2024-10-09 10:43:00
Imagine a visit to the ophthalmologist for glasses: you pay €150, but Health Insurance only reimburses a small part of this amount. This is where complementary health insurance comes into play. Whether we talk about mutual or complementary health insurance, the objective remains the same: to reduce as much as possible what we call the “out-of-pocket cost”, i.e. -say the part not covered by Social Security.
The basis: complementary health insurance in a few words
Supplementary health insurance is a contract which supplements Social Security reimbursements for medical, hospitalization, optical, dental, etc. expenses. Depending on the type of coverage chosen, it can also cover procedures not covered by Health Insurance, such as alternative medicine or excess fees.
For example, Pierre, a student who plays basketball, took out complementary health insurance after twisting his ankle. Without it, physiotherapy and care would not have been reimbursed, or at least not entirely.
How does complementary health insurance work?
The principle is simple: you pay a contribution (monthly, quarterly, etc.), and in exchange, your insurer covers all or part of the medical costs that Social Security does not cover. Depending on the contracts, two types of services are offered:
Direct support : for certain interventions, the insurer pays the costs directly, especially in the event of hospitalization.
Reimbursement : you advance the costs and send the supporting documents to the insurer to obtain reimbursement.
Did you know? Some contracts offer “third-party payment”: thus, you do not have to advance anything to the doctor, and the insurer pays the costs directly.
Who can benefit from complementary health insurance?
Contrary to the widespread idea that only certain categories of people are entitled to it, in reality, anyone can take out complementary health insurance, whether they are a student, employee, retiree or unemployed. The contract can cover the family (spouse, children) depending on the options chosen.
Specific cases
Students and young professionals : They can subscribe to supplementary insurance that covers their specific needs, such as emergency care, specialist consultations, etc.
Company employees : Since 2016, private companies must offer compulsory mutual insurance to their employees, with a minimum participation of 50% of contributions.
Additional Tips : People with low incomes may be eligible for Complementary Health Solidarity (CSS), which allows them to benefit from coverage at no or very little cost.
Choosing your complementary health insurance wisely
Faced with the multitude of offers available, how can you ensure you make the right choice? The first question to ask yourself is: what are your needs?
Routine care and optics : for those who regularly consult specialists.
Hospitalization and prostheses : for the elderly or athletes.
Alternative medicine : if you are a fan of acupuncture or osteopathy, check that complementary health insurance offers reimbursements for these procedures.
Compare offers and request a quote
Many online comparators allow you to find offers adapted to your situation and your budget. Before signing, always ask for a table of benefits to understand what is covered and at what level.
Anecdote : Marie, a young employee, thought that a low-cost supplement would be enough. After unexpected dental expenses, she understood the importance of checking the guarantees according to her real needs.
How to cancel or change complementary health insurance?
It is now possible to terminate your supplementary health contract at any time after one year of membership, without costs or penalties, thanks to the sub-annual termination law which came into force in 2020. Termination is simple and can be done by mail, email, or online.
Special cases of termination
In certain situations (marriage, divorce, change of professional situation), it is possible to terminate your supplement without waiting for the end of the first year of the contract.
Advice : If you change mutual insurance, some organizations even offer to take care of the termination of your old contract for you. One less formality for you!
What reimbursements can we expect from complementary health insurance?
Reimbursement levels depend on the contract taken out. Most supplementary plans cover routine care, hospitalization costs, and certain procedures not reimbursed by Social Security. Here are the main items reimbursed:
Routine care : consultations, medications, analyses.
Hospitalisation : accommodation costs, surgery.
Dental and optical : prostheses, glasses, etc.
Example : Hugo needs a dental implant. Its complementary health covers 80% of the expense, which allows him to pay much less than if he only had Social Security.
Additional services offered by mutual insurance companies
Today, most health insurance companies do not just reimburse your medical expenses. They also offer services such as:
Access to a healthcare network : professional partners with advantageous rates.
Assistance : telephone line available to ask medical questions or find a health professional.
Loyalty and benefits
Some health insurance companies reward the loyalty of their members with discounts, coverage improvements or additional services, such as free consultations.
What is the cost of complementary health insurance?
The amount of contributions varies according to several criteria, such as age, place of residence, or the level of coverage chosen. Young people generally pay less, while older people have higher contributions due to increased medical needs.
Did you know? Employees of private companies often benefit from a more advantageous rate, since their employer covers part of the contribution.
For people with low incomes
Aid exists for people with modest incomes, such as the Solidarity Health Supplement. Do not hesitate to inquire with your health insurance fund.
With this comprehensive guide, you are now ready to make informed choices when it comes to complementary health insurance. Choosing mutual insurance is more than a question of price: it’s investing in your health and your peace of mind!
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