Complementary health insurance

Complementary health, or "mutual" is a contract that allows an insured to recover part or all of its health costs not supported by compulsory health insurance (social security) in consideration of the payment of an assessment.

How does the complementary health

Health expenditures are not reimbursed by social security. The supplementary acts beyond mandatory health insurance reimbursements. Thus, the supplementary occurs for the reimbursement of medical consultations, medicines, hospital stays, the optical...

In practice

Mandatory health insurance fixed for each act or produced a basis that corresponds to the reference fare. It then applies a rate of reimbursement to this basis that determines the amount of the rebate. Apart from cases where the reimbursement rate is 100%, reimbursement of social security is no less than the basis of repayment: the difference between the base price and the reimbursed amount is the "co-payment". It is this sum that complementary health refund fully or partly the difference.

Mandatory health insurance deducted in some cases a franchise or a lump sum contribution of the refund. This amount is rarely supported by complementary. On the other hand, recent support sometimes, to some extent, potential overruns that are billed to the patient. Examples: overflow of fees of a specialist, eyeglasses or dentures.

How to subscribe... or terminate its complementary health

From whom subscribe

For employees, there is often a range of complementary health proposed or imposed by the company. In this case, a portion of the cost is supported by the company, the rest being paid by the employee. This coverage includes usually all members of the family.

It is also possible to subscribe to complementary health contracts individually with the mutuals, institutions of foresight, corporations, or mutual insurance companies. Do not hesitate to compare benefits and prices. Comparators sites are available on the internet.

Understand my contract

Additional health guarantees are generally expressed as a percentage of the basis for reimbursement, sometimes in euros.

• Percentage: a guarantee of 150% of the basis of reimbursement (included compulsory health insurance) means the total refund (security social + supplementary) will be 50% more than the basis of redemption by the social security.

• Euro: a guarantee in the amount of 250 EUR means that repayment of the complementary health will be the more than 250 euros, in addition to the sum reimbursed by compulsory health insurance. It is often the case for reimbursement of optics for example.

Guarantees can be capped to the amount limited by number or time.

Warranty and service

Complementary health generally support the refund:

• consultations and medicines;
• Hospital (living expenses, special room, surgery fees);
• Optics (glasses and lenses);
• Dental (dental and orthodontic prostheses);
• The acts and medical care not covered by compulsory health insurance such as vaccines, osteopathy, the operation of myopia...

They may in addition proposed additional services such as:

• The third charge, that avoids making the advance of certain costs (pharmacy);
• Aaccess to networks of healthcare professionals providing care at negotiated rates;
• Services of assistance and home help in the event of hospitalization or immobilization (housekeeper, childcare)...

The price of complementary health

Complementary health prices vary according to several criteria related to the Subscriber and the contract. The criteria include age, status of employee or not, the revenue of the Subscriber and the type of guarantees and you want refunds. In General, plus the contribution is high and most warranties are extended.

Time waiting or deficiency

Some complementary will not cover expenditures from the subscription or membership. They apply a waiting period during which the Member pays his dues without the benefit of the repayment of certain benefits (programmed in advance hospitalization or optical expenses).

Duration and termination of the complementary health

The renewal of the contract is done usually every year by tacit agreement. The Organization to which you have subscribed annually sends a notice of expiry indicating the amount of the contribution for the coming year and the deadline to which it is possible to terminate. It is always possible to terminate his contract subject to respecting the period of notice provided.