HEYME supplementary health insurance: how to get reimbursed?

HEYME student health insurance

Social security: payment of my medical expenses

Compulsory health insurance partially covers the medical costs of all members of the general social security scheme.

The rates for medical services (consultation, purchase of medicines, biological analyses, etc.) are set by agreement between health professionals and the national health insurance fund.

These convention rates determine the amount of reimbursements and can be modified according to the nature of the medical procedure and the course of coordinated care.

The doctor’s sector of activity, whether general practitioner or specialist, also influences the reimbursement basis:

  • Doctors in sector 1 apply the rates agreed in advance with the Health Insurance.
  • Physicians who are members of the OPTAM (Optics of Controlled Pricing Practice) charge moderate excess fees.
  • Doctors in sector 2 apply free rates.

After reimbursement from Social Security, what is left for me?

After Social Security reimbursement, the rest is made up of:

  • the moderator ticket (the part that remains my responsibility);
  • excess fees charged by certain healthcare professionals;
  • the fixed contribution of €1 applicable to consultations, medical procedures and radiological examinations;
  • the medical deductible applicable to drugs, paramedical and medical transport.

When does the HEYME complementary health insurance come into play?

In addition to your compulsory scheme, HEYME offers you the subscription to complementary health insurance to strengthen your medical cover and reduce your remaining costs.

The HEYME complementary health insurance intervenes after receipt of the Social Security statement to reimburse part or all of the remainder payable (moderator ticket) up to the guarantees subscribed to in the contract.

HEYME student health insurance

How can I be reimbursed for the remaining charge (moderator ticket)?

There are two scenarios for the management of the moderator ticket by HEYME:

1er case :

If you have a vital card, your attending physician sends your care sheet directly electronically to Social Security, which will make a transfer to your bank account to reimburse you for your share.

2th case :

If you do not have a vital card, you will have to send the care sheet with the invoice to the CPAM by post for a reimbursement request.

The reimbursement of the moderating ticket occurs after receipt of your statement on your space Ameli.fr. You will have to send it to HEYME.

It is possible that the management of the co-payment and any overruns of fees will be made by remote transmission if your health insurance fund is linked to HEYME thanks to the NOEMIE system.

HEYME refund calculation example

If you consult a sector 1 contracted general practitioner and he charges you €25 (convention rate), HEYME will reimburse you 100% of the basic Social Security rate.

The amount reimbursed by Social Security:

Social Security will reimburse you 70% of the convention rate, i.e. €25 x 70% = €17.5 (compulsory reimbursement). You subtract €1 of fixed participation from this price and you get €16.5.

The amount reimbursed by HEYME:

The remainder payable is the difference between the rate of the agreement and the reimbursement of the compulsory part by Social Security, i.e. €25 – €16.5 = €8.5

HEYME will reimburse you €7.5 (moderator ticket €8.5 – fixed contribution €1) if you have chosen a level with 100% coverage. Only the fixed participation of €1 will remain your responsibility.

Good to know :

HEYME reimbursements depend on your level of guarantee in your contract. The higher the level, the greater the coverage and the lower the remaining charge.

If your attending physician does not practice excess fees, you will be reimbursed for all of your expenses except for the fixed contribution of €1.

If your state of health obliges you to consult doctors regularly with excess fees, then it would be interesting to subscribe to guarantees which offer a reimbursement rate of more than 100%.

And at HEYME, the reimbursement is fast?

A major player in student mutual insurance, HEYME offers you guarantees adapted to your profile from €9.90 per month to reduce your out-of-pocket costs and obtain the best reimbursements for your health expenses.

Three formulas are offered to simplify your reimbursement process at HEYME:

  • Refund request via your HEYME app

Log in to the Mutuelle HEYME app and press the (+) icon. Select the invoice and the statement.

If you need an estimate for your optical care, choose the “estimate” option and send it as an attachment*. Our team of advisors will process your request as soon as possible.

The sending of the estimate is also valid via the contact form.

HEYME student health insurance

  • Refund request via the contact form

On the heyme.care website, you can access the “contact us” page and fill out the contact form by filling in your details and selecting the subject of your request.

On the “message” part, briefly explain your request, attaching the supporting documents*, such as the paid invoice and the Social Security statement.

HEYME student health insurance

  • Reimbursement request via the Personal space

Log in with your e-mail and your password on the contact tab of your HEYME personal space.

Select “Invoice” and complete the contact form.

Finally, attach* the paid invoice and the Social Security statements.

HEYME student health insurance

* Must not exceed a total of 4 MB per submission with a maximum of 5 files.

You can now consult your doctor or buy medicine without having to pay a penny, thanks to your HEYME health insurance card. It allows you to benefit from third-party payment anywhere in France, provided that your healthcare professional is in agreement with our service provider Almerys.

For any further information, call us on 09 71 09 07 07

👉 HEYME student mutual

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