In order to reduce the "hole in the security", the Health Insurance will reduce its coverage of non-urgent medical transport, from 65% currently to about 50%, according to a decree published Saturday in the Official Journal. And this despite the opposition of complementary health who will have to compensate for this partial dereimbursement.
The average out-of-pocket expenses will increase from 20 to 25 euros
The text provides that "the contribution of insured persons to the costs relating to medical transport", currently included in a range of "30 to 40%", will soon increase to a rate of "45 to 55%" which will be set by the Health Insurance. This decision will apply to so-called scheduled transport, for patients who do not already benefit from an exemption (chronically ill, pregnant women, disabled ...).
The measure aims to "neutralize" the free "urgent medical transport": private ambulances sent at the request of the Samu are indeed 100% covered since January 1, at an estimated cost of 70 million euros per year, according to the impact study of the 2023 budget of the Social Security. This sum will therefore be passed on to some 12 million scheduled journeys, of which the rest at average expense will increase from 20 to 25 euros, according to government calculations.
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This increase will be painless for most policyholders, most of whom are covered by mutual insurance companies, insurance companies and provident institutions. Organizations that were also supposed to benefit from this, since they used to pay for part of the urgent transport.
But the National Union of Complementary Health (Unocam) had opposed it in March, rendering an "unfavorable opinion" because of "doubts about the financial neutrality of the operation". This fear is partly justified, because in the meantime the Health Insurance and ambulance unions concluded an agreement in April, with an envelope of 340 million euros by 2025 including price increases.