Margaret and David sold their semi in Sheffield, bought a stone house outside Sarlat, and did everything the checklists told them to do: visas, removal van, rescue dog, French bank account. Then Margaret’s state pension started, a brown envelope arrived from the NHS with a form called an S1, and the local caisse primaire d’assurance maladie (the local health insurance fund, universally known as the CPAM) asked for papers nobody had mentioned at the airport. Meanwhile their neighbours, a couple in their late fifties living on savings and rental income from a flat kept in Manchester, received something quite different: a demand from URSSAF, the body that collects French social contributions, for several thousand euros of cotisation subsidiaire maladie (the subsidiary health contribution, often called the CSM levy or PUMA levy). Same village, same nationality, two completely different routes into the same health system. Since Brexit turned British citizens into third-country nationals, this confusion has become one of the most common and most expensive misunderstandings between British residents and French social law. This guide explains, for a British reader, which route is yours: who can claim an S1 healthcare certificate paid for by the United Kingdom, how to register it with the CPAM step by step, where the GHIC and EHIC cards fit for travel, who falls back on French PUMA cover instead, and how to challenge a CPAM refusal or a CSM bill with the exact texts and court decisions your adviser can verify online. French terms are explained at first use. The law is stated as in force on 8 October 2026.

I. How Do British Residents Get French Healthcare After Brexit: Through an S1 or Through PUMA?

A. How to Get an S1 and Register It With the CPAM, and Where the GHIC Fits

An S1, sometimes still called an E106 or E121 after the names of its older paper forms, is a healthcare certificate. It says that one state pays while another state provides the treatment. For a British pensioner living in the Dordogne, it says that the United Kingdom pays while France provides treatment on the same terms as for a French insured person, with the French system later reclaiming the cost from the British system. The certificate covers the holder and, in most cases, dependent family members living with the holder in France, each on their own copy of the form. Understanding this paying-versus-providing split answers half the questions British residents ask: you register once, you are treated as if you were insured in France, and the bill travels between administrations behind the scenes.

Three groups of British residents in France are concerned in practice. The first and largest is people who draw a British state pension or certain exportable British benefits and live in France. The British official guidance on healthcare for British nationals living in France states that residents in France who receive a British state pension or an exportable benefit may be entitled to state healthcare paid for by the United Kingdom, with further detail under planning healthcare abroad on the NHS website. The same guidance adds that frontier workers, meaning people who work in one state and live in another, may also be entitled to an S1, and that they must contact HM Revenue and Customs national insurance enquiries to check eligibility. The second group is therefore cross-border workers between Britain and France. The third is posted workers, meaning employees sent temporarily by a British employer to France, whose cover works through a GHIC, an EHIC or an S1 under separate posted-worker rules. If you recognise yourself in one of these descriptions, your first reflex should be to claim the S1 rather than applying for French residence-based cover, because the S1 route is generally simpler, cheaper and better documented than anything else available.

Getting the form is a British administrative step before it becomes a French one. The same official guidance explains that people with a British state pension or another qualifying exportable benefit must apply to NHS Overseas Healthcare Services for the form, answering questions about the pension and the French address, after which the service posts the S1 to the French address. Frontier workers go through HM Revenue and Customs instead. Once the document arrives, the French stage begins, and the official British line is equally direct: the S1 must be registered at the local CPAM office, and there is no shortcut around this registration. An unregistered S1 sitting in a drawer gives you no French rights, no attestation de droits (the paper or online statement proving your cover) and no carte Vitale (the green chip card used at doctors’ surgeries and pharmacies).

Registration itself follows the method the French health insurance describes on its English-language pages. The Ameli English-language guidance for people whose main home is in France but who work, hold rights or draw a pension from a European country asks for the S1 in duplicate — the E106 version for workers and rights holders, the E121 version for pensioners, one copy set per family member. In both cases you attach the printed application for health insurance rights, form S1106, obtainable from the CPAM, together with identity documents, birth certificates for family members and proof of address. The same pages explain that these documents allow affiliation and cover of medical costs under reciprocity rules for the period stated on the S1. Read that last phrase carefully. Your French cover under an S1 lasts as long as the certificate says. If the S1 ends because your British benefit ends or your situation changes, your French cover ends with it unless you have secured another basis in the meantime. Keep a copy of everything you hand over, note the date of filing, and ask for a receipt or a certificate of filing, known as a récépissé, at the counter or keep proof of postage if you file by post.

