Understanding supplementary health insurance in France
In France, Social Security provides health insurance coverage for the majority of medical care. However, reimbursements from the Assurance Maladie only cover a portion of the expenses incurred, leaving a significant cost to be borne by the patient. To remedy this situation, complementary health insurance is available to supplement these reimbursements and offer better coverage of medical expenses. For example, in the case of skin cancer surgery or a consultation with a dermatologist for a skin disease.
The role and benefits of complementary health insurance
L'supplementary health insurance comes on top of the coverage provided by the Assurance Maladie systemThis includes fixed contributions, deductibles, excess fees and other optional medical expenses. This includes fixed contributions, deductibles, extra fees and other optional medical expenses. By choosing a good mutuelle, you can significantly reduce your out-of-pocket expenses, or even eliminate them altogether for certain specific medical treatments.
The different types of supplementary health insurance
There are different categories of supplementary health insurance, depending on your professional and personal status:
- The company mutual : Since January 1, 2016, all private-sector employers have been required to offer their employees supplementary health cover. This contract must be at least 50% financed by the employer and offer a certain level of cover.
- Individual mutual insurance : as the MAAF Santé designed for students, retired people, the self-employed and jobseekers, this offer complements the social protection they already enjoy.
As of January 1, 2020, all French people with a mutual health insurance plan can benefit from full coverage (100%) for certain dental, optical and audiological treatments.
Essential supplementary health insurance benefits
To ensure good coverage, it's essential that your complementary health insurance includes at least :
- consultations and treatments with general practitioners and specialists ;
- drugs purchased in pharmacies ;
- hospitalization ;
- optical care ;
- dental care ;
- audiological care.
Understanding reimbursements and rates for supplementary health insurance contracts
Before selecting your insurer and your contract, it's important to know the basic benefits and reimbursement levels offered, and also to understand how reimbursements and tariffs are established for each of them. Supplementary health insurance contracts are generally divided into :
- Basic coverage: covers only the co-payment;
- Intermediate cover: offers better reimbursements, particularly for hospitalization costs;
- Full coverage: covers all medical expenses, even the most specific.
To choose the contract best suited to your needs, take the time tostudy coverage and reimbursement levels offered by each insurer. For example, if a reimbursement rate of 100% of the TC (tarif conventionnel) is offered, this means that you will be reimbursed by Social Security and your complementary health insurance for 100 % of the tarif conventionnel. However, if healthcare professionals charge extra fees, these will remain at your expense.
Choosing the best complementary health insurance
To choose the insurance that's right for you, you need to consider a number of factors related to your profile:
- Your age and family situation
- The scope of care you need
- The regularity with which you call on healthcare professionals
- Your available budget for a supplementary health insurance plan
Beyond essential guaranteesIn addition, check whether additional options such as preventive services, reimbursement of alternative medicine or coverage of accommodation costs during hospitalization are included in your chosen contract.
Supplementary health insurance is a key element in ensuring better coverage of your medical expenses. Before signing up with an insurer, it's vital to understand the coverage and reimbursement levels offered, and to compare the different contracts available on the market. Take the time to assess your needs and choose the plan that best suits your profile and personal situation.
