Mutual, complementary health, reimbursement basis, care sheets… do you feel a little lost? We explain everything to you here.
Health insurance reimbursements only cover part of the medical services. Subscribing to complementary health insurance (also called mutual insurance) allows you to complete the reimbursement of your health costs and in particular the “ticket moderator”.
- 1 First step, Social Security: reimbursement of the mandatory part
- 2 Then complementary health insurance: reimbursement of the remainder payable
- 3 How are complementary health insurance reimbursements made?
- 4 What about care not covered by social security?
- 5 And at HEYME, what does mutual insurance give?
First step, Social Security: reimbursement of the mandatory part
Social Security reimbursement rates generally depend on three main criteria:
- The medical act : a consultation is reimbursable up to 70% by Social Security, against only 60% for medical analyses.
- The Reimbursement Basis (BR) : reimbursement is made according to an agreement tariff (TC), adapted to each type of medical procedure. For example, a consultation at €30 with excess fees is reimbursed on a BR of €25.
- The care pathway : the convention rate is applied only within the framework of the coordinated treatment course. If you have already declared a general practitioner to your Health Insurance, you must contact him for all your medical procedures. He is the only one authorized to refer you to the specialist doctor.
Once you have received the reimbursement of the compulsory part (Social Security part), it is up to your mutual insurance company to complete the reimbursement of the remainder to be paid or the part of the medical costs not covered by the Health Insurance.
Then complementary health insurance: reimbursement of the remainder payable
After a visit to your doctor.
- If you have a vital card
Your doctor will use your vital card to transmit your personal and medical information (surname, first name, situation, medical act, etc.) to your Social Security center, which will take care of the reimbursement of the compulsory part. This is “teletransmission”. The Social Security statement is then sent electronically to your mutual insurance company for the reimbursement of the remaining charge.
- If you use paper care sheets
If you don’t have a vital card, your doctor will fill out the care sheets which you must then send (along with the invoice) by post to your Social Security centre. A Social Security reimbursement statement will then be sent to you to send to your complementary health insurance.
How are complementary health insurance reimbursements made?
Depending on the guarantees of your contract, you will have different types of reimbursement of complementary health insurance:
- Percentage refunds : 100%, 200% … This means that your complementary will reimburse you up to the percentage indicated in relation to the basic rate of social security. These formulas cover (partially or totally) excess fees, but it is up to you to pay the difference between the convention rate and the amount of the excess.
- Flat-rate refunds : this is the case for non-reimbursed care, such as alternative medicine or optics.
For all treatments not covered by Health Insurance, you must send all your supporting documents (treatment sheets, invoice, etc.) to your complementary health insurance by post. Reimbursement is made within an average of 48 hours, upon receipt of the file.
And at HEYME, what does mutual insurance give?
At HEYME from €9.90/month we cover your essential needs: hospitalization, routine care, pharmacy. And if you need extended coverage, we offer 4 levels of guarantees to meet your expectations.
Regardless of the level chosen, you have unlimited access to medical teleconsultation 24 hours a day with ABI. You can consult a doctor from your smartphone and directly from your sofa!
We also provide you with an app to view your reimbursements, download your third-party payment card, send us your documents and find a doctor near you!
And the icing on the cake… an app with good deals and discounts on your favorite brands: shopping, cinema, restaurant…
👉 HEYME student mutual