The legal machinery behind this everyday procedure sits in European coordination law, which the Brexit Withdrawal Agreement kept applicable to people already in cross-border situations and which continues to organise new ones through its protocol on social security coordination. Within the European Union the reference is Regulation 883/2004 of 29 April 2004 on the coordination of social security systems, together with its implementing Regulation 987/2009 of 16 September 2009, which you can read on EUR-Lex, the official portal for European Union law. Their logic is that an insured person resides in one state while another state foots the bill for healthcare: pensioners are covered by Articles 24 and 25 of the basic regulation, family members by Article 17, and stays outside the state of residence by Article 19. France translated that logic into its own statute at Article L. 160-6 of the Social Security Code, the code de la sécurité sociale, available at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000031669594, which carves S1-type pensioners out of ordinary French cover in these terms: “Les personnes titulaires d’une pension étrangère qui ne bénéficient pas par ailleurs d’un avantage viager d’un régime obligatoire de sécurité sociale français lorsque, en application d’un règlement européen ou d’un accord international, la prise en charge de leurs frais de santé ainsi que de ceux des membres de leur famille qui résident avec elles relève du régime étranger qui sert la pension”. In ordinary English: a foreign pensioner whose healthcare is picked up by the foreign scheme under a European regulation or an international agreement does not enter the French residence-based system. That single sentence explains why a British state pensioner with a registered S1 neither needs PUMA cover nor owes the CSM levy, as long as the S1 is valid and no French pension opens parallel French rights.

A second principle, just as practical, is that only one state’s legislation applies at a time. The Court of Cassation, the Cour de cassation, France’s highest civil court, recalled it on 30 November 2023 in decision number 21-18.251, published at https://www.courdecassation.fr/decision/656844b9ddd7eb8318e53651, holding that “la personne qui exerce normalement une activité salariée et une activité non salariée dans différents États membres est soumise à la législation de l’État membre dans lequel elle exerce une activité salariée”. The facts concerned France and Portugal rather than Britain, but the rule travels: where two states could claim you, coordination designates exactly one. For British readers the lesson is concrete. If you work part of the week in London and live in France, or you run a small French business while keeping British employment, do not let two systems bill you in parallel. Ask the designated institution of your state of residence to determine the applicable legislation, keep the portable document A1 that proves which state covers you, and show it to the CPAM and to URSSAF before either fund builds a file on the wrong assumption.

Travel cover sits alongside the S1 and causes constant mix-ups, so keep three cards and three uses strictly apart. The S1 covers your everyday healthcare in France, your state of residence. The GHIC, the British Global Health Insurance Card, and its predecessor the EHIC, the European Health Insurance Card, cover medically necessary treatment during temporary stays in other countries, such as holidays in Spain or visits to family in Britain. They do not replace registration in France and cannot be shown to a French doctor as proof that you live there lawfully and are covered there. The British guidance lists the three side by side: registering a British-issued S1 with the local CPAM, and separately using a British-issued GHIC or EHIC for temporary stays, including study periods and postings. Once your S1 is registered, you may in addition be entitled to a French EHIC for travel, including visits to Britain, issued by your CPAM. A useful detail for families: the same guidance warns that a dependant’s S1 cover ends when the dependant starts drawing their own British state pension, at which point the dependent must claim and register a personal S1 sent to their registered address by NHS Overseas Healthcare Services. Parents who turn sixty-six while covered as dependants should therefore diary the change months ahead rather than discovering the gap at a pharmacy counter. Where registration drags on and urgent treatment cannot wait, the British guidance gives a practical instruction: contact Overseas Healthcare Services and explain that you need emergency or urgent treatment while registration is delayed. Keep that contact, your S1 copies, your GHIC and every CPAM receipt in one folder, originals and scans, because every later challenge turns on dated paper.

B. No S1? How PUMA Cover, Lawful Residence and the CSM Levy Work

British residents who cannot claim an S1 enter French healthcare through the residence route, whose name you will see everywhere: PUMA, the protection universelle maladie (universal health protection). The French administration presents it as cover for health costs without breaks in rights, even when work or family circumstances change (see the official service-public.fr page on the protection universelle maladie). The statute behind that promise is Article L. 160-1 of the Social Security Code, available at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000044404322, which provides: “Toute personne travaillant ou, lorsqu’elle n’exerce pas d’activité professionnelle, résidant en France de manière stable et régulière bénéficie, en cas de maladie ou de maternité, de la prise en charge de ses frais de santé dans les conditions fixées au présent livre.” Anyone working in France, or living there on a stable and regular basis without working, is covered for illness and maternity. Two adjectives carry the whole system: stable, meaning your home or main place of stay really is in France, and regular, meaning your presence complies with residence law. Miss either one and the CPAM can lawfully refuse you.

