Social Security sets the rates and bases for reimbursement of contracted doctors according to two categories: sector 1 or sector 2.
There is even a sector 3. The price of the consultation as well as the amount of reimbursement will therefore vary according to the sector of the health professional. We’ll explain 😉
Sector 1 Doctors
Doctors in sector 1 charge rates set by Social Security. For example, for a general practitioner in sector 1, Social Security has defined the basis for reimbursement at €25, which is the price of the consultation.
The reimbursement of your expenses is made at 70% less a fixed euro of participation, that is to say that on your consultation at 25€, Social Security reimburses you 16.10€. The rest is taken care of by your Mutuelle.
Sector 2 Doctors
Doctors in sector 2 set their own prices. They are contracted – free fees – and practice overruns as far as reasonable. In this case, Social Security has defined the basis for reimbursement of a consultation at €23.
For example, for a general practitioner in sector 2, who has set his consultation at €40, you will be reimbursed on the basis of €23. So 70% of €23 (-€1 flat fee) = €15.10.
This is where your health insurance comes in, by reimbursing you all or part (depending on your contract) of the remainder payable by you. Please note that these reimbursement rates only apply within the framework of the coordinated care pathway (link to the coordinated care pathway article). If you do not follow the course of care, your reimbursement will be impacted.
And the sector 3 doctors?
Sector 3 professionals are not covered by Social Security and their rates are much higher. If you consult a sector 3 doctor, you will be reimbursed up to 16% of the consultation price less a flat-rate euro of participation.
If your doctor charges €45, the Health Insurance will reimburse you €6.20. Calculation : (45€ x 16%)-1€ = 6.20€
If you subscribe to complementary health insurance such as (like that of HEYME), these overruns will be fully or partially covered depending on the guarantees to which you have subscribed.
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