For the vast majority of the inhabitants of this planet, the ticket is access to the cinema, to a show or even to public transport. As for the moderator, it’s the guy who blocks us on the net when we say a nice bullshit.
But suddenly the user fees what’s this ?! An explanation is in order!
- 1 Everything you need to know about the co-payment
- 2 The co-payment in the coordinated and uncoordinated care pathway
- 3 Moderator ticket: cases of exemption
- 4 And at HEYME, what does mutual insurance give?
Everything you need to know about the co-payment
After having incurred reimbursable medical expenses (treatments, consultations, radiology examinations, hospitalization, medication, etc.), the co-payment is the part that remains your responsibility after reimbursement by Social Security.
Depending on the nature of the risk or treatment, the type of medical treatment and compliance with the coordinated care pathway, the amount of the co-payment may be higher or lower.
Your complementary health (mutual) intervenes after Social Security to reimburse all or part of this remaining sum. Thanks to it, you can benefit from a reimbursement of up to 100% of your health expenses.
The co-payment in the coordinated and uncoordinated care pathway
The coordinated care pathway allows you to benefit from the best rate of reimbursement by Health Insurance and complementary health insurance (mutual).
For this, you must declare to the Health Insurance, a doctor who will be your intermediary for any connection with a specialist. In fact, if you need to see a cardiologist for the first time, you must first see your GP (general practitioner) who will refer you to a specialist. Do you understand mechanics?
If you do not declare your attending physician or if you consult a specialist without going through your attending physician, the Social Security reimbursement rate changes considerably.
Take for example a consultation with a general practitioner for angina.
You have followed the coordinated care pathway
You went to consult the professional you declared as your treating doctor to the Health Insurance. Your reimbursement will be 70% of the Social Security convention rate. At the general practitioner, the basis for reimbursement by Social Security is set at €25. You will therefore be reimbursed €16.50 by Health Insurance after deduction of a €1 flat-rate contribution. Your mutual will reimburse you the rest and your wallet will thank you!
You have not followed the coordinated care pathway
You did not consult the professional you declared as your treating physician to the Health Insurance. Your reimbursement will be 30% of the Social Security convention rate, i.e. €6.50. The reimbursement of your mutual will also be impacted because this increase is not reimbursable by complementary health insurance. The rest will be up to you.
Do you better understand the importance of respecting the course of care?
Moderator ticket: cases of exemption
Certain specialties and medical acts are subject to an exemption from co-payments and are fully covered by Social Security.
You can therefore make an appointment without going through your doctor and be reimbursed at the best rate. This is the case for:
- dental surgeons,
- Psychiatrists and neuropsychiatrists
- Care provided following an accident at work, an occupational disease, or an ALD case.
- Pregnant women from the 6thth months of pregnancy up to 12 days after delivery.
- Care of newborns less than 30 days old.
- People who have experienced terrorism or war
- Disability pensioners
- Reimbursement of excess fees (for doctors who do not comply with Social Security agreement rates) is covered by complementary health insurance and not by Social Security.
- In case of third-party payment (link to third-party payment article), only the moderator ticket is your responsibility (if there is one).
- The CMU-C allows you to benefit from total third-party payment and exempts you from the co-payment.
- The fixed contribution of €1 is added to the co-payment.
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