Reimbursement for a spa treatment is included in your health insurance. However, support is not automatic. To qualify, there are certain conditions that must be met.
What costs related to your spa treatment are therefore covered by your insurance? What conditions must be met to benefit from this refund? What steps should be taken to benefit from it? Here is all you need to know.
Summary
Reimbursement of a spa treatment: what conditions to meet?
Spa treatment is a medical treatment that takes place in a spa. She allows to remedy certain illnesses (muscle pain, digestive disorders, obesity, chronic bronchitis, psoriasis) using waters from mineral springs.
A cure of 3 weeks can cost around 600 €. This is’a substantial investment, part of which can be covered by your health insurance. For this, it is necessary to fulfill certain conditions established by the Public health code, THE Code of Social Security and some arrested.
First, the cure must be prescribed by the attending physician or specialist physician. Then, the condition or pathology to be treated must appear on the list of therapeutic orientations covered by health insurance :
- Neurology;
- Phlebology;
- Gynecology;
- Dermatology;
- Rheumatology;
- Urinary disorder;
- Digestive disorder;
- Cardioarterial disease;
- Psychosomatic disorder;
- Respiratory tract disorders;
- Affection of the bucco-lingual mucous membranes;
- Developmental disorders in children.
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The third condition concerns the choice of the spa. Indeed, it is essential to choose a establishment approved and contracted by the Health Insurance. The standards to be followed by spas are set by articles R1322-52 to R1322-67 of the Public health code.
The fourth important condition to respect relates to the duration of your spa treatment. This is normally set at 18 days of effective processing. However, when the treatment is interrupted for medical reasons, you are reimbursed according to the number of days taken.
What costs are covered by health insurance?
It is the decree of March 4, 1959 which sets the conditions for participation of the primary social security funds in the cost of spa treatments. The services that are covered during your cure correspond to the medical expenses, accommodation and transport expenses and daily allowances.
Medical expenses and reimbursement rates
According to article 1 of this decree, the medical expenses taken into account relate to the expenses of medical fees due for the medical supervision of the cure. Reimbursement is made at the rate of 70% of the conventional rate.
Thus, for a « simple orientation » cure, the monitoring package of which is estimated at €80, you benefit from coverage of €56. The costs related to the treatment itself in the approved public or private thermal establishment are also reimbursed at 65% of the conventional rate.
For a treatment that costs 600 €, you will therefore only have to pay 210 €. Note that when complementary medical benefits are carried out during the cure, a refund is made at 70% of the conventional rate.
At what rate are the costs of staying in the spa center reimbursed?
Your health insurance also covers your stay in the spa. The reimbursement rate is 65% and corresponds to a flat rate set at €150.01. So you only have to pay €52.51.
How to be reimbursed for transport costs for a cure?
To be reimbursed for transport costs, you must send the proof of transport to your health insurance fund. You will be reimbursed up to 65% of the costs on the basis of the price of the 2nd class return SNCF ticket. Costs movement of the person accompanying the patient may possibly be supported.
Living expenses, transport and daily allowances: specific conditions
Accommodation and transport costs are covered only if your resources for the year preceding the treatment did not exceed €14,664.38. This is the ceiling in force since 2010. This is increased by 50% for your partner and for each beneficiary.
To benefit from the daily allowances due to the work stoppage, your resources must be below the annual social security ceiling. In 2022, the latter is €41,136. It is also increased by 50% for your partner and for each beneficiary.
What steps should I take to receive support?
To apply for support, you must fill out a form. Cerfa No. 11139. This contains a care questionnaire completed by the doctor and a declaration of resources that you complete yourself.
Then send the form to your health insurance fund. As a response, the latter sends you a C formErfa No. 11140 consisting of three parts. THE first concerns medical fees and must be sent to the spa doctor. The second relates to spa package and is to be returned to the spa. Part 3 is linked to the transportation and accommodation costs.
What to remember?
In summary, to benefit from the reimbursement of a spa treatment, it must be prescribed by a doctor and carried out in an approved center. In addition, the condition to be treated must be one of the conditions or pathologies covered by health insurance. Finally, the duration of 18 days of effective processing must also be respected.
When all these conditions are met, medical, accommodation and transport costs are covered.
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