How do you know which health insurance fund you depend on?

Employees in the private sector depend on the Primary Health Insurance Fund (CPAM) of their department of residence. They also have an affiliation code to identify them. But what about other workers (self-employed, farmers, soldiers, civil servants, etc.)? And what about students? Discover all the health organizations that exist apart from the CPAM and the MSA. And follow our advice to know your CPAM connection code.

How do you know which health fund you belong to?

There are establishments other than the Caisse Primaire d’Assurance Maladie (CPAM) for reimbursement of your healthcare costs.

Attachment to one or other of these organizations depends on your professional activity:

  • the student scheme was abolished at the start of the 2018/2019 academic year. Therefore, during a student internship, you depend on the general scheme. All documents (medical certificate, work stoppage, etc.) must be sent to the CPAM of your place of residence and no longer to any student fund;
  • employees except those engaged in agricultural activity are attached to the CPAM. This includes employees in the private sector, non-permanent agents in the public sector, childminders, home workers or sellers, sales representatives, freelance journalists, performing artists, people in civic service, employees of hotel, etc ;
  • workers who carry out an agricultural activity are attached to the agricultural social mutual fund (MSA);
  • then, the self-employed (craftsmen, traders, liberal professions, industrialists) depend on the Social Security for the Self-Employed (formerly RSI);
  • and the military, attached to a special regime, depend on the National Military Social Security Fund (CNMSS).
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To note : in the event of a change in your professional situation (retirement or change of activity, for example), you must contact your social security organization to find out what steps to take.

What is the general regime?

The sickness branch of the general scheme concerns four risks: sickness, invalidity, maternity and death. Workplace accidents and occupational diseases are not concerned by this branch.

The general system finances 86% of health expenditure. In France, there are 101 primary funds (CPAM) attached to a head office (CNAMTS).

Generally, the insured are attached to the CPAM in the district in which they have their habitual residence. This is also governed by the Social Security Code (art. R312-1). Note, however, that for some insured persons, the connection is made in the constituency in which their place of work is located.

Officials: what fund do they belong to?

Contract workers are covered by the general social security scheme in their department. On the other hand, it is different for civil servants.

In fact, public service agents depend on a special health insurance scheme for civil servants managed by specific bodies. In addition, this special scheme bears part of the healthcare costs of insured persons and their families and pays a replacement income in the event of cessation of activity due to illness or a non-occupational accident.

On the other hand, in the State civil service, mutual funds manage the Social Security of agents. They differ according to the ministry of assignment. Thus, National Education personnel, for example, are covered by the MGEN (General Mutual Fund for National Education).

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And in the territorial public service and the hospital public service, social security benefits are provided by the CPAMs, which sometimes delegate this role to mutual insurance companies. Your situation actually depends on your department of residence.

To which health insurance fund does itinerant activities depend?

If you are an employee without a home or fixed residence, employed by a fairground merchant, a traveling circus or a theatrical tour organization, your case is particular. There are three possibilities on which your affiliation depends:

  • if you travel from a fixed point, the CPAM depends on this point;
  • if the trips are usually made in a region, you depend on the CPAM of the center of this region;
  • finally, if the trips take place anywhere in France, your branch office is the Paris CPAM.

Independents: how to know your health insurance fund?

First, know that there are 29 agencies in the region and a network of reception points throughout France for the self-employed.

Then, with some exceptions, note that the attachment to a Social Security agency for the self-employed depends on the self-employed worker’s home address.

To know : since 1er January 2019, policyholders who start a self-employed activity or change their self-employed activity are attached to the CPAM. For companies created before 2019, Health Insurance delegates the payment of benefits to a network of approved organizations (mutual or group of insurance companies chosen when creating the company). But anyway, the reimbursement remains the same. .

Where can I find the code of the CPAM organization?

This is one of the questions that CPAM policyholders generally ask themselves. Where can I find the code of the organization to which you belong? This is a number that is difficult to find because it is often absent from correspondence between the Caisse and you.

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But first, be aware that this code is used to identify an insured person based on several pieces of information such as the health insurance center on which he depends. It consists of nine digits.

Note that there are several possibilities to find out your CPAM affiliation code:

  • by going directly to the premises of the Primary Health Insurance Fund. At the counter, you will be given the information after you have presented your national identity card or another form of identification;
  • at a Social Security terminal made available to the insured. You can find it in hospitals or pharmacies. To know your code, you will then have to insert your vital card;
  • on the certificate of entitlement available in your Ameli personal space. The document is to download. On it, you will find your CPAM organization code;
  • via Ameli’s number. It is 3646 (price of a local call).

Advice : record this number because it is information that the insured must be able to access at any time in order to facilitate reimbursement and affiliation operations.

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