Stability is measured with unusual precision. Article R. 111-2 of the same code, at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000049451865, treats as stable the residence of people whose household or main place of stay is in metropolitan France or certain overseas collectivities, with the household understood as the place where people normally live on a permanent basis, and deems the main stay to be in France for those who spend more than six months there during the calendar year for the benefits discussed here. The closing sentence of that article deserves to be quoted because it governs every dispute about evidence: “La résidence en France peut être prouvée par tout moyen.” Residence may be proved by any means. Leases, utility bills, tax notices, school certificates, bank statements showing daily life in France, travel records showing limited absences: everything counts, and no single document is indispensable. Regularity, the second condition, points to the residence rules now applicable to British citizens since Brexit. Visitors on short Schengen stays, people whose visa has expired and people working without authorisation are not regular residents. Holders of a Withdrawal Agreement card, the WARP card, holders of a long-stay visa followed by the matching carte de séjour (residence permit), and family members admitted on that basis are. Readers unsure which permit matches their situation should read our companion guide on which long-stay visa and which carte de séjour British newcomers need after Brexit, and how to challenge a refusal before filing at the CPAM, because a weak residence file poisons the health file built on top of it.

The entry procedure on the residence route is a declaration, not a negotiation. Article L. 160-5 of the Social Security Code, at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000033714770, states that a person who declares to a CPAM that they lack health-cost cover is covered by that fund as soon as identity plus stable and regular residence are proven: “bénéficie de cette prise en charge auprès de cette caisse dès qu’elle justifie de son identité et de sa résidence stable et régulière”. You declare to the CPAM that you lack cover, you prove identity plus stable and regular residence, and cover follows. In practice the CPAM asks for form S1106, a passport, a birth certificate with an official translation where needed, proof of lawful stay such as the residence permit or the visa with the entry stamp, and proof of address, plus, for family members, marriage or birth certificates proving the link. The English-language Ameli pages add a timing detail that surprises many British early retirees: PUMA cover can be applied for after three months of residence in France. Applications before three months of presence will normally be set aside, and the same pages warn that applicants who are refused must find and pay for private insurance to fill the gap meanwhile. British newcomers who arrive with a long-stay visitor visa already know the twin of this rule, because that visa requires a full year of private health insurance precisely so that newcomers do not land on PUMA on day one. Keep that private policy until the CPAM notifies affiliation in writing, and never cancel it on the strength of a counter clerk’s oral reassurance.

The price of PUMA for people living on capital rather than wages is the CSM levy, and this is where British early retirees need numbers explained rather than feared. Article L. 380-2 of the Social Security Code, at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000037947779, opens with the charging principle: “Les personnes mentionnées à l’article L. 160-1 sont redevables d’une cotisation annuelle lorsqu’elles remplissent les conditions suivantes”. Two cumulative conditions follow: professional income in France below a threshold fixed by decree, for the person and where relevant their spouse or civil partner, and no retirement pension, disability pension, annuity or unemployment benefit received during the year, again for both partners where relevant. Where both conditions are met, the levy is charged on capital income as defined by reference to Article 1417 of the General Tax Code, the code général des impôts, meaning rental income, investment income, gains on disposals, non-professional business profits and similar resources, after a statutory abatement and within a ceiling, both fixed by decree, with the rate itself also fixed by decree. The moving parts, thresholds, abatement, ceiling and rate, change by regulation, so treat any figure quoted on a forum as suspect until checked against the decree in force for the year charged. The structural points do not change: people with French wages above the threshold pay health contributions on those wages instead and escape the levy; people drawing any pension, British or French, escape it because the second condition fails; and, crucially, holders of an S1 escape it because Article L. 160-6 keeps them outside Article L. 160-1 altogether, as shown above. A British state pensioner with a registered S1 who receives a CSM demand is therefore looking at a classification error, not a bill to pay quietly. A fifty-eight-year-old living on savings and Manchester rents with no pension and no French wages is, by contrast, squarely inside the charge, and the right question is whether the base and the maths are correct rather than whether the levy exists. Our companion analysis of the early retiree’s PUMA bill, private insurance and how to check and challenge the CSM demand works through those calculations and the evidence to gather, and readers who recognise themselves in that profile should keep both guides open side by side.

