Healthcare in France is heavily subsidized by the State, leading to higher taxes compared to other countries. Healthcare expenses make up about 25% of the country’s wealth, with over 470 million euros being spent annually. In France, a “mutuelle” serves as a private health insurance plan designed to cover medical expenses not included in the state health insurance system, referred to as “sécurité sociale.” You have the option to acquire a “mutuelle” policy individually and extend coverage to your family members, including children.
The monthly premium typically ranges from EUR 30 to EUR 100, on average. For individuals with constrained financial means, there’s the possibility of accessing the “Complémentaire santé solidaire (CSS),” which offers either free or affordable state-sponsored “mutuelle” coverage.
All legal residents and workers in France are covered by the state’s Protection Universelle Maladie (PUMA), which is managed by L’Assurance Maladie or Ameli.fr. This coverage includes essential and emergency treatments. However, patients may still be required to pay for certain services such as doctor visits, dental care, and some prescription medications. After presenting their Carte Vitale during the appointment, a portion of these costs will be automatically reimbursed by L’Assurance Maladie. A list of state reimbursements can be found on their website.
For example, in 2021, a doctor’s visit costs €25 and the patient is responsible for paying this amount at the time of the appointment. L’Assurance Maladie will then reimburse 70% of this cost (€17.50), leaving the patient or their Mutuelle insurance to cover the remaining €6.50. Hospitalization at any state or private hospital is reimbursed at a rate of 80%, with the patient responsible for paying the remaining percentage.
Insurance is an agreement, outlined in a policy, through which a policyholder obtains financial safeguarding or compensation from an insurance provider against losses. The insurer consolidates the risks of its clients to reduce payment costs for the insured. The majority of individuals hold various types of insurance, such as for their automobiles, residences, health, or life. Insurance policies serve to mitigate financial losses stemming from accidents, injuries, or property damage. Additionally, insurance assists in defraying expenses linked to liability, addressing legal obligations for damages or injuries inflicted upon third parties.
A mutuelle is a type of complementary health insurance in France. It is designed to supplement the coverage provided by the French national health insurance system, known as “Sécurité Sociale.” Mutuelles cover various healthcare expenses that are not fully reimbursed by Sécurité Sociale, such as copayments, deductibles, and services that are not covered at all. They can also provide coverage for additional services like dental care, vision care, and alternative medicine.
Mutuelles are offered by private insurance companies, mutual associations, or specialized healthcare funds. They typically operate on a subscription basis, where individuals or families pay a monthly or annual premium in exchange for coverage. The specific benefits and coverage options offered by mutuelles can vary widely depending on the provider and the plan chosen.
HOW TO TAKE OUT A PRIVATE HEALTH INSURANCE POLICY KNOWN AS A “MUTUELLE” IN FRANCE
To take out a private health insurance policy known as a “mutuelle” in France, you need to follow these steps outlined below:
- Do Findings: Compare different insurance providers and their policies to find the one that suits your needs and budget. You can look for information online or consult an insurance broker.
- Write out your needs: Consider what coverage you require, such as hospitalization, dental care, maternity services, or prescription drugs. This will help you select the appropriate level of coverage for your mutuelle.
- Compare quotes: Request quotes from different insurance providers to compare prices and coverage options. You can often do this online or by contacting the insurance companies directly.
- Fill out an application form: Once you have chosen a mutuelle provider, complete their application form with your personal information and desired coverage options.
- Provide necessary documents: Along with your application form, you may need to provide supporting documents such as proof of residence in France or proof of income.
- Review the policy details: Carefully review the terms and conditions of the policy before signing any contracts or making any payments. Make sure you understand what is covered and any limitations or exclusions that may apply.
- Pay premiums: If you are approved for the mutuelle policy, you will need to pay regular premiums to maintain your coverage. The payment method and frequency will depend on the insurance provider’s policies.
Remember that private health insurance in France is optional but can provide additional coverage and faster access to healthcare services than relying solely on the public healthcare system (known as Assurance Maladie).
WHO CAN BENEFIT?
Individuals enrolled in state health insurance systems like the general scheme called “Protection universelle maladie (Puma)” (commonly known as “sécurité sociale”) are eligible to purchase supplementary health insurance, often referred to as “mutuelle.” Alternatively, one can reach out to organizations providing “mutuelles” to inquire whether they accommodate subscriptions from individuals lacking social security or “sécurité sociale” coverage.
IS IT MANDATORY TO TAKE A MUTUELLE IN FRANCE?
Private health insurance in France, known as mutuelle, is generally mandatory and there are limited exceptions. However, individuals may not be required to enroll in their employer’s mutuelle if they already have coverage from another source or if they are on a fixed-term contract lasting less than three months.
HOW MUCH DOES A MUTUELLE COST IN FRANCE?
Individuals have the option to obtain a “mutuelle” insurance policy for themselves and include their family members, including children. The policy requires a monthly payment, typically ranging from EUR 30 to EUR 100 on average.
