Indemnités journalières maladie

The French indemnités journalières maladie (IJ maladie, daily sickness allowances) are the federal sickness cash benefit paid by the Caisse Primaire d'Assurance Maladie (CPAM) to employees and other insured workers who are temporarily unable to work because of illness or non-occupational injury. Their legal basis is anchored in the Code de la sécurité sociale (CSS), principally at article L321-1, which defines the contingencies covered by sickness insurance, and articles L323-1 to L323-7, which establish the right to a daily allowance, its conditions of opening, its duration and its mode of calculation. The implementing rules are detailed in articles R321-1 to R323-12 of the same code, with a major modernisation introduced by Décret n° 2019-1387 du 18 décembre 2019, which simplified the reference salary calculation and aligned several edge cases. Annual revaluations and parametric adjustments flow through each Loi de financement de la sécurité sociale (LFSS).

The administrative authority is structured on two levels. The Caisse Nationale d'Assurance Maladie (CNAM) sets national doctrine, parameters and IT systems, while the regional Caisses Primaires d'Assurance Maladie (CPAM) handle the individual files: verification of contribution conditions, liquidation of the daily amount, payments to the bank account of the insured and medical control. Agricultural workers fall under the Mutualité Sociale Agricole (MSA), civil servants are governed by their statut and largely paid by their employer with specific top-up rules, and the self-employed have a parallel scheme (anciens RSI/SSI) integrated within the régime général since 2018.

The purpose of IJ maladie is to provide a partial income replacement during a temporary inability to work, so that an illness does not translate into immediate poverty for the worker and their family. The legislator chose a moderate replacement rate (50% of the average daily wage in the general case) combined with a duration that is generous enough to absorb most acute episodes (up to 360 indemnified days per three-year window for ordinary sickness, and up to three years in case of Affection Longue Durée — ALD).

Three principles guide the system:

• Contributivity: only workers who have contributed sufficiently to the régime général open a right (this is what distinguishes IJ from a means-tested minimum like the RSA).
• Medicalisation: the entry point is always an arrêt de travail prescribed by a doctor (typically the médecin traitant), not a self-declared incapacity. The CPAM's contrôle médical can review the prescription at any time.
• Articulation with the employer: French collective bargaining is dense. Many conventions collectives nationales (CCN) require the employer to pay full or partial salary during the first weeks and to receive the CPAM allowance directly via the subrogation mechanism. The IJ therefore rarely lands alone in the worker's hands during the first month; it is most often blended with the employer's maintien de salaire.

IJ maladie is, in volume, one of the most-used branches of French social protection. It generates around €16 billion of annual expenditure and concerns roughly 7 million arrêts de travail per year, with strong post-pandemic dynamics around mental health that the legislator is currently trying to contain without weakening the safety net.

Eligibility for indemnités journalières maladie combines an objective medical condition (an arrêt de travail issued by a physician) with a contribution test designed to ensure that the claimant has been genuinely active in the workforce. The rules differ slightly between salaried employees, the self-employed, jobseekers and other categories, but the architecture of CSS articles L313-1, L321-1 and L323-1 is consistent: a doctor opens the right, the CPAM verifies the technical conditions, payment starts on day four for most employees.

1. Salaried employees (régime général). An employee qualifies if, on the date the arrêt begins, they satisfy at least one of two contribution conditions established by articles R313-3 and R313-5 of the CSS:

• they have worked at least 150 hours during the three calendar months (or 90 days) preceding the arrêt; OR
• they have contributed on a salary at least equal to 1,015 × SMIC horaire during the six months preceding the arrêt.

For an arrêt longer than six months, a stricter condition applies (12-month affiliation and 600 hours/2,030 × SMIC), reflecting the fact that long sickness implies a stable contributory history. The CPAM checks these thresholds automatically from the DSN (déclaration sociale nominative) feed transmitted by employers, so most workers do not need to send pay slips manually.

