Does your child need braces, do you need to change your glasses or get an x-ray? Often this medical care costs an arm and a leg! It is important to inquire with your mutual insurance company to find out what your guarantees are. To avoid excessive medical costs, we tell you all about the "Commitment to the readability of complementary health guarantees".
Better readability of warranty tables
In France, the majority of the population is covered by complementary health insurance (only 5% of French people do not have one). Do you know how much medical care really costs us? Between the amount reimbursed by Social Security and what the mutual takes into account, what is left for us? The agreement signed on February 14, 2019 by complementary health insurance aims to improve the readability of the health cost guarantee tables.
This commitment offers greater transparency in the interest of members, in parallel with the "100% health" reform which allows a "zero charge" on optical, dental and hearing equipment. Thus, patients will be able to compare the different reimbursement offers from mutual insurance companies.
What is the remainder at zero charge?
By definition, the remainder to be paid is the amount you must pay once Social Security and mutual insurance have made their reimbursements. Concretely, the remainder to be paid =your expenses – reimbursements. The sums that remain at your expense will be eliminated thanks to the combined effect of the capping of prices, increases in the bases of reimbursement by Social Security and thanks to the obligation of full coverage of the expense by mutual insurance companies.
Harmonized healthcare cost guarantees
To facilitate the comparison of offers, complementary health insurance must:
– Use standardized reimbursement headings on the guarantee grids
– Provide a list of 15 examples of common care whose headings and wordings will have to be harmonised:
On their examples of reimbursement, mutuals will therefore have to indicate in euros (and no longer in percentages) so that members know more precisely the amounts that will be paid to them for their medical care. Complementary health insurance will therefore be required to make reimbursement calculators available to their members. These tables should indicate:
These examples will allow the member to easily calculate his possible remaining charge after the reimbursement of the health insurance and the complementary health.
An example to better understand?
Let's take a concrete case. If your consultation with your general practitioner (without exceeding fees) is billed at 23 euros, social security will reimburse up to 70%, or 16.10 euros. Then your mutual will reimburse the supplement up to 30%, i.e. 7.90 euros. On the other hand, if the doctor exceeds his fees, and the consultation is billed at 32 euros, the reimbursements are the same from your social security and your mutual insurance company. Your remaining charge will amount to 9 euros (32 euros for consultation – 23 euros for reimbursement =9 euros for remaining charge ).
The commitment to the readability of guarantees will therefore allow patients, from 2020, to easily understand their support and to know in advance what their health insurance and mutual will reimburse them. Thus, they will be able to choose the complementary health insurance that best suits their needs.
