The French healthcare system is considered one of the best examples of universal care at affordable rates – but how does the mutuelle work?
What is a mutuelle?
As the state only pays for around 70% of the majority of healthcare costs, many of those living in France choose to purchase a top-up health insurance, called a mutuelle, to cover the rest of the cost.
There are numerous insurers to choose from and, as with all types of insurance, a wide range of policies with varying degrees of cover and premiums. Basic packages tend to cover hospital costs and medicine, but you can choose to add things like dental costs. It is worth shopping around and seeking advice to ensure you choose the best policy for your needs and budget. If you’re an employee of a company, you will most likely be able to join the company’s policy as part of your benefits package.
However this complementary health insurance should not be confused with private health cover in the UK. Although bought by the individual, it simply assists financing the personal contribution element of French healthcare. It is inexpensive, does not guarantee faster treatment times and is not affiliated to private practitioners or clinics as with the UK private healthcare model.
In terms of payment, the individual pays for treatment and the relevant State fund is automatically alerted via the carte vitale system. The percentage refunded by the State is then indicated to the relevant mutuelle which calculates accordingly how much it will reimburse.
If you work for a private company…
Since January 2016 it became compulsory for private companies to provide employees with a company private health insurance policy known as a mutuelle collective. The company must contribute a minimum 50% of the mutuelle’s cost, and employees in theory are obliged to join the scheme unless they have a good reason for not doing so. (This new law does not apply to public sector organisations.) Many private companies have long had a mutuelle collective in place as a staff perk, with many also extending rights to employees’ immediate family members.
If you don’t…
For the rest of the population – civil servants, job seekers, students, pensioners, the self-employed – the only option is a mutuelle under a contrat individuel, and these generally offer less favourable terms. However, the cost of a mutuelle is not comparable with private health cover in the UK. It’s generally affordable and the majority of people in France have one, albeit one offering greater or lesser cover according to their needs and financial means.
How to choose a mutuelle
But be warned: the mutuelle marketplace is crowded and competitive, so it’s advisable to ask French friends or even the local doctor for recommendations to be sure that your choice of mutuelle is right for your needs. You can get a basic idea of costs by looking at online comparison sites, but don’t use them to make a selection as most of these sites are either linked to, or receive commissions from, insurance companies and are not therefore offering independent advice.
The small print of a mutuelle contract, in particular the reimbursement calculation, is not simple to follow. You need to look carefully at what each mutuelle offers, both in terms of cover (basic and options) and compare this with your actual or likely needs, and understand clearly how much they actually reimburse. The latter may be indicated as a fixed amount or in percentage terms. Beware of the percentage indication because this signifies a percentage of the tarif de convention (TC) – i.e. the fixed price set by the state and upon which the state payment contribution is based.
If the health practitioner adheres to the TC and the mutuelle states you will receive 100% of the TC, then you will be effectively reimbursed for all the share of the fee not covered by the state contribution. However, if the practitioner does not adhere to the TC, as many specialist practitioners do not, then they are free to set their own prices which may be much higher – but the mutuelle will still only pay for your share of costs up to 100% of the TC, leaving you to pay the rest of the actual cost. Because of this anomaly, it isn’t unusual to see some mutuelle reimbursements indicated as 150%, 200% or even 400% for more specialised treatments.
Also be aware of the conditions for changing your options and ending your contract. Termination (résiliation) conditions in particular can be quite specific, requiring notice given well in advance within a certain time window, and it is almost impossible to end a contract before it has run its course.
Written by Kate McNally