Health reimbursement Health insurance: what benefits?

Are you in doubt about which health allowance is provided by the health insurance? Here is the list of benefits reimbursed by social security!

In France, social security is a public body that pays for care and medical procedures resulting from conventional medicine according to a fixed rate system.

Which health supplement do I have access to in my care course?

Medical consultation with the general practitioner

When the consulted doctor is your attending physician, the medical consultation is part of the care process. In this case, the reimbursement from the health insurance is provided at a rate of 70% of the price of the consultation, which can vary from €25 to €60 (depending on the nature of the consultation). The reimbursement received is then set at an amount that varies from €16.50 to €41 after deducting the fixed contribution of €1/insured. This reimbursement applies to a general practitioner contracted in sector 1. For sector 2, medical expenses are free: the health insurance provides a reimbursement on the basis of €23, i.e. €15.10 after deducting €1 of participation lump sum.

Apart from the care process, i.e. if the general practitioner is not your attending physician, social security reimburses the patient at a rate of 30%, i.e. €6.50 for a sector 1 doctor and €5.90 for a sector 2 (after deducting the apartment). – rate contribution), i.e. a residual fee of at least €17.50 to be reimbursed by your supplementary health insurance.

Contact a specialist

As part of the care process, i.e. following a referral from your attending physician, the health insurance provides reimbursement at a rate of 70%, regardless of the type of professional practice involved. Apart from the course of care, the social security cover is identical to that of the general practitioner: a reimbursement rate of 30%, supplemented by cover from the mutual insurance company.

It should be noted that certain specialties within the medical sector can be consulted without a prior letter from your attending physician: gynaecology, stomatology, psychiatry, ophthalmology and neuropsychiatry for children between 16 and 25 years of age.

Hospitalization

In connection with hospitalization, the hospital package is the patient’s responsibility, but can be covered according to the contract drawn up with their supplementary health insurance. The health insurance reimburses hospitalization costs up to 80%, excluding excess medical expenses and expenses related to comfort during hospitalization: TV, telephone line, single room. There is still a rate of up to 20% which can be covered by the mutual or by a supplementary hospitalization insurance, depending on the amount of the reimbursement taken out with your supplementary insurance.

the health insurance reimbursement rate by type of treatment

SEE ALSO: How do you reduce the costs of your mutual health insurance?

Medicine

As for medicines, they are reimbursed at full rate when they belong to the list of eligible pharmaceutical specialties. Apart from nicotine replacements, of which the reimbursement is up to 65%, the rest of the medicines are not covered by the primary health fund; your mutual insurance company may reimburse these types of expenses depending on your level of protection.

Maternity

There are special conditions for receiving unemployment benefit in connection with maternity, depending on your professional activity. The easiest way is to contact your department’s health insurance to get precise information about the coverage of your maternity leave. Be that as it may, Social Security covers 100% of medical expenses during childbirth and offers third-party payment for a period of up to 12 days after the birth of the child.

Special case

A person with a long-term disorder (ALD) receives full reimbursement (100%) regardless of the price of the medical procedure, as long as the care and treatment is related to the declared pathology.

💡 To know details of reimbursement ratessee the overview tables available on the health insurance website: https://www.ameli.fr/assure/remboursements/rembourse/tableau-recapitulatif-taux-remboursement

Health insurance: how will you be reimbursed by social security?

SEE ALSO: What does an employee on sick leave cost the employer?

The history of health insurance in France

The Caisse Primaire d’Assurance Maladie (CPAM) was created in 1945 with the aim of offering a guarantee of funds to meet the health needs of all members of a family. 1 year later, occupational risks are included in the role of social security, which is responsible for compensation and prevention of their occurrence in the workplace.

In 1967, health insurance split into 3 different branches to better meet the needs of the French: the health sector, the family sector and the elderly sector.

In 1998, the vital card appeared; it will be a physical medium that allows holders to receive reimbursement for medical expenses in connection with treatment or hospitalization.

Today, the missions of health insurance have expanded: they go beyond simple reimbursement after consultation with a doctor, supply of medicine or maternity leave, it must ensure the management of health goods and services, individual health data and relationships with health professionals.

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