S1 Form for France: Healthcare for British Pensioners, PUMA and GHIC Explained (2026)

Healthcare is the first practical question for most British people moving to France, and there are three different things people mix up: the S1 form, French PUMA cover, and the GHIC card. They do different jobs. This guide explains who each one is for, so you can see which one applies to you before you move.

For the wider picture of the move, see our guide to moving to France from the UK. For your pension itself, see the UK State Pension in France.

What the S1 form is

The S1 is a portable document. Cleiss, the French body that explains cross-border social security, describes it as a form that lets an insured person, and their family members, living in a different country from the one responsible for them register with the health insurance body of the place where they live. It opens the right to healthcare benefits in kind.

In practice, for a British person in France, it means the UK stays responsible for paying for your state healthcare while you receive French care. The NHS says an S1 gives you state healthcare paid for by the UK, in the country where you live, on the same basis as insured residents there. Cleiss says the S1 lets you be looked after on the same terms as someone insured in the French social security system.

Two limits are worth knowing from the start. The S1 covers state healthcare, so private care is a separate matter. And only care received in France is covered by the CPAM under the S1 route described by Cleiss.

Who can get an S1 from the UK

The NHS page on planning your healthcare abroad says the S1 is for people who live in the EU, Iceland, Liechtenstein, Norway or Switzerland, are lawfully present as a resident there, and meet one of these conditions:

• They receive an eligible exportable benefit from the Department for Work and Pensions, including the UK State Pension.
• They are a posted or frontier worker recognised by HMRC.
• They receive the unemployability supplement element of a UK war pension.

Other exportable benefits that qualify, according to the same page, include contribution-based Employment and Support Allowance, Maternity Allowance, and Widow’s Benefit or Widowed Parent’s Allowance. People who already had an S1 before 1 January 2021 on the basis of DLA, PIP, Carer’s Allowance or Attendance Allowance keep it while they receive that benefit.

When you will not get one

The NHS says you are not eligible if you receive a state pension from the country where you live as well as the UK State Pension: the country of residence is then responsible for your healthcare. If you have lived and paid contributions in several countries, the one with the longest contribution period is responsible.

Cleiss gives the French side of the same rule. If you receive a pension from one state only and live in another, the state paying the pension is responsible for health insurance. If you also receive a French pension and live in France, the French system becomes directly responsible.

Cleiss also notes that the arrangement applies only if you hold a pension from a basic statutory scheme.

How to apply from the UK

The S1 is requested from the UK, not from France. Cleiss says you ask the British body that pays your pension. For a UK State Pension, the NHS page says you contact NHS Business Services Authority (NHSBSA) Overseas Healthcare Services, by telephone on +44 (0)191 218 1999 or by email at s1applications@nhsbsa.nhs.uk. The office is open Monday to Friday, 8am to 6pm.

The same page sets out the timing and conditions:

• You can apply up to 90 days before your intended move date, and the S1 starts when you move.
• If you are not yet receiving the pension or benefit, you should wait until you are.
• You need an address in the country you are moving to. It can be a temporary one.
• You must tell NHSBSA about any change of address or circumstances. The NHS warns that otherwise the UK could overpay and your S1 could be cancelled.

If you are a posted or frontier worker, the application goes through HMRC rather than NHSBSA. For a UK war pension, it goes to the Veterans UK overseas account team.

Family members

On the UK side, the NHS says you can add dependants to your S1 application. A dependant who qualifies for an S1 in their own right must apply separately. The NHS also notes that definitions of dependants vary by country.

On the French side, Cleiss says each accompanying family member needs their own S1, issued individually. It also says that family members’ rights are determined by the law of the country of residence, so French rules decide who counts.

Registering with the CPAM

Once you have the S1, register it promptly. The NHS says to register it with the authority in your country of residence, often before you can get a healthcare card. Cleiss says the form must be handed over as soon as possible to the institution at your place of residence.

In France, that institution is the CPAM (caisse primaire d’assurance maladie) for your home address. Cleiss lists what you must supply: a birth certificate showing parentage and a passport or national identity card. Ask your CPAM whether it wants anything else.

On cost, Cleiss says the S1 lets you register without paying new French contributions, since your pension is already subject to deduction in the country that pays it where its law provides for that.

The NHS is explicit that you are responsible for having healthcare cover while registration is pending. Our guides to registering with the CPAM and health insurance for families and couples in France walk through the French side in more detail, although they were written for a US audience.

How long an S1 lasts

Cleiss states that the S1 for a British person in France is valid for the whole period of residence in France. On the UK side, the NHS lists what ends entitlement: starting to receive a state pension from the country where you live, starting to receive sickness benefits from employment in an EU country, or choosing to return to the UK.