2. Self-employed workers (travailleurs indépendants). Since the integration of the former RSI into the régime général in 2018-2020, self-employed workers (artisans, commerçants, certain professions libérales) are also entitled to IJ, but with two specifics: they must have been affiliated to the régime for at least one year on the date of the arrêt, and the daily allowance is calculated on the average of the last three civil years of revenu d'activité, with a floor and a ceiling specific to the indépendant scheme. Professions libérales affiliated to the CNAVPL/CARPIMKO/CARMF etc. operate under their own internal rules; some have a longer carence period than the régime général.

3. Jobseekers (demandeurs d'emploi indemnisés). A jobseeker receiving allocation d'aide au retour à l'emploi (ARE) retains a right to IJ maladie during a sickness episode under article L311-5. The amount is calculated on the salary that served as basis for the ARE, and during the arrêt the ARE is suspended while the IJ is paid. The transition is automatic between CPAM and France Travail (formerly Pôle emploi).

4. Agricultural workers (régime agricole). Salaried agricultural workers receive IJ from the MSA on substantially the same conditions as the régime général. Self-employed exploitants agricoles have a specific scheme (AMEXA) with a flat-rate daily allowance.

5. Workers with carence dérogations. The standard three-day waiting period (délai de carence) is suppressed in several cases: relapse of the same illness (rechute) within 48 hours, arrêt linked to an ALD requiring a known treatment, occupational accident or disease (which moves out of IJ maladie into IJ AT/MP, governed by L433-1 of the CSS).

6. Residence and nationality. Unlike means-tested benefits, IJ maladie does not require a specific minimum residence in France beyond the affiliation. EU/EEA/Swiss workers are covered through regulations 883/2004 and 987/2009 on social-security coordination. Third-country nationals lawfully employed in France are covered identically through their régime général affiliation. Posted workers from another EU state remain insured at home (form A1).

Conversely, three groups are excluded: workers who have not yet completed the contribution thresholds; civil servants under the régime spécial (who receive maintien de traitement from their administration instead); and persons in informal or undeclared work (who cannot prove the 150 hours / 1,015 × SMIC).

The amount of IJ maladie is calculated by the CPAM from the salaire journalier de base (SJB), which is itself defined by article R323-4 of the Code de la sécurité sociale. The Décret n° 2019-1387 du 18 décembre 2019 simplified the reference period: the SJB is now the average of gross salaries from the last three months preceding the arrêt (or twelve months in case of seasonal or irregular activity), divided by 91.25 days.

Baseline daily rate. In the general case, the daily allowance is equal to 50% of the SJB (article L323-4 CSS), so an employee earning a gross monthly salary of €2,500 has an SJB of approximately €82.20 and a daily IJ of about €41.10. The IJ is paid for every calendar day (weekends and public holidays included) once the carence is consumed.

Ceiling. The SJB is capped at 1.8 × SMIC mensuel brut. In 2025, with a SMIC at €1,801.84/month, this gives a maximum SJB of about €3,243.32/month, or approximately €106.55/day. The maximum IJ maladie in 2025 is therefore €52.28 per day gross for an employee on the general regime. This ceiling is one of the main reasons why high-income employees rely heavily on collective top-ups (see CCN below).

Délai de carence. Article L323-1 of the CSS establishes a three-day waiting period (délai de carence) at the start of every arrêt: days 1, 2 and 3 generate no IJ from CPAM. Payment begins on day 4. The carence is consumed only once per arrêt and is waived in three classic situations: relapse of the same illness (rechute) within 48 hours, arrêt linked to a recognised ALD requiring continuous treatment, and arrêt for occupational accident/disease (where AT/MP rules replace L323-1 with full pay from day 1).

Employer maintien de salaire. The Loi de mensualisation of 1978, generalised through article L1226-1 of the Code du travail, obliges most employers to maintain at least 90% of gross salary during the first 30 days of an arrêt and at least 66.66% during the following 30 days, after one year of seniority, provided the employee transmits the arrêt within 48 hours. Many conventions collectives nationales (CCN) are far more generous (e.g. Syntec, Métallurgie, Banque), pushing full-salary maintenance for several months. In practice, this means most insured employees do not feel the 50% rate of the CPAM allowance during the early months: they receive their normal net via the employer, who is itself reimbursed by CPAM through the subrogation mechanism (article R323-11 CSS).

