What is CPAM?
The mission of the Primary Health Insurance Funds (CPAM) is to ensure close relations with the beneficiaries of the National Health Insurance Fund (CNAM).
Their mission is part of the
social security policy
.
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There is at least one CPAM in each department of metropolitan France.
The CPAM allow you to make your requests for reimbursement of care, your declarations of sick leave and all the other formalities related to your rights to health insurance.
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CPAM: what is the difference with Ameli?
Ameli is also responsible for answering social insurance questions.
More specifically, it makes life easier for policyholders by offering them a completely free online service for undertaking administrative procedures, ameli.fr.
This aims to reduce travel to save time for policyholders, especially disabled people and people with reduced mobility.
It offers several features:
communicate online with customer service
make known the state of the health expenses of the insured
create a Shared Medical Record
settle a debt
upload documents
declare a change of situation
manage the EHIC (European Health Insurance Card) and the vital card.
For its part, the CPAM is responsible for:
the payment of compensation
reimbursement of medical expenses
the management of the rights of the insured
treatment of care sheets
improving prevention policies, etc.
Why the name Ameli?
Who has an Ameli account?
Ameli is the acronym for Online Health Insurance.
All insured persons can create an Ameli account.
They can do so using their computer or smartphone by registering via the Ameli application available on the App Store and Google Play, but also from the ameli.fr website.
What is reimbursed by the CPAM?
The health insurance reimbursement rate on the basic rate is variable.
This rate is:
70% for medical acts
60% for paramedical acts, small equipment and transport costs
80% for hospitalization up to 30 days and 100% beyond.
This refund is received within approximately 3 weeks.
If your reimbursement is late or if you have not received your reimbursement, you must contact the CPAM on which you depend.
If the original of the care sheet has not reached your CPAM, you can ask your doctor for a duplicate.
Where to send your care sheets to the CPAM?
You must send your care sheets to your CPAM, either by postage paid, or by depositing it directly in one of the reception points of the CPAM agency in your department.
The
postal address
of your CPAM is available on the ameli.fr website, in the "Addresses and contacts" section.
How do I get my rights certificate?
To obtain a certificate of rights, you must apply for affiliation with your CPAM.
If you have already taken this step, you can contact your CPAM by telephone on 36 46, in order to take stock of your file.
You can then download your rights certificate from your Ameli account in the “My procedures” section.
You can also get it from the Ameli app.
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When does the CPAM pay daily allowances?
(sick leave, accident at work)
In the event of an accident at work, your care is 100% covered, regardless of the nature of your work and as soon as you are hired.
You can receive daily allowances to compensate for your loss of salary.
For this, your employer must complete form n.
S6202 "Salary
certificate - accident at work or occupational disease
", which will allow your health insurance fund to calculate and then pay you daily allowances during your work stoppage.
Your employer can produce this salary certificate online on the net-entreprises.fr website.
If you are a paid employee, regardless of the date of payment of your salary, the daily allowance is calculated on the basis of the gross salary for the month preceding your stoppage of work.
During a sick leave, daily allowances are also paid to you by the Health Insurance to compensate for your salary during the work stoppage.
They are calculated on the basis of your gross salaries and paid after your file has been processed by your CPAM, then every 14 days on average.
Appeal: how to contact the CPAM mediator?
If you have filed a complaint with your health insurance fund and it is unsuccessful, you can contact the mediator.
The referral to the mediator can be done in two different ways: from your Ameli account or by post.
On ameli.fr, you must connect to your Ameli account and ask the Health Insurance virtual assistant (chatbot) on "
contact the mediator
".
By post, you must send a letter on plain paper - using the Model letter to enter the mediator of your health insurance fund (RTF) - and you must send it to the mediator of your CPAM.
An acknowledgment of receipt will then be sent to you.
The mediator will tell you if there are other possible remedies: for example, your CPAM may suggest that you contact the mediator by email or arrange a telephone call.
How do I contact my CPAM?
A single telephone number allows you to contact your CPAM:
36 46
.
This allows you to contact any of the 100 CPAMs that exist in France.
This number will be the same regardless of where you are calling from.
On the other hand, if you are abroad, you will have to dial another number, 33 811 70 36 46.
When to call 36 46?
You can reach an advisor every day of the week, Monday to Friday.
Every day you can call from 8:30 a.m. to 5:30 p.m.
However, the calls are numerous and the wait is often long at certain peak times.
It is therefore preferable to call during off-peak hours, either early in the morning or late in the afternoon.
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What if 36 46 does not answer?
If your CPAM does not answer, you can access certain information without delay, by pressing the star key on your phone.
You can, for example, have access to the amount of your last repayments.
Is 36 46 free?
Since July 1, 2020, the 36 46 is no longer surcharged.
You will only pay the possible cost of the call applied by your operator, with no supplement from Health Insurance.