Medical Practitioners and Assistants (PAM): Activity Statement and Social Plan

A "MAP" is a self-employed person engaged in a health occupation under the Social Plan of Licenced Medical Practitioners (PAMC). He contributes to the Urssaf.

It also reports to one of the following old-age funds for the calculation and recovery of old-age contributions: CARPIMK, CARMF, CARCDSF

The following occupations are in the category practitioners ::

• Doctors (general practitioners and specialists)
• Surgeons and dentists
• Medical Students Replacing a Medical Doctor
• Medical Laboratory Directors and who are also doctors

The following occupations are in the category medical ::

• Midwives
• Nurses
• Masseurs-kinesitherapists
• Pedicures-Podologists
• Speech
• Orthoptists

You must take a number of administrative steps to settle and practice your profession as a liberal:

• Register your diplomas to obtain an Adeli number or an RPPS number
• Sign up for the Primary Health Insurance Fund at your place of practice to inform them of your facility
• Subscribe professional indemnity insurance (PCA)

1. Register your diploma to obtain an ADELI or RPPS number

You must register your diploma and obtain an identification number. Depending on your profession, this is either an "Adeli" number or an "RPPS" number.

The Shared Directory of Healthcare Professionals (SPPP) is the single reference directory for identifying healthcare professionals.

2. Enrol in the Primary Health Insurance Fund of your place of practice

You need to contact Health Insurance to register your liberal exercise.

CPAM saves you in the National Health Professionals File (FNPS).

3. Subscribe professional indemnity insurance (PCA)

All health professionals who practice in a liberal capacity, as well as the businesses they can train, must subscribe to liability insurance covering all the acts they practise.

Failure to do so may result in criminal and disciplinary sanctions.

Company Creation and Recovery (ACRE) Help

The Acre is a mechanism for encouraging company creation. It consists of a partial exemption from social security contributions. When you start your business, you will be exempt, under conditions, for 12 months from certain contributions. You must not have been a beneficiary of Acre for three years.

You may be exempt from sickness and family benefits contributions, as well as from basic pension and disability-death contributions.

Note that this exemption is applied to the instalment contributions and is then reviewed following the filing of the tax return.

3 cases may arise:

• When your income is less than €30,852 : exemptions may apply in full
• When your income is between €30,852 and €41,136 —a degressivity applies
• When revenues exceed €41,136 : there is no exemption, it is withdrawn.

For the MAP (Practitioners and Medical Assistants) plan, there is no application to receive the Acre. The contribution exemption is applied automatically.

CPAM aid

Many financial assistance is offered by the CPAM and can be allocated to you depending on your situation.

In parallel, there are also lump-sum payments made by sickness insurance (aid for teletransmission, compensation for further training, installation premium, etc.).

The support portal for healthcare professionals (health) contains all the relevant information, from training to stopping the activity.

From the date of your start of activity, you must pay social contributions to the Urssaf.

These contributions obligatory online payment. You can choose to pay in one of the following ways:

• Or every month. The monthly payment is made on the 5th of each month (or the 20th on option) by direct debit.
• Either every quarter. The quarterly payment is made by direct debit, by electronic payment or by credit card. Contributions are payable for February 5, May 5, August 5 and November 5.

How are your social contributions calculated?

Social contributions are calculated on the basis of your income from self-employment.

When you start your business, this income is not known. Thus, for the first 2 years of employment, contributions are calculated, on a provisional basis, for the time you file your first income tax return, on a lump sum basis identical to all self-employed workers (€8,358 for 2023).

These contributions will then be adjusted according to the actual income reported the following year.

The contributions and contributions are then calculated (and adjusted) on the basis of your self-employed income reported each year.

You must reportyour business income on the site imp.govt.fr.

Online tax account for professionals (EFI mode)

After taking into account the reported items, you will receive a new schedule with the following:

• Your final contributions for the year you reported (2022 income reported in 2023)
• The recalculation of your current year contributions, calculated on the previous year's income
• For your information, the first instalment amounts for next year.

What are the contributions paid by the CPAM?

By entering into the collective agreement between your profession and Medicare, the MCAPs benefit from the participation of Medicare in certain social contributions on the basis of the income of the activity under contract. This participation may be partial or total, depending on the agreement of your profession.

What are the social security contributions to pay?

The money collected by the Urssaf is returned to the social protection funds.

They are intended, in particular, to finance the benefits offered by the general scheme: reimbursement of medical care, payment of workers' compensation, family benefits and pensions.