Long arrêts and rate uplift. After 30 indemnified days, an insured who has at least three dependent children sees the rate moved from 50% to 66.66% of the SJB (article L323-4 CSS). This is the only family-status uplift in IJ maladie; other parental situations follow IJ maternité/paternité rules.

Maximum duration. Article L323-1 sets a maximum of 360 indemnified days per period of three years for ordinary sickness. For an Affection Longue Durée (ALD) on the list of 30 maladies recognised by HAS (cancer, diabète, sclérose en plaques, etc.), the limit is extended to three years of continuous indemnisation, with possibility of renewal. After exhaustion of the IJ ceiling, the insured can move to pension d'invalidité if a permanent reduction of working capacity is established (see related benefits).

Taxation and CSG. IJ maladie are subject to income tax as wage substitution, and to CSG (6.2%) and CRDS (0.5%). The amounts are pre-filled in the annual déclaration de revenus from data sent by CPAM. CSG/CRDS are partly deductible.

Example, 2025. A single employee, gross monthly salary €2,800, no children, six months of activity. SJB = €2,800 × 3 / 91.25 = €92.05. Daily IJ = 50% × €92.05 = €46.03 gross/day. Days 1-3 = €0 (carence). From day 4: ~€46/day from CPAM, plus 90% maintien from the employer for the first 30 days of arrêt under the Loi de mensualisation.

The application procedure for indemnités journalières maladie is unusual in French social protection: there is no "benefit application form" the insured fills in. The right is opened by the arrêt de travail itself, prescribed by a physician and transmitted to CPAM. The insured's role is concentrated in three duties: deliver the paperwork to the employer, comply with the rules of presence and medical control, and react to CPAM if anything is missing.

Step 1: medical consultation. The insured consults their médecin traitant (or, failing that, any general practitioner or specialist). If the doctor judges that a temporary work stoppage is justified, they prescribe an arrêt de travail with start date, expected end date and reason (the medical reason is confidential and only readable by CPAM's service du contrôle médical). The default tool is the dematerialised arrêt: most physicians transmit it directly to CPAM via télétransmission Sesam-Vitale. A paper version exists, the Cerfa n° 10170, in three carbonless copies: two for CPAM, one for the employer.

Step 2: transmission to CPAM. When télétransmission is used, the CPAM receives the arrêt within minutes; nothing more is required from the insured for this step. When the paper Cerfa 10170 is used, the insured must send copies 1 and 2 to their CPAM within 48 hours (article R321-2 CSS). Sending later is a breach that can lead to a reduction of the IJ (up to 50% for the days preceding the delayed transmission), although CPAM applies a tolerance for first-time delays.

Step 3: notification to the employer. The insured must send copy 3 to the employer (or the dematerialised equivalent) within the same 48-hour window. Failure to do so is a breach of contract (article L1226-1 Code du travail) that can deprive the employee of the maintien de salaire. The employer then issues an attestation de salaire, the document that allows CPAM to compute the SJB. The attestation is filed via net-entreprises.fr; without it, the CPAM cannot pay.

Step 4: payment. Once the attestation arrives, CPAM calculates the SJB and pays the daily allowance every fortnight (cycles of 14 days), directly into the insured's bank account. The payment statement is visible on ameli.fr in the personal space, with the count of indemnified days and the cumulated total for the three-year reference window. If the employer has activated the subrogation, CPAM pays the employer instead, and the employee receives the full subrogated salary through the normal payroll.

Step 5: respect of the obligations during the arrêt. The CSS sets four obligations whose breach can trigger a sanction (reduction or suspension of IJ):

• Respect of heures de sortie: 9-11h and 14-16h, unless the doctor authorised free outings.
• No travel outside the département of residence without prior agreement of the CPAM.
• Authorising medical control visits at home or in CPAM offices.
• Following the prescribed treatment.

The CPAM medical service can convoke the insured at any moment. A no-show without justification can lead to immediate suspension of the allowance.

Step 6: renewals and end of arrêt. A renewal (prolongation) is issued by the same physician or a specialist, with the same télétransmission/Cerfa process. The reprise de travail is automatic at the end date of the arrêt unless renewed; the employer organises the return, sometimes with a visite de reprise by the médecin du travail when the arrêt exceeded 30 days.