Two finishing details complete the picture before any dispute arises. First, keep in mind that the statute organises continuity when situations change. Article L. 161-8 of the Social Security Code, at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000044628954, maintains cash benefit rights for a period fixed by decree for people who stop meeting the activity conditions while still meeting residence conditions. The health-cost side is separately cushioned by a one-year extension mechanism mentioned inside Article L. 160-1 itself. Gaps between jobs, between arrival and affiliation, or between an S1 ending and PUMA starting are therefore not always bare, but each extension has its own conditions and none is automatic, so ask the CPAM in writing which bridge applies to you and keep the written answer. Second, low-income households may qualify for complementary protection, the complémentaire santé solidaire, organised by Article L. 861-1 of the Social Security Code at https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000037950247, which grants top-up cover without charge or at reduced cost below resource ceilings that are revised each April. British residents on small pensions who find the 30 per cent hospital co-payment, the ticket modérateur (the share of each medical bill left to the patient), hard to meet should test eligibility rather than going without treatment. With these foundations laid, the next part turns to what can go wrong and how to put it right.

II. What to Do When the CPAM Says No or URSSAF Sends a CSM Bill

A. How to Challenge a CPAM Refusal Step by Step

Refusals follow patterns, and recognising yours dictates the remedy. The most frequent is the incomplete-file refusal: the CPAM writes that residence is unproven or that lawful stay is unproven, when the real problem is a missing translation, an expired proof of address, or a residence permit still being processed at the prefecture. The second is the wrong-route refusal: an S1 holder is examined as a PUMA applicant and rejected for lacking three months of presence or sufficient resources, or a PUMA applicant is treated as an S1 case and told to produce a form that Britain will never issue to them. The third is the status refusal: the fund argues that the applicant entered France to look for work, or to obtain treatment, and falls under one of the exclusions of Article L. 160-6, when the applicant actually joined a partner, retired, or already works part-time in France. Before writing any appeal, identify which of the three you received by reading the reason given, because each one is answered with different paper.

The answer file has the same skeleton in all three cases. Identity first: passport, and for each family member a birth or marriage certificate with a sworn translation, known as a traduction assermentée, where the civil status document is not in French. Residence second: lease or title deeds, electricity or telephone bills in your name, French tax notices, bank statements showing everyday spending in France, school or nursery certificates for children, and travel records proving that absences stayed short. Lawful stay third: the WARP card or the long-stay visa with its validation, the current carte de séjour or its renewal receipt, the récépissé de demande de titre de séjour, and for European family-reunification cases the documents proving the link. Cover history fourth: the S1 in duplicate with proof of registration request where you hold one, or the private insurance policy and its termination or continuation letter where you do not. Organise originals and copies in that order, number the pages, and keep an identical set at home, because the appeal body will work only from what it can see.

Procedure then runs through three levels, and the order matters. Start by asking the CPAM counter or office in writing what is missing and by completing the file within the time it sets, keeping proof of every further submission. A surprising number of refusals die at this stage once the missing translation or the overlooked entry stamp arrives. If the written refusal is maintained, file an amicable appeal to the fund’s internal appeal board, the commission de recours amiable, generally called the CRA. Send it by registered letter with acknowledgment of receipt, enclose the numbered file, quote the articles relied on, and expressly ask for withdrawal of the refusal and for affiliation with effect from the date the complete file was first lodged. If the CRA rejects the appeal or stays silent beyond its time limit, the dispute moves to court: the social division of the judicial court, the pôle social du tribunal judiciaire, which hears challenges to CPAM affiliation decisions. Proceedings there are largely written and evidence-driven, representation by counsel is not compulsory but is plainly useful where the fund raises exclusion arguments, and the court decides on the papers plus any hearing it orders.

