Before you start

A residence permit or validated visa
Proof of stable residence in France
An employment contract or proof of activity, for the fastest route
A French RIB, for reimbursements

Step-by-step

1
Start the social security registration in your first week
If you are employed, your employer initiates it, but the process is slow and you should track it rather than assume it is moving. The number is what everything else hangs off. Expect months rather than weeks and do not read the delay as a sign something has gone wrong.
Via employerWho: You and your employerWeek 1
2
Start looking for a médecin traitant immediately, and expect it to be hard
Naming a family doctor with the fund raises your reimbursement rate permanently and is the gateway to specialists. Normandy has some of the weakest general-practice coverage in mainland France and practices close their lists routinely. Ask colleagues and neighbours, ask at the pharmacy, and if you genuinely cannot find one the CPAM has a médiation médicale traitant service that can help — most people never learn it exists.
In personWho: YouWeek 1
3
Keep every feuille de soins until the card actually works
Until the carte Vitale arrives you pay in full and the practitioner gives you a paper claim form. Keep all of them — once your file is active they are reimbursed retroactively, and people routinely lose several hundred euros by discarding paperwork that appeared to be going nowhere.
In personWho: You
4
Take the employer mutuelle unless you have a specific reason not to
The state reimburses most but not all of a consultation and covers dental and optical care poorly. Employers are generally required to offer a complementary scheme and to fund at least half of it. Almost everyone in France carries one.
Via employerWho: You
5
Create an Ameli account as soon as you have a number
The online account is where reimbursements, your card status and the attestation de droits live. That attestation is another document you will be asked for repeatedly, by employers, schools and insurers.
OnlineWho: You
6
Learn the three out-of-hours numbers before you need them
15 is for genuine emergencies. 116 117 is the out-of-hours GP access line for everything that is not one — and in a département where finding a GP at all is hard, it is a more important number here than most places. Pharmacies run a duty rota with the on-call pharmacy posted in the window and online.
OnlineWho: You

Documents you’ll need

Residence permit or validated visa
Birth certificate with a sworn translation, frequently required
Employment contract or proof of activity
Justificatif de domicile
RIB for reimbursements

Things most newcomers don’t know

Finding a médecin traitant here is a project, not a formality — and there is an official fallback.

Parts of Normandy have among the lowest general-practitioner densities in mainland France, and practice lists close. Because the reimbursement rate outside the coordinated care pathway is materially lower, having no family doctor costs you on every consultation indefinitely. What almost nobody knows is that if you have genuinely been unable to find one, the CPAM operates a mediation service to help place patients. Ask for it by name rather than assuming the search is simply yours to lose.

Source: l'Assurance Maladie

The university hospital is strong; that is a separate system from primary care.

The CHU de Rouen is a large teaching hospital with real depth, so specialist and hospital care here is good. It does not solve the thing newcomers need first, which is a GP willing to take a new patient — two different systems under two different pressures. Assuming the first fixes the second is how people end up a year in with no médecin traitant and a permanently reduced reimbursement rate.

Source: l'Assurance Maladie

Keep every paper claim form from your first months — they are literally money.

Before the carte Vitale arrives you pay in full and receive a feuille de soins to submit on paper. Once your file is active those claims are reimbursed retroactively, sometimes many months later. New arrivals discard them because nothing appears to be happening, and then cannot reconstruct several hundred euros of legitimate reimbursement they were entitled to.

Source: l'Assurance Maladie

A translated birth certificate is the single most common reason a registration file sits still.

French social security registration frequently requires a full birth certificate, sometimes recently issued, translated by a court-approved sworn translator. Obtaining one from another country takes weeks, and the requirement rarely surfaces until the file is already open and waiting. Start it before you leave rather than when the caisse asks for it.

Source: l'Assurance Maladie

Common mistakes to avoid

Leaving the search for a médecin traitant until you are ill, in a region with a genuine GP shortage.
Not knowing the CPAM's mediation service exists when every list is closed.
Discarding paper claim forms before your social security file is active.
Arriving without a translated birth certificate and stalling registration for weeks.
Declining the employer mutuelle without understanding what the state does not cover.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.