all about this social security status

By Charlotte Beydon August 5, 2022
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Has social protectionuse third-party payment, get your healthcare reimbursed (everything you need to know by registration with CPAM)… In France, it is a right for all those who reside in the territory on a regular and stable basis. This insurance covers the holder, that is, the person who meets the eligibility criteria, who opens this right and who receives the benefits. But she can do that too extend to other relatives : rights holders.

Before universal health coverage came into force in 2016were the rights holders in general spouse and children. It was therefore enough for someone to work or have worked in order to be registered with the Health Insurance Scheme and to see their entire small family protected. But to avoid a lot of inconvenience (discretion of health-related costs, administrative procedures, etc.), the Puma system has abolished the status of recipient.

Thus, the joint heirs have all gained a new status: that ofindividually insured. The only requirement? Live legally in France and for several consecutive months of the year! With regard to children whose minors are still the heirs of their parentsadults must request the opening of their right to CPAM.

Finally, it is important to do not confuse social security beneficiaries with mutual insurance beneficiaries. And with good reason, the supplementary health insurance continues to offer holders of their insurance contract the ability to cover members of their familyand thus transform them… into rights holders!

To know everything about the concept of recipient, the consequences of Puma for spouses and children, just continue reading this article.

The definition of receiver

A right holder is a person who benefits from another person’s right. This term applies to many areas: social security, mutual insurance, inheritance, etc. In this article we focus only on Social protection. Thereby, a beneficiary’s health expenses (consultations with a doctor, costs in connection with a medical procedure, treatments and medicines, etc.) is paid or reimbursed in the name of the insured to whom it is linked : the holder.

It is therefore important to understand the difference between holder and recipient. On the one hand there is holder: the person who opened the rights and who receives them. On the other there is the recipient: the person who, by extension, benefits from the same guarantees than the holder.

Originally, the rights holders were mainly spouse or partner (whether related to the holder through marriage, a PACS or not), and children. But since 2016 and the entry into force of Puma (Universal Health Protection), the rules have changed.

Beneficiary of social security: PUMA has upset the old rules

Until 31 December 2015to be covered by health insurance, you should be employed or have worked long enough to qualify. Otherwise, several solutions were possible to cover the health costs:

  • Claim to maintain his previous rights (if the applicant had already worked)
  • Apply for basic CMU (universal health coverage) every year
  • Be the beneficiary of an insured (ie spouse or child of an insured)

The disadvantages of this system were several:

  • Difficult and regular administrative procedures
  • Loss of privacy protection
  • The potential violation of rights in the event of a change in professional or family situation

With Puma Where Universal health protection, everything has changed since then all adults are insured on an individual basis. Therefore, the new insured can:

  • Receive reimbursement to your own bank account (where previously it was to the cardholder’s bank account)
  • Receive your own refund statement
  • Get your own Ameli account for better data protection

Changes in personal relationships (and in particular divorces) therefore have none no more influence and no longer impose tedious procedures or loss of Social Security coverage.

Good to know : the concept of beneficiary still exists for certain schemes individuals such as the MSA or the Alsace-Mosel scheme.

Joint beneficiaries: what changes?

Before Puma, any change in the situation affected the recipient’s rights. Therefore it was necessary notify the health insurance company immediately to know whether these will be maintained and, if so, for how long. Some examples:

  • In the event of a divorce with the insured spouse: the recipient’s rights are maintained for 1 year. However, if the beneficiary has or had 3 dependent children, he enjoys these rights ad vitam aeternam.
  • In case of termination of PACS with the insured partner: the recipient’s rights are maintained for 1 year. The number of dependent children is irrelevant.
  • In the event of the insured’s death: the rights of the rightful claimant are maintained for 1 year or indefinitely if the latter has 3 dependent children (and this regardless of the ties that unite them – marriage, PACS, cohabitation -).

In any case, it was imperative fill in a form and send a file with supporting documents. And when there was an extension of rightsdid the ex-spouse continue to have access to all the information related to the recipient’s healthcare expenses and must be received at their own expense repayments possible… Which could be a concern in case of a conflict!

With the introduction of universal health coverage in 2016all this is past joint beneficiary status no longer exists. Any adult who resides stably and regularly in France is now insured on an individual basis..

What if you were a joint beneficiary before applying to Puma? Don’t worry, since 2016 CPAM has been looking for all holders of adult rights to make them switch to the correct status. Most simply had to justify their regular and stable presence in the territory through official documents or a housing certificate signed by the policyholder.

To note : to find out if you are still right by your companion or your partner, that’s enoughgo to your Ameli room in the “My Information” section. The rights holders are listed there.

Holders of children’s rights: minors or adults, what difference does it make?

If Puma led to the disappearance of the common beneficiary, for the children, it is a little different. Explanations.

For minors with rights

Minors retain their status as rights holders until they attain majority. They may be indifferently attached to their father, their mother, or even to both. For this you need to fill out The Cerfa form no. 14445*02 regarding the attachment of minor children to health insurance.

Good to know : from 16 yearsit is possible to apply for the title of independent beneficiary at CPAM in your home. A simple letter is enough, there is no evidence to attach. This special status allows you to receive reimbursement of your medical expenses directly to your bank account (and no longer to your parents’).

for adults

After their majority, children can be insured individually : they no longer need to be attached to a keeper (their father, their mother). Therefore, fApplying for affiliation as secured on the basis of residence is essential.

For that it is necessary complete application form for health insurance andsent to the health insurance fund from your home. Supporting documents may be required depending on your situation:

  • Photocopy of your valid identity card or passport
  • Proof of accommodation from your parents
  • Lease agreement, electricity or gas bill if you no longer live with your parents
  • Etc.

Good to know : if you start higher education after your Baccalaureate, you will be insured with CPAM. Take effect, student social security scheme has been permanently deleted.

The case of beneficiaries for mutuals

Unlike health insurance, mutual companies have retained the concept of beneficiary.

Each supplementary health insurance policy provides a list of people who may be covered by the holder’s contract. Most people consider spouse or partneras well as their children as rights holders. For the latter, their attachment often depends on:

  • Your Status: student, on an apprenticeship or professionalisation contract, job search etc.
  • Their age: some mutuals agree to go up to 25 or even 28 years in case of continuing studies in high school.

Finally, some supplementary health insurances allow cardholders to integrate ascending as rights holders.

Good to know : adding rights holders can affect the size of your contribution.

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