How to combine French social security, PUMa, mutuelles, and international plans for full family coverage
France is one of the most welcoming destinations for international students, especially when it comes to healthcare. The country offers generous public coverage, predictable rules, and a clear path to family inclusion. But it can also be confusing at first, because “family student insurance” is not a standard product. Families often expect a single package covering the student, spouse, and children. That package rarely exists.
Instead, France works through a layered system. Students get public social security for free. Family members may qualify through residence. And everyone can improve their protection through a private mutuelle or an international plan. It’s a three-part puzzle, and once you understand how the pieces fit, the system becomes remarkably efficient.
This guide walks you through exactly how it works—clearly, simply, and in depth.
We’ll look at the statutory routes, practical strategies for families, and a realistic Top 10 list of private and international solutions that accept dependants.
Let’s begin with the backbone of the system: French social security.
How the French Healthcare System Works for International Students
France provides a unique advantage: non-EU/EEA/Swiss students staying for three months or more can register for French social security at no charge.
That registration happens online through etudiant-etranger.ameli.fr.
The moment your registration is processed, you are covered. Medical consultations, hospital stays, lab tests, prescribed medicines—everything is reimbursed at standard rates. France generally covers about 70% of official healthcare tariffs. This means you are plugged into one of the most reliable public health systems in Europe.
But the system isn’t designed to cover everything.
And it is not designed to automatically include your spouse and children from day one.
That’s where complementary private insurance comes in.
The Role of the Mutuelle: What It Covers and Why Families Need It
A mutuelle (private complementary health insurance) fills the gap between what French social security reimburses and what you actually spend.
While social security pays around 70% of standard care, a mutuelle can:
- Cover the remaining 30%
- Add extra reimbursement for expensive dental or optical services
- Reduce hospital costs not fully paid by social security
Mutuelles are not mandatory, but almost all students and families in France purchase one eventually.
For students, basic mutuelles typically range from EUR 15–40 per month. For families, generalist mutuelles cost more—usually EUR 60–150 per month depending on region, age, and coverage level.
Some mutuelles allow family members to join the same contract. Others require each person to have their own subscription. The rules differ by provider, so comparing contracts carefully is essential.
But mutuelles only work if you’re already under French social security or PUMa.
And that brings us to your spouse and children.
Family Access Through PUMa: The Most Overlooked Benefit
Many students overlook PUMa (Protection Universelle Maladie), which provides health coverage to legal residents after about three months in France. It’s a powerful tool for families.
Under PUMa:
- Spouses can often be affiliated as residents.
- Children can be attached under the student or spouse for coverage.
- Everyone gains access to the French social security system.
This approach is particularly effective for families staying one year or longer.
But PUMa isn’t instantaneous. You must prove lawful residence and submit documentation. Processing times vary.
During that waiting period, families need a strong private or international plan.
Once PUMa kicks in, families usually switch to:
- French social security for statutory coverage, and
- A mutuelle for complementary coverage.
This two-part structure offers excellent value and broad protection.
But what about the initial months?
And what about families who don’t qualify for PUMa due to temporary residence or complex visa rules?
That’s where international insurance comes in.
Top 10 Private and International Health Insurance Options for Student Families in France
The following options are widely used, visa-friendly, and capable of covering spouses and children. They represent the practical “market reality” for student families.
We’ll break them down clearly.
1. French Student Mutuelles (LMDE-type or generalist brands)
These mutuelles are designed to complement French social security for students.
Role:
- Cover the 30% not reimbursed by public insurance.
- Some allow adding family members or linking contracts.
Cost:
- Usually EUR 15–40 per month for students.
- Family extensions cost more depending on structure.
Mutuelles are not designed to replace social security. They enhance it.
2. Generalist French Mutuelles Offering Family Plans
These are full family versions of mutuelles.
Role:
- Provide comprehensive top-up coverage for families once everyone is under social security or PUMa.
- Improve dental, optical, and hospital reimbursements.
Cost:
- EUR 60–150 per month for family plans, depending on age and region.
These contracts are ideal once the whole family is integrated into the public system.
3. InternationalStudentInsurance.com – Student Plans for France (Brokered)
A flexible option for short stays or transition periods.
Role:
- Useful while waiting for French social security approval.
- Some plans allow dependants.
Cost:
- Student-only: EUR 30–70 per month for basic coverage.
- Family rates increase with each member.
This is a practical bridge solution for many non-EU students.
4. Cigna Global (International Medical Insurance)
A modular global insurance provider.
Role:
- Offers inpatient, outpatient, maternity, and paediatric options.
- Great for families moving between countries.
Cost:
- Mid-tier family coverage in Europe: EUR 150–350+ per month.
Ideal for families wanting a predictable, worldwide solution.
5. Allianz Care (International Student or Expat Plans)
Known for strong hospital networks and visa-friendly certificates.
Role:
- Offers comprehensive inpatient care with optional outpatient and maternity.
- Excellent for families likely to relocate later.
Cost:
- Similar to Cigna.
- High-end maternity coverage increases the price significantly.
A popular choice among long-term postgraduate students.
6. AXA Global Healthcare
Another major international insurer.
Role:
- Works well as both temporary cover and long-term global protection.
- Allows adding spouse and children easily.
Cost:
- EUR 150–300+ per month for Europe-focused family cover.
A strong all-rounder.
7. Bupa Global
Premium worldwide insurance.
Role:
- Strongest for chronic conditions, hospital networks, and maternity care.
- Suitable for research students or high-risk pregnancies.
Cost:
- Often EUR 400–700+ per month for families.
On the expensive side, but highly comprehensive.
8. April International (France-based International Insurer)
A favourite among expatriates in France.
