Complementary health: how it works

Although optional, the complementary health, also called mutual, allows the coverage of care and medication. Find out what complementary health really is for. We also tell you everything about the existing formulas, the aid for complementary health and the average rates observed according to the age and the region of residence of the insured.

What is a complementary health?

Complementary health insurance, also called mutual health insurance, aims to reimburse part or all of the health costs not covered by one of the four compulsory health plans. Complementary health covers what is called the co-payment.

Subscription to complementary health insurance remains optional, except in the context of company mutual insurance. When subscribing, you must pay contributions.

The different health supplements

Complementary responsible health

Among the various health mutuals, there are so-called responsible contracts for the insured. They are based on one principle: the amount of the contribution is not determined according to the state of health of the insured. Thus, the complementary health insurance does not collect any information relating to the health file of its client.

The responsible health mutual covers at least:

  • 30% of the price of consultations in general medicine;
  • 30% of the basic price for medicines (except those for non-serious disorders or similar to certain homeopathic specialties);
  • 35% of the costs of analyzes prescribed as part of the treatment course.

On the other hand, the responsible complementary health insurance does not cover:

  • the fixed contribution of one euro for each consultation procedure carried out by a doctor, health establishment or medical biology procedure;
  • medical deductibles on prescription drugs (50 cts per box), on paramedical procedures (50 cts per procedure) and on medical transport (2 euros per transport);
  • excess fees for a specialist consulted without a medical prescription;
  • the increase in the participation of the insured for non-compliance with the course of care.
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Company mutual and supplementary

On the other hand, there are group mutuals, also called company mutuals. Employees therefore have access to complementary health insurance via their company.

However, they can also subscribe to an additional supplement in order to obtain a more attractive contract. This will cover certain costs at a higher rate. Expenses not provided for in the company mutual fund can also be reimbursed (eg alternative medicine).

Read also: How to know which health insurance fund you depend on?

CMU and complementary health assistance

Finally, people with low incomes can benefit from the CMU (Universal Health Coverage). All costs are covered by Social Security.

But there is also assistance with complementary health care for people whose resources are less than 20% of the CMU ceiling. This is a health check given directly to the mutual or insurance company.

Services covered

Refunds can be related to:

  • expenses covered by health insurance (eg pregnancy, accident, illness, etc.);
  • services not covered by Social Security (eg excess fees, alternative medicine such as sophrology or osteopathy, dental implants, certain vaccines and medications, etc.);
  • to additional services (prevention, personalized follow-up, assistance, etc.).

Namely, for each service covered by the complementary health insurance, the health insurance applies a reimbursement rate. This is calculated according to the base rate determined by the agreement between health professionals and the National Health Insurance Fund.

And with regard to the amount of reimbursement, it depends on the type of contract chosen by the subscriber. Indeed, there are several reimbursement rates, which increase according to the price of subscription to the complementary health insurance.

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On the other hand, some mutual health insurance companies offer various options such as third-party pharmaceutical payment, which makes it possible to avoid the advance of costs.

The rates

Significant price differences are observed from one mutual health insurance fund to another depending on the age of the insured and his region of residence. This is partly explained by local drug consumption, which differs from region to region. But also by the consumption of additional services such as third-party payment.

On the other hand, fee overruns are recurrent in certain areas of France such as Alsace, Rhône-Alpes and Ile-de-France.

The Alsace-Moselle Health Insurance scheme is the one that offers the most advantageous reimbursements. Consequently, the remainder payable by mutual health insurance is reduced. And therefore, the complementary ones offer attractive prices.

Here are some averages:

  • count about 212 euros per month for a senior mutual;
  • approximately 35 euros per month for TNS complementary health insurance (self-employed workers);
  • 90 euros monthly for a family;
  • and approximately 26 euros for a young employed person.

Read also: Cross-border worker in Switzerland: what type of insurance should you take out?

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