What criteria should be checked before subscribing to mutual health insurance?

Some care is little or not at all reimbursed by Social Security. A mutual health insurance can also supplement this coverage and provide you with a better level of social protection. It is still necessary to choose it with discernment and to take into account, before you decide, a certain number of criteria.

Take stock of your needs

This is the first thing to do before subscribing to your complementary health policy. It must meet your real needs and not include unnecessary guarantees.

These needs vary according to your age, your family situation and your state of health. Your financial resources are also to be taken into account. A 30-year-old bachelor in good physical condition will probably be able to make do with the basic guarantees.

If you live as a couple and have children, they should be included in the mutual health insurance contract, as beneficiaries.

If you reach retirement age, your needs are different. Your state of health is not the same, and it is probably advisable to provide a contract adapted to this new situation.

In particular, it must include appropriate reimbursements for dental and optical care or even excess fees for medical specialists. These guarantees are often provided by senior mutuals.

Play the competition

Once your needs have been clarified, you have to start looking for the right mutual insurance company. It is always possible to contact each insurer and examine their proposals. But these steps can be tedious.

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The large number of health mutuals and the profusion of their offers may lead you into some confusion. Not to mention the time spent consulting all these organizations.

The best is then to use a comparator of mutual. This tool, available online, is indeed very convenient. You will first have to indicate your preferences in terms of guarantees, so that the comparator can draw up your profile.

This done, you will be able to consult a summary table, presenting you, in a very clear way, the mutual health insurance adapted to your needs and offering you the most advantageous rates.

This free service chooses for you, from a wide range of mutual health insurance, those that best meet your expectations. It allows you to save valuable time.

Check warranties

The extent of these guarantees will largely depend on the extent of your health coverage. The main guarantees are included in most contracts. They relate to the coverage of routine medical care, the most frequent dental and optical care, as well as hospitalization.

What often makes the difference are the additional warranties. They concern areas where Social Security intervenes little or not at all. It can be the reimbursement of a hearing aid, a dental implant or an osteopathy session.

Some prevention services can also be covered by mutual health insurance. This is the case, for example, of consultations and tobacco care, support for the patient in his search for a balanced diet or the reimbursement of certain vaccines.

Some health mutuals still offer, in certain cases, the intervention at home of a household help or school support for your child in the event of hospitalization.

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It is taking all these elements into account that will allow you to choose the mutual health insurance company with the guarantees best suited to your situation.

Choose a responsible mutual

The vast majority of mutual health contracts, and in particular those of company mutuals, are said to be responsible. As their name suggests, they are intended to encourage policyholders to adopt responsible behavior with regard to health expenditure. They are thus led to measure the extent of the cost of social protection.

This is why these contracts make the extent of the reimbursement dependent on the passage of the insured person through the course of coordinated care. This provides for the choice by the insured of a general practitioner, whom he must consult before any visit to a specialist.

Similarly, responsible contracts are distinguished by the capping of certain reimbursements, that of fee overruns in particular. In return, these health mutual benefit from advantageous taxation. They therefore cost less to the insured.

Conversely, there are non-responsible mutual health insurance contracts. They generally provide for broader reimbursements, and sometimes even unlimited coverage of excess fees. But, by choosing one of these mutuals, you will pay higher contributions.

Be aware of certain limits

These limits can in fact give less interest to a contract which, at first glance, seems to include all the desirable guarantees.

This is firstly the case of the waiting period which, if provided for, must be clearly indicated in the contract. This is a period, more or less long, during which you cannot claim a refund. This delay is often applied to important care, such as dental or optical care.

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Similarly, health mutuals most often provide for certain exclusions of guarantees. Thus, they can refuse to pay for treatment following an accident caused by drunk driving or the practice of a dangerous sport. It is advisable, before choosing the mutual, to check the presence and the extent of these exclusions of guarantees.

Finally, some mutuals require you to complete a medical questionnaire to establish your profile. If he is « at risk », the mutual will apply higher rates. It is therefore preferable to choose a mutual health insurance that does not provide for this type of questionnaire.

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