Buronia guides employees through the IJ maladie process by translating the arrêt into the language of the insured (Arabic, Portuguese, Romanian, Polish, English, etc.), reminding them of the 48-hour rules, helping them check whether their convention collective grants a higher maintien de salaire, and flagging when the CPAM has not yet received the employer's attestation. This is particularly useful for migrant workers and recently hired employees, who are over-represented in late-attestation cases and missed maintien.

Sickness cash benefits exist in every EU member state, but the architecture of French IJ maladie looks unusually moderate at first glance, with a baseline replacement rate of only 50%. To understand the system in context, it is essential to compare it with neighbouring schemes and to remember that the French gap is generally closed by employer obligations and collective bargaining, not by the social-security branch itself.

Germany — Krankengeld. Under §44 SGB V, the employer pays 100% of net salary for six weeks (Entgeltfortzahlung), then the statutory Krankenkasse takes over with 70% of gross salary, capped at 90% of net, for up to 78 weeks within a three-year window for the same illness. The German baseline is therefore much higher than the French 50%, but the duration is shorter than French ALD provisions.

Netherlands. Dutch employers must pay at least 70% of salary for up to two years (Loondoorbetalingsplicht bij ziekte, art. 7:629 BW), and many CAOs push this to 100% for the first year and 70% for the second. After two years, the state takes over with WIA/IVA (disability). This is the most generous employer-funded system in Europe and an outlier.

Austria — Krankengeld. Employers pay full salary for 6-12 weeks (depending on seniority), then half-salary for an additional four weeks. The ÖGK Krankengeld then pays 50% of the daily contribution basis for the first 42 days, rising to 60% from day 43, for up to 52 weeks (extendable to 78). French baseline 50% is similar; the Austrian uplift mechanism is duration-based, the French one is family-based.

Belgium. The employer pays salaire garanti (100%) for the first month (employees) or two weeks (workers). The INAMI mutualité then pays 60% of capped salary for up to one year (incapacité primaire) and a slightly lower rate during the invalidité phase.

Italy — INPS indennità di malattia. A graduated scheme: 50% of average daily wage for days 4-20, then 66.66% from day 21, with the employer obliged by most CCNL to top up to 100%. Maximum 180 days/year.

Spain — incapacidad temporal (INSS). 60% of regulating base for days 4-20, then 75% from day 21, for up to 12 months (extendable to 18). Days 1-3 are unpaid by default; many convenios colectivos require the employer to pay them.

Poland — zasiłek chorobowy. 80% of the contribution base from day 1 paid by employer for the first 33 days (14 days for workers over 50), then ZUS for up to 182 days. Rises to 100% for hospitalisation or pregnancy.

Comparative table — baseline cash replacement rate (state-paid portion).

• France: 50% (66.66% with 3+ children after 30 days)
• Germany: 70% (gross) / ≤90% (net) after 6 weeks of full employer pay
• Netherlands: 70-100% (employer-paid) for two years
• Austria: 50% then 60%
• Belgium: 60% (after 1 month of 100% employer pay)
• Italy: 50% then 66.66%
• Spain: 60% then 75%
• Poland: 80% (100% in special cases)

EU coordination. Regulation 883/2004 ensures that frontier workers, posted workers and EU migrants do not lose their sickness rights when crossing borders. An employee insured in France but residing in Belgium, for instance, claims IJ maladie from the French CPAM and uses the Belgian healthcare network. Form S1 is used for residence registration; form S2 for planned medical treatment in another state. Coordination does not harmonise the cash-benefit rates: a French worker keeps the 50% baseline even if posted to a country with a higher rate.

Why France looks low and is not. Two French specificities raise the effective replacement rate well above the 50% headline:

• The Loi de mensualisation and the conventions collectives create de-facto employer top-ups for the first one to three months for most employees with one year of seniority — often pushing the effective rate to 90-100% during the critical early period.
• The ALD regime offers up to three years of indemnisation for serious illnesses, longer than the German 78 weeks and far longer than Italian or Spanish ceilings.

