How to choose a health mutual?

How to choose a health mutual

Before choosing your health mutual, you should define your needs and take a good look at the guarantees and reimbursement rates offered. Is it compulsory to have one? What criteria should be taken into account?

Currently, 5% of French people, i.e. approximately 3 million people, do not have complementary health insurance, which prevents them from accessing care. A mutual health insurance company offers supplementary medical coverage services. In other words, mutual health insurance is an organization you can join to benefit from additional protection for your healthcare expenses. Mutual health insurance therefore completes the basic coverage offered by Social Security by reimbursing additional expenses. THE Reimbursement rates may vary depending on the contract that you have chosen and of the mutual insurance company to which you belong. Is it OBLIGATORY to have health insurance? What are the criteria to be taken into account when choice of a mutual health insurance?

Is it compulsory to have health insurance?

Nothing obliges you to take out mutual health insurance. So what is it for? Social Security only reimburses part of the health costs, for example 70% of a consultation with a general practitioner at 25 € or a sector 1 approved specialist at €30. The rest of the sum is not covered. Free fees, dental and optical care increase the sums payable by the insured. The role of complementary health insurance is in particular to supplement coverage by reimbursing all or part of the costs that have not been reimbursed by the compulsory scheme. Currently, 5% of French people, i.e. approximately 3 million people do not have supplementary health insurance, which prevents them from accessing care. “In this case, do not hesitate to turn to the CMU, recommends Dr. Monique Quillard, general practitioner. Complementary universal health cover (CMU-C) is free health protection. It is awarded subject to residency and resource conditions. To request it, a file must be compiled (forms and supporting documents). Once awarded, the CMU-C is granted for one year. Renewal must be requested each year“.

What is the difference between an insurance and a mutual?

Two types of structures offer their services: insurance governed by the insurance code are commercial enterprises seeking above all profitability, and mutuals, non-profit organizations, governed by the code of mutuality and operate on the principle of solidarity.

Rates can vary considerably: so don’t hesitate to compare quotes from different health insurance companies and adapt them to your needs… Consulting the Internet allows many choices. Do not hesitate to spend time there, you can make significant savings. To help you, you can also use online health insurance comparators: you indicate your priorities to access offers adapted to your needs.

What are the criteria to take into account when choosing a mutual health insurance?

► Before you start, take stock of your health needs and consumption taking into account:

  • The number of doctors, general practitioners and specialists consulted each year
  • The consumption of medication and complementary care (physiotherapy, osteopathy, psychologist, psychoanalyst, etc.)
  • The age of the insured(s): some organizations offer rates that increase according to age, generally with each change of decade, or every 5 years.
  • The use of dental care: orthodontics, prostheses, etc.
  • The use of optical care: glasses, contact lenses

Predict the need for hospitalization. Check:

  • The duration of reimbursement during hospitalization.
  • Coverage of the hospital package.
  • Support for any excess fees.
  • The management of a particular room.
  • Rates covered in a clinic.

Health questionnaires. They are not always mandatory. Choose a supplementary health insurance that does not require a health questionnaire that could lead to exclusions or surcharges.

The waiting period corresponds to the period during which certain reimbursements are not taken into account. Choose a health insurance that does not apply a waiting period.

Third-party payment. Ensure that the health insurance fund applies third-party payment. The third-party pharmaceutical payer avoids having to advance drug costs.

Reimbursement deadline. Some mutuals reimburse in a few days, others at the end of the current month. It’s time to check.

► Watch the care not reimbursed by Social Security. Some treatments are not covered by Social Security: this is the case for sessions osteopathy, dietetics or psychotherapy. “On the other hand, some mutuals offer, on invoices, to reimburse part of it or to make an annual flat rate. If you use these therapies, this is also a point to check“, recommends Dr. Quillard. Vaccines, certain treatments for impotence, nicotine substitutes to quit smoking… can be covered by your mutual health insurance. Some companies impose mutual insurance on their employees, for which they provide part of the reimbursement. The conditions offered to employees are generally advantageous.

Thanks to Dr Monique Quillard, general practitioner.