Courts approach these files with a healthy attention to real life rather than to administrative shortcuts, and two decisions show what that means for British readers. On 13 March 2026 the social division of the judicial court of Boulogne-sur-Mer, in case number 25/00157, published at https://www.courdecassation.fr/decision/69b9104dcdc6046d47f26c0d, dealt with a CPAM refusal of affiliation on residence grounds. The fund argued that the applicant, a Romanian citizen present in France for over three months, was in an irregular situation and excluded from cover. The court examined the actual situation, found that she had joined her partner rather than entered to seek work, accepted the lease and shared daily life as proof of stability, and held: “DIT que Mme [H] [F] remplit les conditions d’affiliation au régime général de la sécurité sociale sur critère de résidence”. It then ordered the remedy British readers should know by name: “ORDONNE à la caisse primaire d’assurance maladie de la Côte d’Opale de procéder à l’affiliation de Mme [H] [F] au régime général de la sécurité sociale sur critère de résidence”. Three lessons travel directly to British files. First, the fund cannot invent irregularity where lawful family presence is documented. Second, late registration with the employment service does not retrospectively turn a family arrival into a job-seeking stay. Third, judges order affiliation; they do not merely annul refusals and send applicants back to the queue. Plead for that order expressly, with the effective date, in every CRA letter and every court application.

The second decision governs overlapping-work cases, which concern British frontier workers and dual-activity households. In its judgment of 30 November 2023, number 21-18.251, cited above, the Court of Cassation dealt with a contributor affiliated in France who invoked salaried work in Portugal and produced a Portuguese fund certificate. The court recalled the dialogue procedure of Article 16 of Regulation 987/2009, in the decision published at https://www.courdecassation.fr/decision/656844b9ddd7eb8318e53651, and held that a court faced with a genuine conflict over the applicable legislation must invite the designated institution to operate that procedure and wait: “il lui appartenait d’inviter la caisse à mettre en oeuvre la procédure prévue par l’article 16 du règlement n° 987/2009 et, dans cette attente, de surseoir à statuer”. Where a British reader works on both sides of the Channel and two funds each claim exclusive competence, the authority to quote is therefore this one: the judge should organise the administrative dialogue between institutions and stay proceedings meanwhile, not pick a winner on incomplete files. Attach the A1 certificate, the employment contracts, payslips from each state and the correspondence between funds, and ask the court in terms for that dialogue and that stay.

While the challenge runs, treatment cannot always wait, so manage the interim with the same discipline as the file. Keep the GHIC for genuine temporary needs within its proper scope, keep the private policy alive until written affiliation arrives, ask the CPAM for provisional proof of filing for urgent appointments, and for hospital care ask the admissions office in advance which documents it will accept from a person whose affiliation is under appeal. Pharmacies and specialists’ practices in France routinely ask for the carte Vitale or its attestation; showing up with an unregistered S1 and an oral promise of imminent cover helps nobody. A dated folder with the S1, the S1106 receipt, the CRA letter with its postal acknowledgment and the court application turns every one of those conversations from an argument into a presentation. Note every telephone call with the date, the name of the person spoken to and what was said, and confirm important statements by letter or through the online account, because memories of counter conversations carry no weight before the CRA or the court.

B. How to Check and Challenge a CSM Demand, Including in Paris and Île-de-France

CSM demands arrive from URSSAF, not from the CPAM, and they obey a different logic: the CPAM decides whether you are covered, while URSSAF decides whether you owe money for that cover. Read the demand as an auditor before reacting as a debtor. Check the year charged, because the levy is annual and each year stands alone. Check the personal scope: are you named correctly, is your spouse or civil partner’s situation correctly stated, and does the notice claim pension income you never received or ignore French wages that take you out of the charge. Check the base: which rental, investment and gains figures were used, whether losses and exempt amounts were handled, whether the statutory abatement was applied and whether the ceiling was respected. Check the supporting documents cited: the demand should rest on your tax return and on identified sources, and anything you cannot reconcile is something to question in writing. Then sort your situation into one of three columns: not liable at all, liable but overcharged, or liable and correctly charged. Only the third column ends with payment; the first two end with a challenge, and confusing them is how good money follows bad.

Not liable at all covers four recurring British profiles. The pensioner with a valid registered S1, excluded from Article L. 160-1 by Article L. 160-6, owes nothing for the years the S1 covers, even with substantial capital income. The person with French professional income above the decree threshold for the year owes contributions on those earnings instead and falls outside the levy. The person who drew a pension, annuity or unemployment benefit during the year fails the second condition of Article L. 380-2 and falls outside as well. And the person who was not stably and regularly resident in France for the year, such as a second-home owner still within the 90/180-day Schengen rhythm, is outside PUMA entirely and owes nothing under this head, whatever else they may owe as a property owner. Each of these exits must be proved with the matching paper: the S1 with its registration attestation, the payslips and contribution notices, the pension statements, or the passport stamps and travel records showing residence elsewhere. A bare assertion that you are a pensioner, or that you work, without the statement or the payslip, will not move an URSSAF file.