The French choice is, in short, lower baseline / longer tail / more reliance on collective bargaining — a model very different from the German or Dutch "high employer pay, shorter state tail".

The IJ maladie is the entry point of a much wider network of French social protection benefits that cover health, disability and income. Understanding the articulation is essential because, in many situations, the insured will transition from IJ maladie to a different scheme without realising it, or could be claiming several benefits in parallel.

1. Affection Longue Durée (ALD). The ALD regime, governed by articles L324-1 and D322-1 of the CSS, exempts the insured from ticket modérateur for care related to their long-term illness (30 chronic diseases on the official list: cancer, diabète, AVC, mucoviscidose, sclérose en plaques, schizophrénie, etc., plus the "ALD 31" — out-of-list serious illnesses, and "ALD 32" — polypathologies). It also lifts the 360-day IJ ceiling and replaces it with up to three years of continuous indemnisation. The ALD does not replace IJ maladie; it relaxes its parameters. The insured applies via their médecin traitant, who completes a protocole de soins validated by the CPAM medical service.

2. Pension d'invalidité. When IJ rights are exhausted or when the insured is recognised as permanently incapable of regaining at least two-thirds of normal earning capacity, they transition to pension d'invalidité under articles L341-1 and following of the CSS. The pension has three categories: 1st category (capable of partial work) at 30% of average salary, 2nd category (incapable of work) at 50%, and 3rd category (incapable of work and requiring third-party assistance) at 50% + majoration tierce personne (~€1,266/month in 2025). The transition is initiated by CPAM, often around month 24-30 of a long arrêt.

3. IJ accident du travail / maladie professionnelle (AT/MP). If the illness is recognised as occupational under articles L411-1 (accident) or L461-1 (maladie professionnelle), the insured leaves IJ maladie and moves to IJ AT/MP: 60% of SJB for days 1-28, then 80% from day 29, paid from day 1 without carence, and not taxed. The employer also has stricter maintien obligations.

4. IJ maternité / paternité / adoption. Childbirth, paternity and adoption interrupt IJ maladie for the corresponding leave (16 weeks for maternity in the standard case, 25 days + 3 for paternity since 2021). The IJ amount is calculated on similar bases but at 100% of capped net salary, not 50% of gross, and is paid by CPAM.

5. Complémentaire santé solidaire (C2S). The means-tested complementary health coverage that replaces the former CMU-C and ACS since 2019. It does not replace IJ, but it ensures zero-cost healthcare during a sickness, which complements the income replacement.

6. Protection universelle maladie (PUMA). Created by the Loi de modernisation de notre système de santé (2016) and codified in article L160-1 CSS, the PUMA guarantees healthcare reimbursement to anyone working or residing in France in a stable and regular manner. PUMA does not open a right to IJ — only contributory affiliation does — but it ensures that everyone has a Carte Vitale and can access the system.

7. Aide Médicale d'État (AME). For undocumented foreigners with at least three months of stable residence, the AME (articles L251-1 and following of the Code de l'action sociale et des familles) provides full healthcare reimbursement. The AME does not open IJ either, but it ensures that sickness care is not blocked by the absence of a residence permit.

8. Revenu de solidarité active (RSA). When IJ is exhausted, when contribution conditions are not met, or when the worker has never been insured, the RSA (article L262-1 CASF) provides a last-resort means-tested income. RSA is incompatible with IJ except in specific transition cases; in practice the CAF and CPAM coordinate to avoid double payment.

9. Action sociale of the CPAM. Each CPAM operates a fonds d'action sanitaire et sociale: discretionary aid for insured persons whose financial situation deteriorates during a long arrêt (rent help, electricity, medical equipment). The amounts are limited and require a social worker referral, but they are an important safety net for low-income workers in long arrêts.

10. Mutuelle d'entreprise. Since the ANI of 2013 and the Loi Sécurisation de l'emploi, every private-sector employee has a mandatory complementary health insurance through their employer (mutuelle obligatoire). Most of these include a prévoyance contract that pays additional IJ on top of CPAM and the maintien de salaire, often pushing the total replacement to 100% net for the duration of the arrêt.

