User ticket, package and deductibles (Social security)

Verified 01 January 2025 - Directorate for Legal and Administrative Information (Prime Minister)

Are you wondering if Health Insurance (Social Security) covers all medical expenses? She doesn't fully reimburse medical expenses. Indeed, some of the expenses remain at your expense: user fees, €24 for certain heavy acts, flat-rate participation by €2, medical allowances. However, there are exceptions. Here are the rules to know.

Definition

The user fee represents the part of the expenses that remains at your expense after reimbursement of the sickness insurance and before deduction of the lump sum contributions.

User fees apply to all benefits covered by the Health Insurance (e.g. consultation with a doctor, purchase of prescription medicines).

Exempt persons

In certain situations (for example long-term affliction - ALD, if you are enclosure, costs of abortion), you are exempt from paying user fees.

The Health Insurance then takes care of it at 100% within conventional tariffs.

Amount 

The amount of the user fee varies according to the services (care, medicines, equipment...).

For example, for a consultation with your GP, it is equal to €9.

Calculation detail:

  • Conventional rate : €30
  • Support at 70% by Health Insurance: €21
  • User Fee Amount: €9.

Surcharge

The user fee can be increased if you are seeing a healthcare professional outside of the home coordinated care pathway.

For example, for consultation with a primary care physician outside the coordinated care pathway, it is equal to €21.

Calculation detail:

  • Conventional fare: €30
  • Support at 30% by health insurance: €9
  • User Fee Amount:€21.

Reminder

The user fee represents the part of the expenses that remains at your expense after reimbursement of the Health Insurance and before deduction flat-rate participations.

The increase is not reimbursed by the health supplements as part of a responsible contract.

Payment

The user fee is automatically deducted the amount of your refunds. It is deducted from the refund statements.

FYI  

If you have a health supplement, it can support user fees according to the contract you have signed. Check with your complementary organization.

Services concerned or not

User fees are replaced by a flat-rate fee for certain major medical procedures (procedures that cost at least €120).

Certain acts and costs are not covered by the flat-rate contribution and are covered by 100%. For example:

  • Hospitalization costs from 31e consecutive day of hospitalization
  • Emergency transport costs, in the event of hospitalization during which an act is carried out at a rate of more than or equal to €120.

Amount

The package is €24.

The same is true if several heavy acts are performed during the same consultation or hospitalization.

Exempt persons

The package does not apply to persons who are in the care of 100% because of their situation or health.

These include:

Payment

You must pay directly to the healthcare professional or health facility for the package you owe.

If you have a health supplement, it can take charge of the package according to the contract you have signed. Find out from her.

Definition

This flat-rate contribution is due following a visit to the emergency department which is not followed by hospitalization in the medical, surgical, obstetric or dental departments of the institution.

Amount

The amount of the package is €19.61.

This package shall be reduced irrespective of the reason for the change to €8.49 for the following insured persons:

  • In long-term illness (ALD)
  • Under the occupational accidents and diseases (AT-MP) scheme with a disability of less than 2/3.

FYI  

The health mutual or health supplement reimburses this package in full.

Exempt persons

The package does not apply irrespective of the reason for the passage for the following persons:

  • Pregnant woman as of 6e months for all care
  • Newborns less than one month old
  • A person who receives an annuity or an allowance paid under the legislation on occupational accidents and diseases (AT-MP) with a disability of at least 2/3
  • Military or disability pensioner.

Finally, this package does not apply for the following people when their emergency department visit is related to their specific situation:

  • Organ donor
  • Victim of an act of terrorism
  • Victim of a serious and exceptional health risk
  • Minor victim of sexual abuse.

Benefits concerned

A flat-rate contribution is payable at each consultation or medical procedure, except in particular in the context of a full hospitalization of one or more days.

This participation also applies to any act of radiology or medical biology.

Amount

The flat-rate contribution is €2.

The maximum number of flat-rate contributions at your expense during a calendar year is €25.

If, during the same day, you consult the same doctor more than once or if you benefit from several procedures carried out by the same professional, the number of lump-sum contributions supported may not exceed 4, or €8 per day maximum.

Example :

If a doctor performs 6 different actions during the same visit, the maximum participation will be €8 for consultation with this doctor.

Exempt persons

The flat-rate participation of €2 does not apply to the following persons:

Payment

The flat-rate contributions are automatically deducted the amount of your refunds. They are deducted from refund statements.

The flat-rate participation of €2 is not reimbursed by health supplements as part of a responsible contract.

Benefits concerned

A medical deductible remains at your expense for the following costs:

  • Medicines
  • Paramedical procedures
  • Sanitary transport.

Please note

Franchise does not concern :

  • Drugs prescribed during hospitalization
  • Paramedical procedures done during hospitalization.

It also does not apply to emergency transport.

Amount

The amount of the deductible is:

  • €1 per pack of medicines (or any other unit pack, e.g. vial),
  • €1 by paramedical act up to €4 per day,
  • €4 by sanitary transport up to €8 per day.

The amount of the deductible shall not exceed €50 per year per person.

Exempt persons

Franchise does not apply to the following persons:

Payment

Medical deductibles are automatically deducted the amount of your refunds. They are deducted from refund statements.

Medical deductibles are not reimbursed by health supplements as part of a responsible contract.

Who can help me?

Find who can answer your questions in your region

  • Health Info Rights

    A telephone line created by a collective of user associations to provide legal or social information related to health

    By telephone

    01 53 62 40 30

    Price of a local call

    Open Service:

    • Monday, Wednesday and Friday from 2pm to 6pm
    • Tuesdays and Thursdays from 2pm to 8pm.

    By Form

    You can also ask your question by completing the contact form ;

    From this form, you can request to be called back.

    The response time by email is 15 days.

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