Liable but overcharged is the larger battlefield and the one where methodical taxpayers win most often. The levy base draws on figures defined by reference to Article 1417 of the General Tax Code, and every classification error upstream in the tax return flows downstream into the demand. Rental deficits wrongly added back, gains computed without the correct acquisition costs, income belonging to a different year, income of a spouse wrongly attributed, double counting of amounts already subject to professional contributions: each of these has been seen in practice, and each is corrected with the tax notice, the notarial statement, the agency accounts or the bank records that prove the right figure. The abatement and the ceiling, both fixed by decree, are the next checkpoints, because applying last year’s parameters to this year’s demand is a classic administrative slip. Work through the demand line by line against the decree parameters for that exact year, recompute independently, and put the alternative computation in a table the reviewer can verify without redoing your work. Where the figures depend on a tax assessment under appeal, say so expressly and ask for the levy file to follow the tax outcome rather than crystallising a contested base.

The challenge route mirrors the CPAM path with URSSAF as the counterpart. Write first to the URSSAF office that issued the demand, by registered letter with acknowledgment of receipt, identifying the notice, stating the column you fall in, enclosing the numbered evidence and asking for withdrawal or rectification with a corrected computation. If that letter fails, file the amicable appeal to the URSSAF appeal board within its time limit, repeating the request with the full file and expressly seeking a stay of recovery while the appeal is examined. Recovery while under challenge is the point most readers fear, so ask for it in terms: suspension of enforced collection until the board and, if needed, the court have ruled. If the board rejects the appeal, the case goes to the same social division of the judicial court, which controls both the principle and the maths of the levy. Frame court applications the way the successful affiliation cases are framed: the exact order sought, the effective date, the corrected figures, and the documents proving each element. The Boulogne and Cassation decisions discussed above show courts willing to order funds to do what the law requires and to police the coordination procedure; a CSM file argued with the same rigour, S1 exclusion plus decree parameters plus reconciled base, speaks the language those courts understand.

Paris and Île-de-France add practical weight without changing the law. The CPAM of Paris handles an enormous volume of foreign-insured files, S1 registrations there routinely take longer than in a rural department, and counter appointments are harder to obtain, so Paris-based British residents should file earlier, favour tracked postal or online filing with saved receipts over walk-in counters, and allow extra weeks before planning treatment that requires the attestation. Rental-heavy British households are also over-represented in the capital region, which means CSM files with larger bases and more lines to check; a Paris flat let while the owner lives nearby on investment income concentrates every classification risk described above in a single notice. Jurisdiction follows the standard social-security rules, with the Paris judicial court hearing the capital’s disputes, and its docket rewards the same qualities as everywhere else: numbered exhibits, a clear computation table, and requests framed as orders with dates. One genuinely local tip: keep the contact details of the international-relations correspondent inside your CPAM office, where one exists, because S1 files that stall at a general counter often move once seen by the officer who handles European coordination daily. None of this alters the substance, but in a region where delays are measured in months, procedure done once and done properly is worth more than procedure done twice in a hurry.

Conclusion

British healthcare in France after Brexit is a sorting exercise before it is a paperwork exercise. Pensioners and other S1 holders belong to the British-paid route: claim the certificate from NHS Overseas Healthcare Services, register the duplicate at the local CPAM with form S1106, travel with the GHIC within its proper scope, and diary every change of benefit that could end the cover. Everyone else belongs to the residence route: prove stable and regular presence by any means the law allows, file after three months with private cover bridging the wait, and accept that living on capital without wages or pension brings the CSM levy with the cover. When the system misfires, the response is the same on both routes: read the reason given, build the numbered file that answers it, seek the CRA review, and ask the social division of the judicial court for the precise order desired, affiliation from a given date or withdrawal and recomputation of a levy. The two court decisions in this guide show judges doing exactly that where the paper supports it. Keep originals and scans of every S1, every attestation, every demand and every postal receipt in one folder, and the folder will argue for you long before any hearing does.