French indemnités journalières maladie sit on a programme of remarkable scale that has been growing steadily for two decades. The CNAM publishes detailed statistics in its annual Charges et produits report, and the Cour des comptes regularly audits the trajectory. The most recent figures point to a system under structural pressure, dominated by an ageing workforce and a rapid rise of mental-health-related arrêts.

Volume. France generates around 7 million arrêts de travail per year in the régime général, covering roughly 5 million distinct workers (some workers have multiple arrêts in the same year). The average duration is approximately 35 days, but the distribution is skewed: more than 60% of arrêts last less than two weeks, while a small share of long arrêts (>3 months) concentrates most of the expenditure.

Expenditure. Total IJ maladie expenditure (excluding maternité and AT/MP) reached ~€16 billion in 2024, up from €8 billion in 2010 and €12 billion in 2019. This is the fastest-growing line of the régime général excluding pensions, and the Cour des comptes' 2024 report specifically targeted it as a candidate for parametric reform.

Diagnostic mix. The medical reasons behind arrêts have shifted significantly:

• Mental health (depression, anxiety, burn-out): from 12% of long arrêts in 2015 to over 20% in 2024. This is the single largest growth driver and reflects both better recognition by physicians and a genuine increase in psychological distress.
• Musculoskeletal disorders (TMS): about 20% of arrêts, stable, concentrated in industrial and care sectors.
• Cardiovascular and oncological conditions: long but stable, mainly captured by ALD.
• Pregnancy-related pathological arrêts: small but growing share.
• COVID-19 sequelae ("COVID long"): identified by CPAM as a new specific category since 2023.

Demographics. Workers over 55 have an arrêt frequency three times higher than workers under 25. The female arrêt rate exceeds the male rate by roughly 25%, reflecting both pregnancy-related medical events and over-representation in sectors with higher musculoskeletal risk (santé, services à la personne).

Geographic distribution. The Hauts-de-France and Provence-Alpes-Côte d'Azur regions show the highest per-capita IJ expenditure, while Île-de-France and Bretagne are below national average. These variations partly reflect industrial mix (more manual work in the north) and partly demographics.

Policy debate, 2024-2030. Several reform tracks are openly discussed:

• Reinforced contrôle médical: the LFSS 2024 already strengthened CPAM's right to suspend IJ when the medical justification appears insufficient. Further automation through machine-learning targeting of suspect arrêts is on the table for 2026.
• Carence in the public sector: a temporary three-day carence was reintroduced for civil servants in 2018 and remains politically contested. Some proposals would harmonise it with the private sector permanently.
• Cap on the maintien de salaire: the LFSS 2025 raised the question of capping the reference salary for the employer top-up, which would shift costs from CPAM to employers but reduce the implicit subsidy enjoyed by high-income employees.
• Mental-health protocol: HAS and CNAM are co-designing a structured protocol for burn-out arrêts, with mandatory psychological support and graduated temps partiel thérapeutique. Expected rollout 2026-2027.
• EU coordination: ongoing discussion at the EU level (Regulation 883/2004 revision) on whether sickness benefits should be more easily exportable across borders for short-term Erasmus-style work mobility. France has been broadly supportive but cautious on cross-border medical control.

Outlook to 2030. CNAM projections estimate that, in a status quo scenario, IJ maladie expenditure will grow to around €20-22 billion by 2030, driven by ageing, persistent mental-health pressure and rising healthcare prices. A reform scenario combining tighter medical control, structured mental-health protocols and partial employer-cost reallocation would slow growth to ~€18 billion. The branch is therefore expected to remain one of the central political battlegrounds of French social protection, but the legislator has consistently rejected a frontal cut of replacement rates: the political consensus around protecting sick workers remains strong, even when controls are tightened.

Bottom line. French IJ maladie is a system with a modest headline rate (50%), an extensive collective-bargaining superstructure that lifts the real replacement rate close to 100% for many employees, and a long-tail design (ALD up to three years) that protects severe illnesses better than most EU peers. It will continue to evolve, but its core architecture — doctor-prescribed arrêt, CPAM cash, employer top-up — is unlikely to be dismantled before 2030.