• Health Insurance Contribution (PA) : The sickness and maternity insurance contribution funds the benefits paid by the general social security system.
• Family Allowance Contribution (FA) : This contribution is intended to finance the benefits paid by the family allowance funds.
• Generalised Social Contribution (GSA) and Social Debt Repayment Contribution (SDRC) : The income from the CSG finances health insurance schemes, family benefits, the old-age solidarity fund and the national solidarity fund for self-government. The Social Debt Repayment Contribution (SDRC) was created to fund the Social Debt Depreciation Fund (Cades).
• Daily Allowance (DI) : There is a daily sick leave for medical practitioners and assistants between the 3^e and 90^e days off.
• Contribution to Regional Health Professional Unions (Curves) :: The health professions are represented by regional unions of health professionals who contribute to the organisation and evolution of health care provision at the regional level, including the preparation and implementation of the regional health project. These unions are funded by the Curps, which is due only by settled health professionals.
• Contribution to Vocational Training (PSC) : This contribution funds training actions for liberal doctors through the Medical Profession Training Insurance Fund (FAF-PM) and for other PAM professions through the Interprofessional Training Fund for the Professional Professions (FIF PL).
• Contribution to voluntary occupational accident/sickness insurance (AVAT)): This voluntary contribution covers risks of accidents at work, occupational diseases and accidents along the way. It is to be subscribed to your CPAM and then recovered by the Urssaf.
• Pension contributions: In the conventional pension plan, the Urssaf does not call pension contributions; these will be called by the pension fund corresponding to your profession: CARPIMKO, CARMF, CARCDSF. As part of the simplified offer for replacement physicians, the contribution rate includes CARMF contributors.

If your spouse (married or married) or partner regularly participates in the company's activities, it must have a status.

There are 3 statuses: partner, salaried spouse, collaborating spouse.

You must choose a status and declare it on the website of the company formalities window.

When you become an employer, you are subject to certain reporting obligations.

You must make the following declarations:

• Employee Statement. Pre-Employment Declaration (PSEA) is completed no earlier than 8 days prior to hiring. It is carried out online:
  
  Online Pre-Hire Declaration (EPAD)
• Nominal Social Declaration (DSN). The registered social declaration (DSN) replaces the majority of social declarations with social protection organisations and is made monthly net-companies.fr.
  
  Nominal Social Declaration (DSN)
  
  From this declaration, as an employer, you pay social contributions (Urssaf, unemployment insurance, supplementary pension, pension...).

For simplifying the social formalities associated with the employment of employees you can join Company Job Title (Tese), an online service of the Urssaf.

Company Service Job Title (Tese)

This allows for a single declaration for the EPAAD and the employment contract. There are no more pay slips to be completed: the Tese centre handles them from the remuneration elements entered.

Finally, a payment to your Urssaf for compulsory social protection contributions and for income tax is deducted at source (if the employee is taxable).

The DSN and certain annual returns are made by your Tese centre (tax certificate...).

Health care professionals must complete a formality at the company Formalities Office in the event of a change in their situation. For example, it is a transfer of head office for a business, change of address for an independent professional.

All situation changes must be declared on the site cfe-urssaf.fr ::

Urssaf CFE: change and discontinuation formalities

In parallel, the Urssaf will receive information from the CPAM indicating this change of situation, together with other information affecting the calculation of contributions.

The CPAM may decide to "disqualify" the liberal practitioner for a maximum 3 months. This means that it may decide to suspend the effects of the agreement on the healthcare professional;

It may take such a decision in the following cases:

• Repeated application of higher tariffs than conventional tariffs, except in cases provided for by the texts, or non-compliance with the nomenclature of professional acts
• Non-compliance with rules on care sheet requirements
• Misuse of overflow for specific requirements.

In order to cease your activity, you must complete the following within one month (30 days) of the cessation of your activity: cancellation at: www.cfe.urssaf.fr

Urssaf CFE: change and discontinuation formalities

You then have a 90 days for report to the Urssaf your business income for the year of termination and/or the previous year. 

Contributions are subject to regularisation. 

If you receive a credit, the overpayment is charged to the additional contributions and contributions due, or is refunded to you. 

If you are a debtor, the additional contributions and contributions resulting from the settlement must be paid within 30 days of the sending of the notice of appeal of this supplement. 

In the event of termination of employment, the provisional or final social contributions and contributions which have been deferred or averaged and which remain due shall be paid within 60 days of such termination.