Supplementary health insurance comes third in the reimbursement process. It supplements the coverage of health insurance and mutual health insurance. Subscribing to a “surmutual” makes it possible to deal with the most expensive care such as optics or dental care, which would not be fully covered by insurance or mutual insurance. We explain to you in which case it makes sense to take out additional insurance.
Definition of a health supplement
In terms of health, there are 3 levels of reimbursement:
- The compulsory scheme (general or specific scheme depending on your profession): every Frenchman is automatically linked to it and benefits from a compensation basis.
- The supplementary scheme: the supplementary mutual insurance remains optional, except in the case of compulsory mutual company insurance. However, its subscription is highly recommended to enjoy a good level of protection.
- The extra supplement: this unit comes in addition to the other 2 to strengthen your reimbursement level, especially for expensive health items with a significant out of pocket.
It therefore gives you the opportunity to improve your health cover by taking out specific guarantees adapted to your needs:
- Alternative medicine (osteopathy, hypnosis, sophrology)
- Orthodontic costs
- Enhanced optical and dental costs
- Hospital package such as the private room during admission
Despite the 100% health reform implemented since 2019, fee overages and exclusion of certain health services continue. In this case, the additional surcharge reduces or cancels the remaining charge. It is particularly useful in optical, dental and hearing care, where overruns are most frequent.
Good to know: Take out your supplementary health insurance and your mutual insurance with the same organization to benefit from third-party payment.
>> Click here to compare health insurance and mutual health insurance
In what cases is this wise?
Choosing a supplementary supplement gives you the opportunity to get tailored protection. As a result, it is preferred when you want to target specific treatments where the coverage of your mutual insurance is insufficient.
You can choose a top-up to enhance more care items, thus improving your overall health coverage. But also decide to take out specific supplementary health insurance:
Tip: choose a supplementary supplement without waiting period that covers your care immediately.
How do you choose your health supplement?
First of all, you must take stock of your medical expenses in order to choose your supplementary health insurance. To do this, take stock of your healthcare needs and your current level of coverage.
Then the simplest approach is to compare the different offers available in the health insurance market. Thanks to online comparators, you can obtain more detailed offers quickly and for free. You can thus choose a supplementary health supplement adapted to your situation and at the best price. It is also possible to choose mutual insurance for less than 5 euros per month! On the other hand, it will be necessary to pay attention to the level of coverage, the most protective formulas are often more expensive. It’s about comparing insurance companies.
Update on dental or optical supplements
By definition, the additional surcharge is intended to moderate or even eliminate your deductible. This is done after repayment of the mandatory part and the supplementary part. Often policyholders choose it to bolster their coverage for their dental and optical care.
In these specific cases, the supplement comes after reimbursement from your mutual insurance company. It is based on a reimbursement rate calculated according to the social security ceiling (PMSS). In addition, the percentage of reimbursements from your mutual insurance company is not cumulative with your mutual insurance company’s, but comes in addition. If, for example, the mutual coverage is 200% and the additional 300%, the latter only compensates up to 100% for a total coverage of 300%.
Specifically, in dental care, the extra surcharge brings the reimbursement rate up to 400% or even 500%. For optical care, the amount is generally expressed in euros, with an amount applicable to a frame or lens package. Please note that under no circumstances can your compensation exceed the total cost of your care.