The Cleiss Brexit FAQ adds that, for Britons in France, the position rests on the Withdrawal Agreement and on rights acquired before 31 December 2020. For how that agreement affects your right to live in France, see Withdrawal Agreement residence rights in France.

If you have no S1: PUMA

Many British people moving to France will not qualify for an S1, for example because they are working in France or do not draw a UK State Pension. Their route is French universal health cover, PUMA (protection universelle maladie).

Service-public sets out the conditions. You must work or live in France in a stable and regular way, and both conditions apply together:

• Regular: nationals of the European Economic Area and Switzerland can show it with an identity card or passport. Other nationals need a residence permit or document. The UK is not in the EEA (the Eurostat list of the 30 EEA members does not include it), so a British national should expect the second case; check the details with the CPAM.
• Stable, if you work: affiliation is immediate once the application is accepted.
• Stable, if you do not work: you must wait 3 months after arrival.

Service-public lists some people for whom the 3-month wait does not apply, such as refugees and recipients of the adult disability allowance (AAH) or the supplementary disability allowance (ASI). Rights stay open if you live in France for at least 6 months of the year.

To apply, you fill in the form “Demander l’ouverture des droits à l’Assurance maladie”. Service-public notes that deliberately refusing to affiliate, or persistently not starting the process, is punishable by 6 months in prison and a fine of 15,000 euros, or one of those penalties.

It also says that, from the 2026 social security financing law, a financial contribution is planned for certain beneficiaries without activity who owe no CSG, CRDS or health insurance contribution under an international agreement. The amount is to be set by a decree that had not been published when the page was read. Whether that touches you is a question for the CPAM.

Two cautions. First, S1 and PUMA are different routes: which one applies depends on your situation, and the CPAM decides. Second, the CLEISS page on the S1 (read on 17 October 2026) mentions no waiting period: it says the certificate must be handed to the institution of your place of residence as soon as possible. The 3-month wait that service-public describes for the Puma applies to people without a professional activity who claim it, and no page I read says whether it applies to an S1 holder, so ask your CPAM in writing if you need certainty. Our guide to private health insurance before CPAM cover starts explains the gap in more detail.

What the GHIC covers and what it does not

The GHIC is a UK-issued card for trips. The NHS says it gives access to state-funded necessary medical treatment during a temporary visit to other eligible countries, and describes temporary visits as usually up to 90 days. The covered care includes emergency treatment, treatment for long-term or pre-existing conditions, and routine maternity care unless you travel abroad to give birth. Some treatments, such as kidney dialysis or chemotherapy, should be pre-arranged.

It does not cover repatriation, private facilities, or ski and mountain rescue, and it does not cover costs a local resident would have to pay. The NHS states plainly that it is not a replacement for travel insurance.

Eligibility is built around living in the UK: you must be ordinarily and legally resident there and have no healthcare cover from an EEA country or Switzerland. The NHS points to narrow exceptions for people living in the EEA or Switzerland, including those with a registered S1. It also says S1 holders are entitled to a GHIC or EHIC for temporary visits to other eligible countries, and, from 1 January 2024, to NHS treatment in England on the same basis as UK residents.

The NHS also stresses that the NHS is a residence-based system: permanent movers are no longer automatically entitled to NHS treatment, and you should tell your GP practice before you leave.

Related guides for British readers

• Our guide to UK qualifications and school enrolment in France covers the French statement of comparability for a UK degree, regulated professions after Brexit and enrolling a child in a French school.

FAQ

Can I use my GHIC instead of an S1 when I move to France?

No. The GHIC is designed for temporary visits, and its eligibility rests on you living in the UK. Once you live in France you need the S1 or French cover.

Do I ask the CPAM for the S1?

No. Cleiss says to ask the institution that pays your pension, which for a UK State Pension means NHSBSA Overseas Healthcare Services. The CPAM is where you register it.

Can I apply for the S1 before I have an address in France?

The NHS says you need an address in the country you are moving to, though it can be temporary. You can apply up to 90 days before you move.

Can my spouse be covered by my S1?

You can add dependants to your application, and the NHS says a dependant who qualifies in their own right applies separately. Cleiss says each family member needs an individual S1, and that French law decides who counts as a family member. Check with the CPAM.

What if I get a French pension as well as my UK State Pension?

Cleiss says that if you receive a French pension and live in France, the French system becomes directly responsible for your health insurance. The NHS likewise says you cannot get an S1 if you receive a state pension from the country you live in.

Do I need to tell anyone if my situation changes?

Yes. The NHS says you must tell NHSBSA about changes of address or circumstances, or the UK could overpay and your S1 could be cancelled.