REQUIREMENTS FOR A MUTUELLE
To be eligible for a mutuelle health insurance policy in France, you need to reside in the country and be registered in the state healthcare system. As a foreign citizen living in France, you will need to provide certain documents such as your passport, residency card or visa (titre de séjour). Additionally, you will be asked to present evidence of your work status (tax return or avis d’imposition, work contract, or payslips) or proof of at least 6 months’ residency in France (rental receipts or quittances de loyer, electricity bills, or a signed attestation from the homeowner you are staying with).
HOW DOES IT WORK?
Mutuelle health insurers, known as “mutuelles de santé,” are the exclusive providers of mutuelles health insurance. These insurers are non-profit cooperative organizations owned by their policyholders.
The concept of mutuelles originated in French history before the Revolution, but they gained prominence after World War II as large organizations aimed at improving protection and care for the population. The ideology and organization of mutuelles have a rich history of conflict and liberty which can be explored further in this source (assuming you understand French).
It’s important to note that while mutuelles may offer various insurance policies such as home or car insurance, these are distinct from “les mutuelles de santé” which solely focus on health insurance. These other types of mutuelles d’assurances operate similarly but are governed by the “code des assurances” instead, meaning they do not provide the same comprehensive coverage.
WHICH MUTUELLE SHOULD YOU CHOOSE?
There is a wide range of mutuelles available in a competitive market, so it’s advisable to compare options and find the most suitable one for your specific needs.
- When selecting a mutuelle, it’s crucial to consider the policies available and the coverage provided. It’s important to fully understand what is included and excluded from the coverage as these can differ significantly between insurance companies.
- The cost of the policy is another important factor that varies depending on the insurer and policy chosen.
- It’s also essential to check which medical establishments accept the mutuelle you are considering. Not all establishments accept all mutuelles, so conducting additional research can save you frustration later on.
- While there are many popular mutuelles available, such as MGEN, Mutualia, Mutuelle Générale, Unéo, Harmonie Mutuelle, MNT, and Previfrance; this list is not exhaustive.
HOW TO APPLY
Numerous companies provide “mutuelles.” It’s advisable to compare multiple offers to identify the most suitable one for you, assessing factors like their rates and reimbursement assurances. In France, if you’re employed, your company is obligated to offer an employee “mutuelle.” You can inquire with your employer about the eligibility criteria for accessing this benefit. Typically, the company contributes towards the cost of the “mutuelle.”
Certain “mutuelles” offer customizable packages, enabling you to adjust coverage according to your specific requirements. After selecting your “mutuelle” and confirming the included guarantees, you’ll proceed to sign a contract. The company will guide you through the necessary steps and documentations, including providing a bank identity document such as a “relevé d’identité bancaire (RIB)” for reimbursement processing directly into your account.
AFTER APPLICATION
After enrolling, your “mutuelle” will inform the organization overseeing your health insurance benefits, known as the “caisse d’assurance maladie,” if you’re registered with them. You can verify the connection of your “mutuelle” to your state health insurance account, for instance, on ameli.fr.
In most cases, you can enjoy the benefits of remote transmission, a system allowing your “caisse d’assurance maladie” to automatically inform your “mutuelle” about any unreimbursed healthcare expenses. This implies:
No additional steps are required from your end.
Upon receiving the notification, your “mutuelle” will reimburse your medical expenses within the limits of the coverage outlined in your policy.
Reimbursements will be directly deposited into your bank account.
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CONCLUSION
When selecting a mutuelle, the crucial factor to consider is the policy you opt for and the extent of its coverage. Initially, it’s important to note that supplementary insurance, like mutuelles, only reimburses expenses that the securité sociale also covers; they no longer function as distinct services.
Nevertheless, different mutuelles provide varying amounts of financial support for different services. For instance, while some may offer €400 towards new glasses, others might provide only €120. Hence, it’s imperative to clearly assess your needs when requesting a quote during your mutuelle search. Some mutuelles may offer favorable rates for dental care, while others may not. Typically, mutuelles cover hospital stays and home nursing care, but additional medical services may either be included at no extra cost or require a co-payment, depending on your contract.
If you anticipate needing surgery, it’s advisable to join a mutuelle beforehand. Additionally, it’s essential to check whether there’s a waiting period before you can access certain services. For instance, some mutuelles require a membership duration of at least 9 months before maternity coverage takes effect for women planning to conceive.
Many mutuelles include coverage for complementary health services such as osteopathy and physiotherapy, and some may extend coverage to herbal medicine and alternative therapies, albeit at potentially higher premiums.
It’s crucial to ensure that the healthcare professionals you consult are validated by the state, meaning they hold the Diplome d’Etat and are part of the recognized conventional medical system. France’s healthcare system tends to favor traditional medicine, and mutuelle reimbursements reflect this. You can verify which professionals and facilities are covered by consulting Ameli.
One notable aspect where French healthcare surpasses that of the UK, for instance, is in coverage for fertility treatments. Public hospitals like Cochin in Paris provide free procedures with mutuelle assistance. However, opting for a private fertility clinic entails out-of-pocket expenses, typically around €60 per consultation, which mutuelles do not cover.