Becoming a CPAM-approved taxi: the health insurance agreement
Seated patient transport keeps many French taxis busy, under a national agreement revised in 2025.
Checked by Radif Partners · Editorial policy · Method and sources
In France, a taxi may carry patients whose fares are reimbursed by the national health insurance (Assurance maladie, run locally by the CPAM) only after signing an agreement with the local fund, under article L322-5 of the Social Security Code. The current model is the national framework agreement approved by the order of 29 July 2025, published in the Official Journal on 8 August 2025. To qualify, the licence holder or the person running the licence must show at least 3 years of actual, continuous use of that taxi licence. Since 1 November 2025, each journey is billed with a €13 flat fee covering the first 4 kilometres, then a per-kilometre rate set for each département, from €1.07 in Gironde to €1.27 in Alpes-Maritimes, plus a €15 fee in twelve big cities and three départements around Paris. The agreement runs for one year, renewed automatically up to five years. It requires GPS tracking and SEFI e-billing by 1 January 2027, and more than half of journeys for patients from the licence’s own area.
Amount for a seated patient journey
Base amount for the journey
€36.10
| Pick-up flat fee (first 4 km) | €13.00 |
| 21 km at €1.10 | €23.10 |
| “Big city” flat fee | €0.00 |
Grid from the framework agreement approved by the order of 29 July 2025, in force since 1 November 2025. Default rate: Bouches-du-Rhône. Tolls, waiting, shared rides, wheelchair supplement and discounts excluded.
Why an agreement is needed
Patient transport on a doctor’s prescription is reimbursed by the French health insurance system. When the journey is by taxi, article L322-5 of the Social Security Code sets a simple rule: it is reimbursed only if the taxi firm has first signed an agreement with a local health insurance fund. Without one, the patient gets nothing back and the taxi loses that work.
Each local agreement follows a national model. The current one is the framework agreement approved by the order of 29 July 2025, published in the Official Journal on 8 August 2025. Ameli states that it came into force on 1 November 2025. An approved-taxi driver is still a taxi driver: the agreement replaces neither the professional card nor the licence. Nor should it be confused with medical transport vehicles such as ambulances and VSLs, which follow different rules described on our page about becoming an ambulance driver.
Who can apply
Article 3.2 of the framework agreement limits approval to the holder of the taxi licence (autorisation de stationnement, ADS), or the person running it, who can show at least 3 years of actual, continuous use on the date of the application. The text explains what use means: at least one driver and one vehicle assigned to that licence. Put simply, the licence must genuinely have been on the road for three years.
The same article refers to local mapping: each département is split into areas, from one to seventeen according to the Cnam charter, and local needs are taken into account. So approval is not automatic; it also depends on local supply. Applicants typically present their professional card, a professional liability insurance certificate and an up-to-date roadworthiness test for the car.
For a new taxi driver the order is clear: licence first, approval later. Our page on the taxi licence explains how to get one, and the page on renting a taxi licence explains how to run someone else’s, which also counts as use.
Fares since 1 November 2025
Annex 2 of the framework agreement sets the fares that apply “from 1 November 2025”. There are three building blocks:
| Item | Amount | Rule |
|---|---|---|
| “Pick-up and assistance” flat fee | €13 | covers the first 4 kilometres driven with the patient |
| Per-kilometre rate | €1.07 in Gironde, €1.10 in Bouches-du-Rhône and Haute-Garonne, €1.27 in Alpes-Maritimes | set for each département, charged from the 5th kilometre |
| “Big city” flat fee | €15 | pick-up or drop-off in Paris, Marseille, Lyon, Toulouse, Nice, Nantes, Montpellier, Strasbourg, Bordeaux, Lille, Rennes, Grenoble, or in départements 92, 93, 94 |
Every département’s rate appears in the annex table; we quote only a few rows, checked against the text. Look up your own before using the calculator, which defaults to the Bouches-du-Rhône rate. Ameli also publishes a list of facilities where the big-city fee applies by extension, updated in April 2026.
The calculator gives a base amount: flat fee, kilometres at the département rate and the big-city fee. It does not work out tolls, waiting time, the supplement for passengers with reduced mobility or shared-ride rules; those depend on the agreement you sign with your local fund.
Shared rides
Service-public notes that a taxi carrying patients must offer them a shared ride with one or more other patients. Three limits protect the patient: a detour of at most 10 km, a radius of at most 30 km around the destination, and no more than 45 minutes of total waiting. On the patient’s side, article L322-5 provides for lower reimbursement after an unjustified refusal of a shared ride. The same article leaves shared-ride pricing rules to the framework agreement; check the grid in your local agreement.
Equipment due by 1 January 2027
The framework agreement sets two deadlines, 1 January 2027 at the latest:
- SEFI billing, the integrated electronic billing system, becomes compulsory in place of the B2 standard;
- geolocation of the car, with a device certified by the health insurance fund according to service-public, recording pick-up and arrival.
The equipment costs money, which varies by supplier and is set by no public text: get quotes and add them to your car costs in the net income calculator.
Working your own area: the 50 % rule
This is the change that most affects day-to-day habits. Article 5.2 of the framework agreement asks each licence to carry mostly, more than 50 %, patients from its own area. The Cnam national charter, June 2026 version, sets out the calculation:
- the rate is worked out per licence, meaning per vehicle attached to the approved licence;
- it counts journeys: a patient carried seventy times counts seventy times;
- patients living in the area count, and so do patients picked up there, whatever their address;
- the data covers a year’s journeys billed by the following March.
The charter gives its own example: a taxi that carries one local patient seventy times in a year and thirty outside patients once each reaches 70 %. A change of car lasting more than thirty days must be reported to the fund within 30 calendar days.
It is being phased in. The first reviews in local joint committees will cover 2026 figures, by June 2027 at the latest, with a half-yearly update sent to each firm. No proceedings may be brought on this ground in 2027: only reminder letters, to which the firm can respond.
Term, renewal and penalties
The agreement with the fund lasts one year. It renews automatically, a year at a time, up to five years. For breaches, the framework agreement provides contractual penalties up to withdrawal of the agreement for 5 years at most. Losing approval cuts off a client base that, for many taxis outside the big cities, makes up a large share of takings.
What approval does to your income
Patient transport brings steady volume, paid on a grid known in advance and often directly by the fund rather than the patient. In return it demands equipment, electronic billing and activity focused on the licence’s area. To see what it leaves you, enter your takings in the calculator on how much a taxi driver earns. Business status, owner-driver or company, is covered on our page about self-employed taxi drivers.