Suffering from a long-term condition is distressing and exhausting enough not to inflict financial anxiety on yourself that could harm your already fragile health. Learn to see more clearly in the reimbursements from the Health Insurance and the mutual to find or keep your precious serenity.
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When is ALD considered?
The acronym "ALD" stands for "long-term condition" and as explained by the Health Insurance, "this device allows the management of pathologies that require prolonged and expensive treatment". There are exempt ALDs and non-exempt ALDs.
For a serious illness, evolving for more than 6 months and requiring expensive treatment, the health costs related to the illness are reimbursed 100% within the limit of the reimbursement ceiling of the Social Security: it is then an exempt ALD. Examples: Alzheimer's, Parkinson's, type 1 and 2 diabetes, cancer...
In the case of a non-exempt ALD, which requires less expensive care, the Health Insurance reimburses at the usual rates the costs incurred in connection with the illness.
A fracture of the ankle that is complicated by the occurrence of an infection can lead to a stop of more than 6 months to obtain a non-exonerating ALD. Glaucoma or epilepsy are also considered non-exempt ALDs. To supplement health costs that are not covered by the Health Insurance, a mutual insurance is essential.
What is the coverage of the Health Insurance for ALD?
If you are in exempt ALD, the health expenses related to the illness are reimbursed at 100% within the limit of the reimbursement ceiling of the Social Security. However, some costs may remain your responsibility:
- the flat-rate contribution of 1 euro, set up to preserve the French health system, knowing that it can not in any case exceed 4 € per day. You will also have to pay 50 cents for boxes of medicines (the costs you will have to cover will never exceed 50 € per year).
- The hospital lump sum, which represents the patient's financial contribution to the accommodation and maintenance costs incurred by his hospitalization, is also not part of the expenses reimbursed by L'Assurance Maladie. Turn to your health insurance to find out if your contract provides for it. Fixed by ministerial decree, the amount of the hospital fee is 20 € per day in hospital or clinic.
- Fee overruns.
But for all these expenses that fall to you, a good mutual can lighten or even eliminate the rest to be charged.
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What is the coverage of the mutual for an ALD?
The subscription of a mutual is not always mandatory, but strongly recommended whether you work in the private, public or self-employed. If you suffer from a pathology affected by ALD, a large part of your expenses will be covered by the Health Insurance, but not all.
Your mutual insurance company can help you pay for excess fees or the hospital package. Comfort costs (a single room can be valuable in some cases!) are also part of the costs that the mutual can cover, partially or totally.
A package for alternative medicines, which relieve many ailments, may be welcome. Study plans that offer high levels of coverage to benefit from it.
If you have questions, if you are not sure if you have the right health insurance, take the time to compare contracts and companies, to choose a health insurance adapted to your needs.
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What are the pathologies concerned by ALD?
The list of ALDs is fixed by decree. It includes disabling stroke, chronic active liver disease (hepatitis B or C) and cirrhosis, human immunodeficiency virus (HIV) infection, type 1 diabetes and type 2 diabetes in adults or children, severe neurological and muscular disorders (including myopathy), severe epilepsy, hemophilia, severe chronic respiratory failure and Alzheimer's disease.
Apart from this list, there are also the so-called "off-list" ALD (ALD 31) which refer to serious diseases that evolve over a foreseeable period of more than 6 months, the treatment of which is particularly expensive.
How to get your ALD support?
It is your attending physician who will establish a request for ALD coverage for care and treatment related to your disease by filling out a form called "care protocol". Don't worry, he is (unfortunately) used to doing this, which will only take him a short time. The ALD will be recorded in your file within 48 hours of receiving the care protocol.