Healthcare in France is state funded, but it still requires people to 'pay in' to the system - and for certain groups this can come in the form of unexpected healthcare charges known as 'cotisations' (also known as PUMa).

France is known for having an impressive and accessible healthcare system, which foreigners can also benefit from after at least three months of 'stable and ongoing' residency.

The system works via reimbursements - you pay upfront for appointments, medication and medical procedures and, if you are registered in the system, the French state reimburses you some or all of the cost.

But of course the system itself must be funded, and users 'pay in' to the system via social charges known as cotisations.

Most people who are working in France won't really notice these - they disappear from your salary or income along with a bunch of other things including income taxes, pension contributions and unemployment insurance.

Some foreigners in France however, mainly early-retirees, may be surprised to be sent a bill for cotisations.

Here's a look at how healthcare charges are deducted.

Employees/self-employed

The funding of the health system is done primarily via payroll deductions. These are collected and distributed by the French government body Ursaff.

Workers in France (salariés) pay around 15 percent of their gross salary each month toward the healthcare system, while companies (entreprises) pay out around 29 percent of the wages earned by their employees, according to Ameli.

Workers can see these charges when looking at their pay stubs (fiches de paie) where deductions are broken down into taxes (impôts) and social charges, which include healthcare.

Self-employed people are also liable for deductions from their income for social charges, organised by URSSAF.

Retirees

People who have worked in France and then retire here continue to have their healthcare covered by the French state, on the basis that they have previously 'paid in' to the system when they were working.

The system is a little different, however, for people who have never worked in France, and then retire here on a foreign pension.

EU citizens and Brits are covered by the S1 system - which is basically a reciprocal agreement where the country where you worked continues to pay for your healthcare even while you live in France.