In France, we are lucky to benefit from a free social protection system!
Finally, in principle, because in reality Social Security only reimburses part of routine care (consultation, optical, dental, etc.).
So, to obtain complete health coverage, there is the principle of mutual insurance.
Supplementary health insurance which absorbs the remainder payable after intervention by Health Insurance.
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What is mutual insurance?
The term mutual refers to both an organization and a contract aimed at supplementing Social Security reimbursement.
This concerns the payment of the co-payment.
This out-of-pocket cost varies depending on the medical procedure, the sector of the healthcare professional, the treatment or even compliance with the care pathway.
In terms of reimbursement, mutual coverage is total or partial in relation to the remainder payable.
It depends on your mutual contract and the level of cover taken out.
In fact, each mutual organization offers different formulas that are more or less covering.
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What is a mutual fund used for?
Is mutual insurance compulsory?
No, except for employees in the private sector who must join a company mutual fund since 2016. For others, having a mutual fund remains optional, but strongly recommended.
For what ?
Because mutual insurance, also called complementary health insurance, is the only way to reduce health costs.
In addition to reimbursing the unreimbursed portion of Social Security, the mutual fund can also cover procedures not reimbursed by Health Insurance, such as alternative medicine or certain so-called “comfort” procedures.
Subscribing to mutual insurance has several advantages:
Obtain additional reimbursement for care covered by Social Security
Coverage of medical care poorly reimbursed by Health Insurance such as optical costs, dental prostheses, etc.
Receive reimbursement for actions not reimbursed by Social Security: this includes alternative medicine, smoking cessation, etc.
Benefit from third-party payment: this means not having to pay up front to obtain your medication, consult a specialist, etc.
Take advantage of additional services: assistance services such as housekeeping in the event of hospitalization/immobilization
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How does mutual insurance work?
A mutual contract operates according to a guarantee schedule and additional services.
Each mutual organization or insurer offers several formulas with varying levels of guarantee.
Of course, the more efficient your mutual insurance company is, the higher the monthly contribution will be.
A basic level of guarantee generally covers the co-payment.
This is what we call a 100% BR (Reimbursement Basis) mutual contract.
Concretely, your mutual insurance supplements the Social Security reimbursement to obtain a full reimbursement of the convention rate.
For example, when you consult a general practitioner: social security reimburses you 70% and mutual insurance 30%.
Please note, this type of contract does not reimburse excess fees.
If you want to benefit from an optimal level of reimbursement, you must choose a mutual with higher guarantees.
There are mutual support levels of up to 400% reimbursement.
Here, the mutual will cover your excess fees.
Did you know it?
We often hear about the responsible mutual contract.
This type of contract aims to make policyholders responsible by declaring a treating doctor and respecting the coordinated care pathway.
It allows you to obtain advantages in terms of reimbursement and prices.
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