Role:
- Offers standalone policies for spouses and children, or combined family cover.
- Integrates well with French social security.
Cost:
- Mid-range pricing, more than mutuelles but less than premium global plans.
Very convenient for settling long-term in France.
9. Specialized French Expat Brokers / Aggregators
Broker platforms assemble custom solutions.
Role:
- Combine mutuelles with international family plans.
- Useful for complex situations (short stay, partial PUMa eligibility, or two-country coverage).
Cost:
- Varies widely.
- Brokers usually provide 3–5 pricing tiers.
Good for families needing personalised configuration.
10. Home-Country International Plans Covering France
Some families retain coverage from their home insurer.
Role:
- Works if the plan is valid in France, covers inpatient and outpatient care, and meets visa requirements.
- Good for families with strong private insurance back home.
Cost:
- Usually similar to European plans.
- Claims handling may be slower.
A viable but less common option.
Cost Patterns for Student Families in France
Costs depend heavily on:
- Age
- Benefits
- Maternity needs
- Deductibles
- Whether social security/PUMa is active
But realistic patterns help families budget.
For France stays over 3 months
Most international students follow this structure:
- French social security (free) for the student
- Mutuelle for the student (EUR 15–40/month)
- PUMa for spouse and children after residence is established
- Mutuelle for the whole family (EUR 60–150/month)
This is the most cost-effective setup.
For non-EU families needing international coverage
Common premium ranges:
- EUR 150–350+ per month for mid-tier Cigna/AXA/Allianz-type plans
- EUR 400–700+ per month for Bupa Global premium plans
Families planning maternity care in France should budget closer to the upper end.
6. Key Comparison Points: Statutory System vs. International Plans
A clear framework helps families choose the right path.
| Aspect | French Social Security + Mutuelle | International Family Plan |
| Eligibility | Student staying 3+ months; PUMa covers legal residents; dependants depend on status. | Available regardless of social security status if visa rules met. |
| Coverage | Doctor visits, hospital care, medicines, partial reimbursements, top-ups via mutuelle. | Inpatient, outpatient, medicines, evacuation, maternity, dental depending on options. |
| Geographic Scope | Primarily France, with EU coordination. | Europe-wide or worldwide options available. |
| Cost for Student | Social security free; mutuelle ~€15–40/month. | International student plans ~€30–70/month. |
| Cost for Family | Mutuelle ~€60–150/month once under PUMa/social security. | Global plans ~€150–350+/month mid-range; more for premium. |
| Visa Role | Long-stay visas accept social security or strong private cover; short stays require private plans. | Often used as initial proof of insurance before social security registration. |
7. Practical Tips for International Student Families in France
These actionable steps help you choose wisely and avoid unnecessary expenses.
Tip 1: Check Your Visa Requirements First
If your stay is under 3 months, French consulates expect solid private insurance.
For stays over 3 months, plan to register for French social security as soon as possible.
Tip 2: Use Private Insurance as a “Bridge”
The social security registration process takes time.
Private international insurance protects your family while the paperwork is processed.
Tip 3: Plan for PUMa for Spouse and Children
Once legally resident:
- Your spouse can often join PUMa.
- Minor children can be attached under you or the spouse.
- Then you can buy a family mutuelle instead of multiple private plans.
This is the most cost-efficient structure for long-term stays.
Tip 4: Pay Attention to Family-Critical Benefits
When comparing international plans, examine:
- Maternity waiting periods
- Paediatric services
- Vaccinations
- Chronic-care management
- Mental health
- Evacuation and repatriation options
These features matter far more for families than for single students.
Tip 5: Use University and Government Guidance
French universities provide excellent instructions for:
- Social security registration
- Mutuelle selection
- Visa documentation
- Insurance timelines
Their guidance is updated annually and tailored to student realities.
Building the Perfect Family Insurance Setup in France
Navigating healthcare as an international student with a family can feel complex at first.
But France offers a clear pathway once you understand the system.
The most effective setup usually looks like this:
- Register the student for French social security (free + reliable).
- Purchase a mutuelle to cover the remaining share of medical costs.
- Affiliate spouse and children under PUMa once they become residents.
- Use international insurance as initial proof of coverage or as a long-term top-up.
This hybrid structure gives families the best of both worlds:
the stability of French public healthcare and the flexibility of private international coverage.
References:
- Assurance Maladie (France). (2025). Protection Universelle Maladie (PUMa): Health coverage for residents. https://www.ameli.fr
- Assurance Maladie (France). (2025). Social security registration for international students. https://etudiant-etranger.ameli.fr
- Service Public France. (2024). Health insurance rights for foreign students. https://www.service-public.fr
- Ministère de l’Enseignement Supérieur et de la Recherche. (2024). Health insurance and social security for students in France. https://www.enseignementsup-recherche.gouv.fr
- European Commission. (2024). Coordination of social security systems in the EU. https://ec.europa.eu/social
- Allianz Care. (2024). International health insurance plans. https://www.allianzcare.com
- April International. (2024). International medical insurance for expatriates in France. https://www.april-international.com
- AXA Global Healthcare. (2024). Global health plans. https://www.axaglobalhealthcare.com
- Bupa Global. (2024). Worldwide health insurance plans. https://www.bupaglobal.com
- Cigna Global. (2024). International medical insurance plans. https://www.cignaglobal.com
- InternationalStudentInsurance.com. (2024). Student health insurance for France and Europe. https://www.internationalstudentinsurance.com
- LMDE – La Mutuelle des Étudiants. (2024). Student mutuelle and complementary health coverage. https://www.lmde.fr
- French Expat Broker Networks (e.g., AOC, Expat Insurance France). (2024). Brokered expatriate medical insurance options. https://www.expatinsurance.fr
