Complementary, mutual, insurance you regularly hear these terms, but what is a mutual health insurance fund? What is its role and why is it so important to have one? The goal of your mutual insurance company is to cover part or all of the health costs (dental care, medical consultations, hearing aids, etc.) not reimbursed by social security. Let’s see in detail how it works and how it is used.
Mutual health insurance and compulsory insurance: what’s the difference?
To fully understand how healthcare reimbursement works in France, you should know that there is compulsory insurance. It is famous social security or health insurance. It is compulsory for all workers and is divided into different schemes depending on the socio-professional category (general scheme, agricultural social mutuality, etc.). Social security does not ensure full coverage of care. To obtain additional reimbursement, this is where mutual health insurance comes in. So what is mutual health insurance? It is complementary insurance, which will reimburse you partially or totally for what social security does not finance. The part that remains at your expense after reimbursement of compulsory health insurance is called the co-payment.
Mutual health: how does it work?
The mutual health can also take the name health insurance or supplementary health: all these terms are used to describe the same type of contract. Its role is to cover part or all of the costs that social security does not reimburse. In other words, it is essential if you want to have good coverage of your health costs. There are many organizations on the market that offer mutual health insurance. What is the difference from one complementary to another? The price of your insurance contract changes depending on:
- Of your age;
- Your personal and professional situation;
- Your geographic location;
- Selected guarantees;
- The level of reimbursement.
To fully understand how mutual health insurance works, you must first know the method of calculating reimbursements. Note that the guarantees offered by the complementary are expressed in Euros (flat-rate) or as a percentage. This percentage is based on the reimbursement offered by social security. In short, the higher the percentage offered by the complementary insurance, the better you will be reimbursed, and the higher the contract price will be. Coverage levels range from 100 to 500% depending on the care.
Example: you go to a specialist whose fees amount to 100 € for the consultation. Social security reimburses 70% on the basis of € 60 (for very complex consultations, see the list on the Health Insurance website), i.e. € 42. Your mutual health insurance company offers 100% reimbursement for this type of care. It will, therefore, reimburse the remaining part of the € 60, i.e. € 18. You will be responsible for any excess fees for this doctor.
Mutual health insurance: support
From one health mutual to another, the basic guarantees are generally the same. However, there are significant differences in reimbursement levels. Your mutual health insurance, therefore, makes it possible to supplement the basic reimbursements of compulsory health insurance but also offers additional packages to reimburse the care not covered.
Among the most frequent health costs covered by mutual health insurance, we note the following benefits and services:
- Fees for consultations and medical care (general practitioners, dentists, paediatricians, etc.);
- Fees for consultations for alternative medicine (osteopaths for example);
- Medicines purchased in pharmacies;
- Hospital costs;
- Dental care (dental prostheses, implants, etc.);
- Optical care (frames, glasses, glasses, etc.)
- Hearing aids;
- The cost of analysis in a medical laboratory;
- Thermal cures.
What is good mutual health? It varies from person to person. Indeed, you must ask yourself about your most common health costs and expenses to make your choice among the different contracts. In all cases, the third-party payment option is strongly recommended. This allows you not to advance the costs. The co-payment is then paid directly by your mutual insurance company, thanks to agreements made with health professionals.
Individual contract or mutual health collective contract, what is it?
For employees, the company has the obligation to take out complementary health insurance.
In this case, the contracts are covered at least 50% by the employer. The latter can choose the health insurance he wishes, on condition that it offers a minimum basket of care (full user fee, daily hospital fee, dental care up to 125% of the security reimbursement base. social, a minimum package for optics). This collective mutual is compulsory for company employees, except in exceptional cases (individual contract still in progress, attachment to the spouse’s family mutual, etc.).
We speak of an individual mutual insurance contract when the latter is taken out directly with an organization. In this case, insurance is optional. Nothing prevents a person who works in a company and who already has a collective mutual insurance company from taking out, in addition, an individual contract. It is then a question of additional health. This insurance offers a third level of reimbursement, which comes after social security and the first mutual. This alternative can be interesting in the event of heavy dental or optical costs, for example.
Example: your mutual insurance company reimburses the care for a dental prosthesis at 100% of the basic rate of social security and your supplement covers 150%. Health insurance will reimburse you for 70% of the amount. Your mutual will supplement up to 30% and the addition will allow you to benefit from the reimbursement of the additional 50%.
to summarize
What is mutual health? It is a complementary, paid insurance that allows you to:
- Receive a better reimbursement of your costs and health care than that offered by compulsory health insurance;
- Benefit from the reimbursement for costs and health care that are not covered by social security (alternative medicine for example);
- Carry out your care without having to advance the costs in the case of third-party payment.