An accident can happen quickly: broken wrist, fracture of the leg, tearing of the cruciate ligaments… so many heavy health expenses to finance and without Complementary Health the bill can be salty! Being well protected is important to be well reimbursed.
Even if Social Security covers part of your health expenses, it does not reimburse everything! Subscribing to complementary health insurance (mutual) is strongly recommended to reduce all or part of the costs that remain your responsibility.
A little lost in how the care system works? We explain everything to you!
- 1 The health system in France
- 2 Social Security
- 3 Complementary health insurance (mutual)
- 4 And at HEYME, what does mutual insurance give?
The health system in France
A little history…
Created in France after the Second World War, Social Security is a collective protection system that dates back to 1945. At that time, the country was devastated and society had to be rebuilt. It is within this framework that it was decided to develop a national system of universal solidarity aimed at covering each individual against “social risks”.
Social security is therefore based on a principle of solidarity; every citizen is protected (employees, self-employed, civil servants, students, etc.) and everyone participates according to their means (contribution system) so that each person benefits from this protection.
Thus, thanks to their contributions, people in good health are in solidarity with the sick and workers are in solidarity with the inactive and retired.
More than 70 years after its creation, Social Security plays a very important role in the daily lives of French people. It protects in terms of illness (healthcare costs, maternity, etc.), old age (retirement, loss of autonomy, etc.), family (early childhood, youth, etc.), occupational diseases/work accidents.
In France, Social Security covers you through the “scheme” to which you are attached according to your professional activity or status (students, salaried workers, self-employed workers, employees or farmers, liberal professions, civil servants, etc.).
As a student, you are attached at the general scheme of Social Security. Thus, the Primary Health Insurance Fund (CPAM) of your place of residence is responsible for reimbursing your healthcare costs for the compulsory part (70% on average) and your mutual insurance company is responsible for reimbursing you for the additional part (responsible).
Social Security does not reimburse all your health costs
Social Security covers health expenses on the basis of the fixed agreement rate. Depending on the medical acts, the reimbursement rates vary but are on average around 70%. Below are some examples:
- 70% for medical consultations and radiological examinations
- 15% to 65% for drugs
- 60% for nursing care, physiotherapy acts, biological analyzes
Reimbursements are broken down into two levels:
- The obligatory partcovered by Social Security
- The complementary partalso called moderator ticket and which remains your responsibility
TO KNOW !
The tariffs for medical care are set by Social Security. For example, a consultation with a general practitioner is set at €25. However, some health professionals practice fee overruns and therefore freely set their rates. Fee overruns are never covered by Social Security but can be covered by complementary health insurance.
As you will have understood, Social Security does not reimburse everything and to avoid a remaining charge, it is strongly recommended to subscribe to complementary health insurance, also called mutual insurance, to complete your reimbursements.
Complementary health insurance (mutual)
What is a health supplement for? ?
An accident quickly happened: broken wrist, broken leg, torn cruciate ligaments…
without complementary health the bill can be salty!
The role of complementary health insurance is to cover all or part of the health expenses that remain your responsibility (moderator ticket) after reimbursement from Social Security, hence the designation of “complementary”: doctor’s, dental, optical expenses , fee overruns, hospital package, …
Some supplements can also pay for other services not reimbursed by Social Security, such as: alternative medicine, dental implants, certain medications or vaccines for foreigners, etc.
In addition, with your mutual you benefit from third-party payment which allows you to no longer advance the costs to most doctors. Your complementary health insurance liaises directly with the healthcare facility to settle the bill.
TO KNOW !
To facilitate access to care, there is a device allowing better care in the fields of optics (eyeglasses), audiology (hearing aids) and dental (dental prostheses); it is the 100% health reform. This reform, which has been rolled out gradually since 1 January 2019, should allow access to quality care fully covered by Social Security and complementary health in the 3 aforementioned areas. Concretely, if you need a pair of glasses, the optician has the obligation to offer you at least one quote that meets 100% health standards.
Concretely, how does it work ?
Once you have subscribed to complementary health insurance, you must provide your mutual with a RIB (bank details) to receive your reimbursements, as well as a copy of your certificate of affiliation to Social Security so that your mutual can set up relationship with your Caisse Primaire d’Assurance Maladie (CPAM) and activate the remote transmission.
Without the remote transmission, you will have to connect to your personal space on the official site ameli.fr and download your reimbursement statement to send it to your health insurance fund by post or electronically.
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…