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The French healthcare system is known for its universal access and strong public reimbursement rates. But in three departments of Eastern France, Bas-Rhin, Haut-Rhin, and Moselle, residents benefit from a unique and more generous scheme: the Régime Local d’Alsace-Moselle.
If you are an expat living, working, or retiring in Strasbourg, Mulhouse, Metz, or anywhere in these regions, it’s important to understand how this special system works, what it covers, and whether you may qualify.
This article breaks down everything you need to know, from reimbursement rates to eligibility rules.
What Is the Alsace–Moselle Local Health Insurance System?
The Régime Local d’Assurance Maladie d’Alsace-Moselle is a compulsory local health insurance scheme that applies to certain residents of Bas-Rhin (67), Haut-Rhin (68) and Moselle (57).
Its origins date back to the period when these territories were part of the German Empire (1871–1918), benefiting from Bismarck’s early social insurance model. When France created the national Sécurité Sociale system in 1946, local pressure preserved this more generous regional coverage.
It became permanently recognised under French law in 1991.
Important note: The Régime Local is not universal. Only around 65% of insured people in Alsace-Moselle are covered. Everyone else remains under the standard national Sécurité Sociale.
What Makes the Alsace–Moselle Regime Different?
The Régime Local offers a higher reimbursement rate than the national Sécurité Sociale.
Here’s how its reimbursements compare:
More generous reimbursement rates
Under the Régime Local:
➡️ GP and specialist consultations are reimbursed at 90% (instead of 70% under the national system)
➡️ Dentists and medical auxiliaries (physiotherapists, nurses, etc.) reimbursed at 90% (instead of 60%)
➡️ Scheduled medical transport reimbursed at 100% (instead of 55%)
➡️ Hospital accommodation (frais de séjour) reimbursed at 100%
➡️ Hospital daily charge (forfait journalier), 20 € per day, covered 100%
This significantly reduces out-of-pocket costs for medical care.
A complementary system, not full coverage
The Régime Local improves basic reimbursement but does not replace the need for a mutuelle (supplementary health insurance).
You still need top-up insurance for:
➡️ Doctors charging above the regulated fee
➡️ Optical care
➡️ Dental prosthetics and orthodontics
➡️ Private hospital rooms
➡️ Specialist services not fully reimbursed
Who Is Eligible for the Régime Local?
Eligibility depends on where you work and your professional status, not solely on where you live.
Automatically included
You are covered by the Régime Local if you are:
✅ A private-sector employee working in Bas-Rhin, Haut-Rhin, or Moselle
✅ A territorial public servant working part-time in these departments
✅ An itinerant employee whose work contract specifies activity in Alsace-Moselle
✅ An unemployed worker receiving benefits and your last job was eligible
Retirees
You keep your rights in retirement if:
✅ You were under the Régime Local for 5 consecutive years before retiring, or
✅ You were affiliated for 10 out of the last 15 years of your career
This allows many long-term residents to remain covered even after stopping work.
Who Is Not Eligible?
You are not part of the Régime Local if:
❌ You live in Alsace-Moselle but work in another department
❌ You are self-employed (unless you previously accumulated qualifying salaried years)
❌ You are a student with no qualifying work history
❌ You are an expat arriving without eligible employment
❌ You gain healthcare access via PUMa, not French salaried activity
In these cases, you fall under the standard French national Sécurité Sociale.
How Are Contributions Calculated?
Unlike the national system, where employee health contributions are largely paid by employers, the Régime Local includes an employee contribution.
Contribution rate: 1.5% deducted from gross salary It is lower for retirees and exempt for certain benefits
This small contribution funds the enhanced reimbursement level.
What Does the Régime Local Cover?
The regime covers most standard healthcare expenses, including:
✅ GP and specialist consultations
✅ Dental care
✅ Physiotherapy and nursing
✅ Hospital stays and daily fees
✅ Medical transportation
✅ Prescription medications (within Sécurité Sociale limits)
Important: If a doctor charges beyond the Sécurité Sociale tariff, reimbursements remain based on the official rate. A mutuelle (top-up policy) is still recommended, especially for optical care, dental prosthetics, orthodontics, and specialist consultations.
Is a Mutuelle Still Necessary With the Alsace–Moselle Regime?
Yes.
The Régime Local is more generous than the national system, but it is not full coverage. Many residents choose a supplementary insurance plan to cover:
➡️ Excess medical fees
➡️ Glasses and optical care
➡️ Dental prosthetics and orthodontics
➡️ Alternative medicine
➡️ Private room in hospital
➡️ Specialist services not fully reimbursed
Fab French Insurance can help you choose the right mutuelle for your needs, whether you’re an expat, employee, student, or retiree in Alsace-Moselle. Explore your options here.
Can Visitor-Visa Holders Join the Régime Local?
No.
This is one of the most important clarifications for expats. Expats on long-stay visitor visas, foreign retirees, or anyone accessing healthcare through PUMa cannot join the Alsace-Moselle Régime Local.
Eligibility requires qualifying salaried employment in Alsace-Moselle, or retirement rights based on previous eligible employment in these departments
Summary for expats
✅ Must have held qualifying employment in Alsace-Moselle
✅ Or must receive a French pension tied to qualifying activity
❌ Simply living there is not enough
❌ Being a retiree from abroad does not create rights
❌ Applying for PUMa as a visitor does not grant access
Foreign retirees and visitor-visa holders in Alsace-Moselle receive the standard national Sécurité Sociale reimbursement rates, not the enhanced local rates.
Why Is This System Important for Working Expats?
If you are employed in Strasbourg, Colmar, Mulhouse, or Metz, the Régime Local can significantly reduce your healthcare expenses.
Benefits for eligible expats:
➡️ Higher reimbursement on doctor and dentist visits
➡️ Lower out-of-pocket costs
➡️ Better hospital coverage
➡️ Automatic affiliation through your employer
However, many expats, particularly freelancers, self-employed individuals, digital nomads, and remote workers, are not eligible, so understanding the rules before relocating is essential.
Key Takeaways
➡️ The Alsace–Moselle Régime Local is a unique, more generous regional health insurance system.
➡️ It offers 90% reimbursement for most outpatient care and 100% for hospital stays.
➡️ Eligibility depends on professional activity, not residence.
➡️ The employee contribution rate is 1.50%.
➡️ Retirees keep rights only if they previously qualified through employment.
➡️ Visitor-visa expats and foreign retirees do not have access.
➡️ A mutuelle remains essential for full coverage.
