Need braces for your child, new glasses, or an X-ray? These expenses can add up quickly. As health insurance experts, we recommend checking your mutuelle's coverage to avoid surprises. Learn about the 'Commitment to Readability of Complementary Health Guarantees' for greater clarity.
Improving Readability of Guarantee Tables
In France, over 95% of the population relies on complementary health insurance like mutuelle. But how much do medical services truly cost after Social Security and mutuelle reimbursements? A landmark agreement signed on February 14, 2019, by complementary health insurers enhances the readability of these guarantee tables, aligning with the '100% Health' reform for zero out-of-pocket costs on optics, dental, and hearing aids.
This initiative promotes transparency, empowering policyholders to compare reimbursement offers effectively.
What is 'remainder to charge'?
The remainder to charge is what you pay after Social Security and mutuelle reimbursements: total expense minus reimbursements. The '100% Health' reform eliminates this through price caps, higher Social Security reimbursement bases, and mutuelle mandates for full coverage.
Harmonized Health Cost Guarantees
To simplify comparisons, insurers must:
– Use standardized reimbursement categories in guarantee grids.
– List 15 common care examples with uniform headings:
Reimbursement examples must now show amounts in euros (not percentages) for precision. Insurers provide online calculators detailing:
These tools help estimate out-of-pocket costs post-reimbursement.
A Real-World Example
Consider a standard GP visit at €23: Social Security covers 70% (€16.10), mutuelle adds 30% (€6.90), leaving nothing out-of-pocket. If fees exceed to €32, reimbursements stay the same (€23 total), so remainder is €9 (€32 – €23 = €9).
From 2020, this commitment enables patients to grasp their coverage instantly, forecast reimbursements, and select the best mutuelle for their needs.
