card" issued under the post-Brexit regime) is accepted as proof of regular residence.

UK pensioners receiving a UK state pension and holding an S1 form (formerly E121) are affiliated with French health insurance with the UK paying their basic-coverage costs back to France. They are equally eligible for CSS if their joint resources (UK pension + French income) fall below the ceiling. The S1 status does not exclude CSS — both can coexist.

UK citizens who arrived after 1 January 2021 must hold a French residence permit independent of the Withdrawal Agreement (visa long séjour valant titre de séjour for active workers, visiteur card for retired or self-financed, étudiant card for students, salarié or passeport talent for skilled workers). They become eligible for CSS once they meet the three-month PUMA residence condition and the means test.

EU/EEA/Swiss nationals exercising their freedom of movement are eligible from day one if they are workers, self-employed or members of a workers' household. Inactive EU nationals (retirees, students, self-supported) must hold an Attestation d'inscription on commune register or prove sufficient resources to not become a burden on the system; once affiliated with PUMA they may apply for CSS like any French resident.

For Eastern European workers (Polish, Romanian, Bulgarian, Lithuanian, Latvian, Estonian, Croatian, Hungarian, Czech, Slovak), CSS is the practical alternative to a Polish-style ZUS-private package when the worker is posted in France for more than 24 months. A1 detachment certificates from the home country exclude French affiliation; CSS is therefore not available during the detachment period. After detachment ends or after a permanent move to France, CSS becomes available.

For non-EU nationals on a regroupement familial, the residence permit (carte de séjour vie privée et familiale) gives access to PUMA and therefore to CSS, with the same three-month residence delay.

Foreign students enrolled at a French university are affiliated with the régime général via PUMA. They are eligible for CSS if their resources (scholarship, parental support, student work, internship indemnities exceeding the threshold) fall below the ceiling. The CROUS, the Sécurité sociale étudiante service (now absorbed by the general scheme), and the student unions (UNEF, FAGE) provide guidance and help filling the form. Boursiers du CROUS at échelons 5, 6 and 7 are presumed eligible without further resource declaration; the bourse itself counts but is well within the ceiling for échelons 5+.

Asylum seekers (demandeurs d'asile) are not eligible for CSS during the procedure — they fall under PUMA after three months of presence and can request the Couverture maladie under specific provisions, plus AME for any uncovered period. Once granted refugee status (statut de réfugié), the protected person obtains a carte de résident valid 10 years and full PUMA affiliation, and may apply for CSS immediately. The OFII orientation worker generally assists with the file. The same applies to beneficiaries of subsidiary protection (protection subsidiaire) and stateless persons.

Persons regularised under exceptional admission to stay (admission exceptionnelle au séjour — circulaire Valls), economic regularisation or family regularisation, are eligible for CSS as soon as their carte de séjour is delivered. Time in administrative regularisation procedure does not count toward the three-month residence delay if the person was undocumented during that period; the delay starts at the issuance of the residence document or at first PUMA affiliation, whichever is later.

Persons in détention pénitentiaire are not eligible for CSS but receive free medical care via the unité sanitaire of the prison. At release, the SPIP (Service pénitentiaire d'insertion et de probation) social worker prepares the CSS file in advance so that coverage starts immediately upon release.

Persons living in a structure d'hébergement (CHRS, CADA, foyer de jeunes travailleurs, résidence sociale) are eligible for CSS on the same conditions as any other resident. The structure social worker generally facilitates the application by providing the domicile certificate and the household-composition statement.

CSS combines with all other French social benefits. The simultaneous granting of RSA, AAH, ASPA, ASI, ASF, prime d'activité, allocations familiales, APL, ALS or any housing benefit does not affect CSS eligibility (the prestations familiales are excluded from CSS resources).

Recipients of RSA socle automatically benefit from CSS without participation if they request it, because the RSA resource test is stricter than the CSS test. The CAF or MSA notifies the CPAM of any new RSA opening and the CPAM sends a CSS information packet within 30 days. The RSA beneficiary still needs to file the CSS Cerfa form, but the resource declaration is replaced by a simple statement of RSA receipt.

Recipients of AAH (Allocation aux adultes handicapés) with a taux d'incapacité above 80 % or a restriction substantielle et durable d'accès à l'emploi (RSDAE) are eligible for CSS in their own right as long as their resources stay below the ceiling. The AAH itself counts as a resource, but the complément de ressources and the majoration pour la vie autonome are excluded. The MDPH worker often files the CSS request at the same time as the AAH renewal.

Recipients of the ASPA (minimum vieillesse) are typically eligible for CSS avec participation due to ASPA being close to the upper ceiling. The CARSAT, MSA or SSI gestionnaire of the ASPA file usually flags the case to the CPAM proactively.

CSS does not replace the carte mobilité inclusion (CMI), which is granted by the MDPH for mobility, parking and recognition purposes. The two benefits coexist and do not interact.

Pregnant women on CSS benefit from full and immediate coverage of the maternity package: seven prenatal consultations, two ultrasounds, one trimester-three preparation visit, all blood tests of the pregnancy panel (toxoplasmosis, rubella, syphilis, HIV with informed consent, group rhesus, glucose tolerance), the maternity-leave income replacement via Assurance Maternité, the hospital stay for delivery (forfait journalier covered), and post-delivery visits for the mother and the newborn.

