We recently published an article about French mandatory health benefits, and why British business owners should be aware of them if they wish to establish a successful presence in France.
One such benefit is mutuelle health insurance, which provides ‘top-up’ cover for medical costs not covered by the French state. Mutuelle health insurance is a mandatory requirement for all employees in France, and the employer must pay at least 50% of the cost.
How does mutuelle health insurance work in practice?
A sick employee will visit their GP as soon as they fall ill. During the consultation, they will present their Carte Vitale, which is issued to every French citizen over 16 and entitles them to subsidised healthcare from the state.
The GP uses the employee’s Carte Vitale to issue an electronic healthcare form, which details information about any medical procedures needed and the associated cost. Usually, this information is also sent to the Caisse Primaire d’Assurance Maladie (CPAM) – which is the local health insurance fund – automatically.
The employee will pay their GP at the end of the consultation, then await reimbursement by the CPAM. Generally, this is received within five days, paid directly into the bank account associated with the employee’s social security number.
Mutuelle health insurance is particularly important because not all healthcare costs are reimbursed by the CPAM.
There is an official fee for each medical procedure, called tarif de convention. This fee is used as the basis for determining individual CPAM reimbursements, when it is referred to as base de remboursement. This is usually calculated at between 15% and 100% of the total cost.
The total amount reimbursed can be low, particularly for optical, dental, and hearing procedures, and there are some exclusions. This makes mutuelle insurance particularly vital, since it ‘tops up’ these shortfalls. It also explains why some French companies choose to pay over the 50% mandatory mutuelle contribution, sometimes with additional provision for partners and family members, as a valuable benefit that promotes employee health and wellbeing.
Depending on the level of cover chosen, the mutuelle reimburses all or part of the remaining fee, following reimbursement by the CPAM.
The amount reimbursed is expressed either as a percentage of the tarif de convention or base de remboursement, or as a fixed price in euros.
There is a large number of mutuelles available for employers to choose from. In most French companies, the convention collective will set out a minimum level of health cover that must be provided to all employees.
Can we answer your questions about mandatory health benefits in France?
Our experienced team can help you both understand and navigate the French healthcare system, and which requirements may apply to your company.
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