Supplementary sickness cover (mutual)

Verified 15 May 2024 - Directorate for Legal and Administrative Information (Prime Minister)

What is a complementary health (mutual)? It is used to supplement the reimbursement of the sickness insurance (social security) in whole or in part. It then reimburses the remaining costs to you according to the contract chosen. Some contracts allow reimbursement of benefits not covered by Social Security (e.g. osteopathy or certain vaccines). We'll lay out the rules for you.

FYI  

Mutual societies may also offer related services (assistance, prevention, etc.).

Any person can subscribe to a health supplement on an individual basis, and possibly for the benefit of one or more members of his family.

Under certain conditions, related in particular to your resources, you can benefit from the complementary health solidarity (CSS).

FYI  

Before choosing a health supplement, check with your employer. Indeed, he can offer you a group insurance, more advantageous, and to which you are sometimes obliged to adhere.

Choosing an insurer

To subscribe to a supplementary health contract, you can contact the following organizations:

  • Mutual
  • Insurance company
  • Provident institution
  • Banking institution

Timeout

Before you enter into a contract, check for a waiting period (called waiting period). This is a period, starting from the subscription and variable according to the contracts, during which you are not reimbursed for certain benefits.

For example, the contract may specify a 6-month waiting period for dental care.

Fee rates are linked to your situation and depend on factors such as:

  • Selected Coverage Level
  • Amount of income
  • Age
  • Status (employee or self-employed)
  • Place of residence

Please note

Depending on the complementary body, the contract is free or not.

The level and nature of supplementary health care benefits vary according to the contract.

Reimbursement of health expenses

The health supplement reimburses the following costs, depending on the contract signed and therefore the contributions paid:

  • What remains to be paid after reimbursement by the Health Insurance, more or less extensively (user fee, fee overruns)
  • Expenditure not covered by sickness insurance

Contract called responsible

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Doctor's fees

Within the framework of fees of the doctor, the user fee must be supported.

Excess fees and user fees due to non-compliance with the care pathway are not necessarily supported. Likewise, the flat-rate contribution of €2 stay at your charge.

Medicines

User fees for drugs with a major medical service (MRS.) (reimbursed to 65%) is required.

User fees for drugs with moderate and low MRS. (reimbursed to 30% and 15%) and that of homeopathy is not necessarily covered.

Hospitalization

In the case of hospitalization, the daily fee in full, without limitation of duration, is obligatorily covered, as is the user fee.

There is no limit to the cost of care if the doctor is a member of the contract for access to care. Otherwise, support is limited.

Optical

The user fee for glasses or lenses is mandatory.

Care includes a pair of glasses every 2 years or less (annually for children or for vision changes) and a frame at the height of €100 maximum.

There are minimum and maximum limits depending on the complexity of the equipment. For example, for a single glass, the support is between €50 and €420 and up to €800 for certain progressive lenses.

Dental

Dental user fees are mandatory.

Some prostheses, such as metal crowns, are supported until €290, ceramic crowns up to €500, ceramic bridges up to €1465 or complete dentures until €1,100.

Hearing aid

Hearing aid user fees are mandatory.

Category 1 devices are supported up to €1,700.

  • Class 1 hearing aids: these are the entry-level hearing solutions. They meet essential hearing needs, with a guarantee of quality. Capped at €950, they enter the basket 100% health. Your health insurance or supplementary health insurance must cover all or part of the costs that are not reimbursed by the Health Insurance.
  • Class 2 hearing aids: these are the customized solutions of higher ranges. They meet all specific needs with more advanced technologies, to treat complex hearing loss. They don't fit in the basket 100% health. Your health insurance or supplementary health insurance can cover all or part of the costs that are not reimbursed by the health insurance.

FYI  

Since 1er january 2022, the responsible contracts provide for the acceptance by the complements of the practice of paying third party (waiver in advance of fees) on the equipment and care of the basket 100% health (optics, dentistry and audiology).

Wording of guarantees

The amount reimbursed by your health supplement can be indicated as a percentage of the reimbursement basis or in euros.

Thus, a guarantee up to 150% of the conventional tariff (Health insurance included) means that your total reimbursement (Health insurance + health supplement) can reach 50% in addition to the conventional sickness insurance rate.

A service up to €200 means that your health supplement will reimburse you to the maximum €200 in addition to any amount reimbursed by the Health Insurance.

You can view examples of refund calculations in the Unocam brochure.

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Renewal

Your contract is renewed automatically every year. Your supplementary health care organization must send you an annual notice of the deadline (at least 15 days before the deadline).

Termination

You can terminate your contract without charge or delay after 1era year.

Such termination shall take effect 1 month after that the mutual has received notification (by letter, mail, etc.).

This possibility of termination must be mentioned both in the settlement (or contract) and in the notice of termination.

If you have paid beyond the date covered after termination, you will be refunded within 30 days.

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