In these lines, we discuss the various options and guarantees available in order to identify the best optical mutual. With the reform of 100% Health, it is essential to understand the particularities of each offer to choose the one that will best meet your expectations. We reveal tips for selecting your mutual insurance company and advice for taking advantage of the most attractive reimbursements. How to determine the optical mutual that suits you? Browse our guide.
Summary
100% Health
What is 100% Health?
Glasses are expensive and reimbursements were sometimes insufficient. To overcome this problem, the « 100% health » reform was born in 2019. It guarantees quality optical equipment without exceeding your budget.
What optical equipment is in the 100% Health basket?
With 100% health, those who have a responsible health contract (95% of contracts) benefit from full reimbursement, regardless of their level of guarantee. Opticians, for their part, must offer frames and lenses that comply with this reform: they belong to what is called Basket A. Basket B includes products whose reimbursement depends on the mutual insurance company.
Basket A provides, at a minimum:
- 17 adult frames in two colors, price capped at €30,
- 10 children’s frames in two colors, price also capped at €30,
- Quality lenses for all visual disorders, with a ceiling price ranging from €235 to €340 depending on the complexity of the correction.
By choosing complete equipment from Basket A, you are guaranteed full reimbursement by health insurance and your complementary health insurance. Your pair of glasses will cost you nothing, an ideal option to equip the whole family.
In which cases is it interesting to choose a reinforced optical guarantee?
When you wear contact lenses
Lentils do not benefit from the 100% health offer. It is therefore relevant to turn to a reinforced optical guarantee. The latter allows reimbursement in addition to that of health insurance.
Lenses are covered up to €23.69 per eye. Many contracts provide specific packages to reimburse more. Comparing offers is essential to find the one that best suits your situation.
It is essential to keep in mind that opticians freely set contact lens prices. As a result, prices fluctuate considerably for the same model.
Quality requirements (comfort options for corrective lenses)
If you are looking for lenses with the latest technological advances, a higher guarantee will be ideal. It will support, to a greater extent, options such as anti-fog treatment, anti-blue light filter or even polarizing lenses.
A warranty will allow you to benefit from a better reimbursement for your specific needs and to optimize your viewing experience.
Specific aesthetic requirements
The optical frames offered in the 100% healthy range, available from all opticians, meet European quality standards. However, they may not meet your expectations in terms of style or comfort.
If this is the case, it is likely that you want to move towards a frame at free price. A reinforced optical guarantee, offered by your mutual health insurance, allows reimbursement adapted to your aesthetic preferences.
cataract surgery
Cataract surgery is covered by health insurance, up to €397, corresponding to the conventional rate. However, in the event of fee overruns, hospitalization cover in excess of 100% of the reimbursement basis will be useful.
An optical guarantee including a dedicated package is also necessary to obtain additional reimbursement for the ocular lens replacing the lens. This coverage applies in particular to multifocal or toric implants.
refractive surgery
Refractive surgery, considered a comfort operation, is not covered by Social Security. However, it is possible to reduce the costs associated with this intervention thanks to the packages offered by certain mutual health insurance companies.
Tips for choosing the right optical health insurance
The Benefits of Loyalty in Health Coverage
Some mutuals offer loyalty bonuses which increase with the years of membership. The optical package can thus improve. The loyalty bonus then makes it possible to benefit from better support without impacting the contribution.
The postponed package, a flexible solution
Some health mutuals offer an interesting option: package deferral. If you do not spend all of your optical package during a year, it may be carried over, in whole or in part, to the following year.
This advantageous method allows you not to lose unused sums, thus offering greater flexibility in managing your optical expenses.
Change health insurance to improve your reimbursements
The infra-annual termination, effective since December 1, 2020, facilitates the change of mutual health insurance. If your sight changes, you can take out a contract more suited to your needs.
To benefit from it, one condition must be met: your current contract must have been underwritten for at least one year. Termination, without fees or penalties, is simplified.
Care networks
The care networks bring together approved professionals who undertake to practice negotiated rates, which are more advantageous than those on the market.
These networks also offer exclusive services and a wide range of quality products.. Coverage can be increased by 20 to 30%, significantly reducing your remaining costs. For a pair of glasses with single lenses, it is possible to save an average of €100, and nearly €200 for progressive lenses.
Among the best known are Carte Blanche, Itelis, Kalixia, Santéclair, Sévéane, Terciane, Kalivia and Optistya-Mgen of the Istya group.
Buy glasses online
The glasses offered on the internet can be up to 60% cheaper than in stores. If low prices do not necessarily mean poor quality, it should however be kept in mind that the support and the adjustments, in particular the pupillary distance, can be less precise.
Do not hesitate to compare offers online to find the best option, while keeping in mind the advantages and disadvantages of this mode of purchase.
What is the best mutual insurance for glasses?
The best mutual in 100% Health
The best option to take advantage of glasses without a charge is an affordable responsible health insurance. Indeed, 95% of the offers on the market are responsible contracts, a sine qua non condition for benefiting from the 100% health care basket.
Thus, if the equipment in the basket is sufficient, there is no need to select a mutual insurance company with a high optical guarantee, which would only increase your contributions. It is wiser, if your budget allows it, to favor essential guarantees such as hospitalization, to better cover serious risks.
The best mutual at free rate
Regarding optical equipment at free rates, mutual and complementary health insurance must cap reimbursements for responsible contracts. Support for mounts is now capped at €100, down from €150 previously. Non-responsible contracts offer better coverage, but the premiums are often higher.
For lenses, it is possible to combine 100% healthy lenses with a frame at a free price, ensuring full reimbursement of the lenses and coverage of the frame according to the optical guarantee taken out.
It is important to emphasize that the mutuals offering high optical guarantees generally provide for other good level reimbursements, such as hospitalization, single room or dental. The price must be evaluated taking into account all of the coverage of the contract.
Finally, it is essential to carefully compare the different mutuals to determine which one will best meet your needs., whether you are looking for a 100% health offer or a reinforced optical guarantee for equipment at free prices. Identify your needs. Then take into account the services offered, the packages offered and the other supports included in the contributions to make an informed choice.
Consult the ranking of mutuals that best reimburse optics. Then use an online comparator to help you determine the contract that will give you the best coverage, without compromising your budget.
