Hospitalization without complementary health insurance: what are the costs?

HEYME supplementary health insurance

In France, the costs of hospitalization are particularly high. Despite good coverage by Social Security, all costs incurred are not reimbursed.

If you have taken out supplementary health insurance, you have made the right choice. If you haven’t done it, the bill at the exit is likely to be salty!

Without complementary health insurance, how much does a hospitalization cost? What is the coverage of the health insurance and what are the costs that remain your responsibility?

We take stock of hospitalization without complementary health insurance!

How much does hospitalization cost without supplementary health insurance?

Whether you are hospitalized in a public institution (hospital) or private institution (clinic), you must count:

❖ The hospital package

The hospital package represents your financial contribution to the accommodation and maintenance costs incurred by your hospitalization. It is due for each day of hospitalization, including the day of discharge.

This is the sum that remains your responsibility, after reimbursement by Social Security, for any stay of more than 24 hours in a public or private hospital.

He’s from :

● €20 per day (day of discharge included) in hospital or clinic;

● €15 per day in the psychiatric department of a health establishment.

⮚ Social Security does not reimburse the hospital package. It may be covered by your complementary health insurance if the contract you have taken out provides for it.

Without complementary health insurance, the bill gets heavier very quickly!

HEYME supplementary health insurance

Exemption from the hospital package in certain cases

You will not have to pay the hospital package if:

● You are a pregnant woman hospitalized during the last 4 months of pregnancy, for delivery or during the 12 days after delivery;

● You benefit from Complementary health solidarity (ex-CMU-C and ACS) or state medical aid;

● Your child is hospitalized within 30 days of birth;

● Your hospitalization is due to an accident at work or an occupational disease (when the hospitalization is attributable to the accident at work or an occupational disease);

● You are being treated as part of hospitalization at home;

● Your disabled child under the age of 20 is housed in a special or vocational education establishment;

● You depend on the Alsace-Moselle regime;

● You are in receipt of a military pension;

● You are the victim of an act of terrorism and benefit from full coverage for care related to this event with a valid certificate.

❖ Costs and care related to hospitalization

In addition to the care provided, the salaries of health professionals (doctor, surgeon, anesthetist, radiologist, nurses, etc.) must also be taken into account, not to mention the salaries of administrative staff, the costs of drugs, medical devices and building charges (electricity, heating, etc.).

❖ Additional costs

If you wish to improve your personal comfort (a single room, television, internet, travel by loved ones to the bedside, etc.), the additional costs or additional costs are also your responsibility.

⮚ Complementary health insurance can finance these costs depending on the cover chosen.

❖ Fee overruns

We talk about excess fees when the rate charged by a health professional is higher than the conventional rate set by Social Security.

The amount may be fully or partially covered by the mutual insurance company depending on the contract and the level of guarantees chosen.

If you choose to be hospitalized in a hospital establishment which practices fee overruns, you will have to pay them unless you have taken out complementary health insurance which reimburses overrun fees.

❖ Hospitalization in an establishment not under agreement

Non-contracted establishments apply free rates and health insurance reimburses on the basis of conventional rates. The cost of hospitalization in an establishment not under agreement is higher than in a hospital or private clinic under agreement. If you choose a non-contracted private clinic, the costs to be borne by you will be higher.

Hospitalization without supplementary health insurance: what coverage by health insurance?

The cost of hospitalization without complementary health insurance is no different from hospitalization with complementary health insurance: the establishment will not charge you because you do not have mutual insurance. However, being hospitalized without complementary health insurance means that you will have a significant amount to pay. Although Social Security covers a large majority of health expenses, it does not guarantee total coverage.

In general, Social Security covers 80% of hospitalization costs. If you do not have complementary health insurance, the remaining 20% ​​are entirely your responsibility. However, certain situations may give rise to 100% coverage:

● If you are hospitalized for more than 30 days in a row. Social security covers hospitalization costs up to 100% from the 31st day.

● If you are a pregnant woman and you have been hospitalized for delivery during the last 4 months of your pregnancy and during the 12 days following delivery.

● If your newborn has been hospitalized within 30 days of birth.

● If you have been hospitalized following an occupational disease or an accident at work.

● If you have been hospitalized for a long-term condition.

● If you are the beneficiary of a pension for an accident at work, with a degree of incapacity equal to or greater than 66.66% or beneficiary of a beneficiary’s pension.

● If you are the holder of an invalidity pension, invalid widow’s or widower’s pension, old-age pension which has replaced an invalidity pension or a military pension.

● If you are a beneficiary of the Alsace-Moselle local scheme.

● If you are a beneficiary of the CMU-c or the AME.

Social Security also covers health expenses and necessary care after hospitalization (in approved establishments of course). However, even with 100% coverage, hospital costs, excess fees and additional benefits for personal comfort are not reimbursed.

⮚ Mutual insurance contracts cover hospitalization from the first formulas, hence the need to take out complementary health insurance. This will allow you 100% coverage: it will save you from having to pay the hospital package and the co-payment, and depending on the cover chosen, any excess fees. Subscribing to complementary health insurance also allows hospitalization in better conditions, without having to pay the supplements.

Is it possible to take out complementary health insurance during hospitalization?

Some mutuals agree to insure patients during hospitalization. However, you must make sure you have opted for a complementary health insurance called without deficiency, which means that the effects are immediate.

To benefit from maximum cover, make sure you take out it from the first days of your hospitalization.

To choose the offer best suited to your needs, remember to compare the terms of the various complementary health insurances without deficiency, because these do not offer the same guarantees and do not give the same rights to reimbursement. HEYME can accompany you!

The importance of taking out supplementary health insurance

Although it is optional, complementary health insurance is highly recommended; otherwise, you will have to bear the rest, which can quickly reach substantial sums, in particular in the event of hospitalization where the hospital package, the co-payment and excess fees are your responsibility.

The costs associated with hospitalization are particularly high, especially if it takes place in surgery, resuscitation or intensive care units. Subscribing to an appropriate mutual insurance company may therefore be useful to complete the partial coverage of Social Security.

Good to know

Doing without complementary health insurance is a choice! If you do not wish to take it out for budgetary or other reasons, you must still study the possibility of hospitalization cover only to meet health costs in the event of a problem.

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 depending on your budget and the level of protection you want.

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