To prepare your application for Complémentaire santé solidaire, gather information about your household, the required tax notices and details of your resources. The primary health insurance fund (CPAM) reviews your complete application and informs you of its decision.
Review the people in your household
In principle, a single application covers the entire household: you, your spouse, cohabiting partner or Pacs partner, as well as certain people dependent on you. For children under 25 who are genuinely and continuously dependent on you, their inclusion in a tax household, where they live and whether they receive tax-deductible maintenance payments are among the factors to examine, with an exception for payments arising from a court decision.
Other people under 25 who are genuinely and continuously dependent on you may also belong to the household if they are included in your tax household or that of your spouse, cohabiting partner or Pacs partner. Certain situations allow an individual application, including that of separated spouses.
Before completing the application, take time to check the situation of each person concerned. If it is difficult to determine, ask your CPAM or a municipal social action centre (CCAS) for help.
Gather supporting documents for CSS
Whether applying online or on paper, prepare a tax assessment notice or an income tax declaration status notice (ASDIR) for each person. If you lived abroad during the preceding 12 months, you must also provide documents showing your tax and social security status in the country or countries concerned.
For an application through your ameli account, scan the required supporting documents so you can attach them. If you receive CAF benefits, also have your file number ready.
Prepare information about your resources
The reference period corresponds to the 12 calendar months preceding the month before the month of application. Identify this period before preparing your declaration: it depends on the month in which you submit your application.
When applying through your ameli account, certain resources, such as wages, retirement income, pensions and unemployment benefits, are obtained directly from the organisations that hold the information. The CPAM can also obtain information about employment income and social benefits through the monthly resources system; these resources do not then need to be declared.
However, you must declare certain net resources received in France and abroad by household members: in particular, self-employment income at the start of an activity when it has not yet been included in an income tax return, as well as other resources, such as gambling winnings. For a self-employed activity that has already been included in an income tax return, the net income shown on the latest income tax declaration status notice or tax assessment notice known at the time of application is taken into account.
The CPAM also takes into account amounts it knows about from other sources, including daily allowances, family benefits, income from assets and investment returns. Some resources are not taken into account, including the RSA and the activity bonus.
Report your housing situation
If you own your home or are housed free of charge, a standard housing amount is added to your resources. Its amount depends on the household composition.
For housing assistance, the ameli guidance specifies, in its table excluding Mayotte, that the standard amount is included only if the allowance is higher than that amount. Otherwise, the actual amount of the assistance is taken into account.
Choose how to apply and the managing organisation
You can apply through your ameli account or send or submit the paper form and supporting documents to your CPAM. In your ameli account, the form is in the “Mes démarches” section.
When applying for the first time, you must indicate the organisation that will manage your Complémentaire santé solidaire. If you already have a supplementary insurer that manages Complémentaire santé solidaire, indicate this in your application.
If you do not have a supplementary insurer or if it does not offer Complémentaire santé solidaire, you must choose either an organisation that offers it or your CPAM. On the paper form, remember to complete the “Le choix de votre organisme complémentaire” section, then date and sign the form before sending or submitting it with the supporting documents.
Get help completing the application
For help preparing your Complémentaire santé solidaire application, you can also contact health and social services, an approved association or a healthcare facility. These are in addition to the CPAM and the CCAS in your town.
Once the application is complete, the organisation assisting you can send it to your CPAM with your consent.
After submitting the application
After an application through your ameli account, an electronic acknowledgement of receipt is sent to the account's message inbox. If necessary, the CPAM may contact you for further information.
Upon receipt of the complete application, the CPAM reviews it within 2 months and informs you of its decision. If you discover an error in the form, contact your CPAM to correct it.
Steps to take if your application is approved
Without a financial contribution
If you are granted Complémentaire santé solidaire without a financial contribution, the CPAM sends you a certificate of entitlement and asks you to update your carte Vitale.
With a financial contribution
If a financial contribution is due, the CPAM tells you the amount for each household member. If you have chosen a supplementary insurer as the managing organisation, it sends you an enrolment form or a contract and a direct debit mandate to sign and return to it.
If you have chosen the CPAM as the managing organisation, it sends you the enrolment form and direct debit mandate directly, to sign and return to it.
In these situations involving a contribution, entitlement begins on the first day of the month following the managing organisation's receipt of these documents and is granted for one year. The ameli guidance also provides for special arrangements for the effective date in the event of hospitalisation.
If your application is accepted, your certificate of entitlement is available in your ameli account if you have one; otherwise, it is sent to you by post.