The 100 % coverage of the assurance maternité starts at the beginning of the sixth month of pregnancy regardless of CSS status; for CSS beneficiaries, the coverage is total from day one of pregnancy and includes the participation forfaitaire and any sector-1 specialist visits (obstetric, dental, dermatological, all complications). Tiers payant applies systematically.

The newborn is added to the parents' CSS file from the day of birth on a simple notification to the CPAM (déclaration de naissance via the maternité is automatic for the carte Vitale enrolment; a separate written notification updates the CSS attestation). The child's CSS is free even if the household's CSS variant requires monthly contribution from age 0 to 29 — there is no per-child supplement during the first 12 months for households opening rights mid-year.

The most frequent reason for a refusal or for a contested overpayment recovery (indu) is a misdeclaration of household composition. A child whose parents are separated cannot count in both households simultaneously. A cohabitant whose income is taken into account must be declared. A spouse temporarily abroad still belongs to the foyer unless legally separated.

The second most frequent mistake is over- or under-declaration of resources. Many applicants forget to declare alimony received, rental income from a small inheritance property, or interest from a Livret A even though only the interest counts (not the capital). Conversely, many over-declare by including the gross wage before contributions when the form asks for the net imposable. The avis d'imposition is the authoritative reference and should always be the starting point.

The third common mistake is delay in renewal. Filing the renewal one month before expiry is the standard practice; less leaves no margin for the CPAM to process and gaps in coverage may follow. The pre-filled form sent by the CPAM is mailed two months in advance and should be returned within ten days for safest processing.

The fourth mistake is misuse of tiers payant. The CSS attestation must be shown together with the carte Vitale. The healthcare provider has the right to refuse the tiers payant if the attestation is not presented even if the carte Vitale shows CSS rights — many sector-1 doctors are not familiar with CSS-specific flows and a printed paper attestation removes any ambiguity.

The fifth mistake concerns sector-2 doctors: even though CSS bans dépassements d'honoraires, some practitioners ask the patient to pay upfront and reclaim. This is illegal. The patient may file a complaint with the CPAM conciliator who has the power to recover the excess from the doctor under Article L. 162-5-13. CSS beneficiaries are advised to confirm with the doctor's secretariat in advance that the practitioner accepts CSS and the tiers payant.

Free assistance is available at multiple points of contact:

• CPAM agency — every CPAM has a dedicated CSS officer. Appointments are booked at 36 46 (CPAM national number) or via ameli.fr in the agency-locator. Walk-in support is provided in larger agencies for urgent matters.
• CCAS / CIAS — the centre communal or intercommunal d'action sociale in every municipality has a social worker who routinely fills CSS files and forwards them to the CPAM. The CCAS also issues the domicile certificate for persons without stable housing.
• PASS (Permanence d'accès aux soins de santé) — in public hospitals, the PASS social worker assists hospitalised patients with no rights to set them up with CSS, PUMA and AME within a few days. The PASS is the priority contact for newly arrived migrants and for persons just released from prison.
• France services — the national network of multi-service public points includes CPAM-trained staff who handle CSS requests for residents in rural areas without a CPAM agency.
• Maisons départementales des personnes handicapées (MDPH) — for disabled persons whose AAH or carte mobilité inclusion file is being processed.
• Mutualité Sociale Agricole (MSA) — for agricultural workers and farmers under the régime agricole.
• Associations — Secours catholique, Secours populaire, Restos du Cœur, Médecins du Monde and the Croix-Rouge française all run CSS-help desks in major cities. Médecins du Monde in particular operates Mobile CASOs (Centre d'accueil de soins et d'orientation) that combine free medical consultation with CSS file preparation.
• Mutuelles partenaires — beneficiaries who choose a mutuelle as gestionnaire receive the same level of help directly from the mutuelle's customer service.

The 39 39 number (Allô Service Public) and the dedicated CSS information page on the official portal mes-aides.gouv.fr also provide eligibility simulations within five minutes. A negative simulation does not bar an actual application — only the CPAM decides on the formal file.

Three practical tips significantly improve the chances of a smooth CSS file:

First, gather all supporting documents before starting the form. The Cerfa 12504*09 is structured by section and a missing pay slip on page seven will force the user to start over. The CPAM social worker provides a checklist on request.

Second, file the application as soon as eligibility is met. CSS does not have retroactive effect beyond the date of receipt of a complete file. A six-week delay in filing means six weeks of out-of-pocket healthcare costs that will not be reimbursed.

Third, keep all original documents and copies of correspondence with the CPAM for at least three years. In case of a recovery action (action en répétition de l'indu), the burden of proof rests with the beneficiary to demonstrate the resources declared were accurate at the date of declaration. Bank statements and tax notices are the strongest evidence.

CSS is a major French solidarity benefit covering 7.4 million residents as of 2026 (5.7 million on CSS sans participation and 1.7 million on CSS avec participation), at a budgetary cost of approximately €3.2 billion to the Assurance Maladie. It is by design free of stigma — every CSS holder uses the same carte Vitale and benefits from the same médecin traitant pathway as any other insured person. Healthcare providers are paid the full sector-1 tarif and the patient out-of-pocket is zero, removing the main barrier to early medical consultation that disproportionately affects low-income households. For migrant communities, CSS is the single most accessible health-coverage tool in France and the practical equivalent of mainstream German AOK/TK coverage combined with a free Zusatzversicherung.