Complementary company health (Mutual health)

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

What is a complementary company health? In addition to the basic guarantees of social security, an employee may receive supplementary health benefits from his company (or the association which employs him). It is the employer who negotiates the contract and follows up with the insurer. The complementary company health must take care of a minimum of guarantees. Here are the rules to know.

Health Insurance (Social Security) does not fully reimburse your health expenses. The company health supplement completes these refunds, in whole or in part.

In addition to the supplementary health, the collective company system may offer other guarantees (death guarantees, dependency guarantees, etc.).

Please note

Only companies are concerned. The individual who employs a homeworker is not concerned.

The employer must provide all its employees with additional health cover, regardless of their length of service in the company.

However, you can be exempt from membership in certain situations.

FYI  

If your employer has not contracted a health supplement, you can to refer the matter to the labor council.

You don't have to take any steps. It is your company that negotiates the contract and follows up with the insurer.

FYI  

If you and your spouse or Civil partnership partner both have a mandatory mutual, it is sometimes possible to terminate one of them. It is recommended to get in touch with your mutual.

Minimal care basket

The supplementary company health must cover at least the following guarantees (care basket):

  • Entire user fee on consultations, documents and benefits reimbursable by sickness insurance. However, there may be exceptions.
  • Entire daily hospital fee in case of hospitalization
  • Dental expenses (prostheses and orthodontics) up to 125% of the conventional tariff
  • Optics costs on a flat-rate basis per 2-year period (annually for children or in the event of changes in vision) with a minimum of care fixed at €100 for a simple correction, €150 (or €200) for a complex correction.

Guarantees of a contract called responsible

The health supplement may be a so-called contract responsible in your company. In this case, health expenditure shall be covered as follows:

What the contract supports is called “responsible”
Tableau - Key deliverables of a responsible contract

Benefits

Support

Routine care (visits and drugs at SMR.: titleContent major reimbursed to 65%)

100% of the social security reimbursement basis

Daily Package

100% unlimited duration

Routine dental care (consultations and care such as scaling or treatment of cavities)

100% of the social security reimbursement basis

Optical

100% the social security reimbursement basis.

For optical costs that are beyond the conventional rate, the health add-on may offer, cumulatively, limited support as follows:

  • One pair of glasses at most every 2 years (annually for children or for changes in vision) 
  • Frame at the height of €100 maximum
  • Minimum and maximum limits depending on the complexity of the equipment (e.g. for a single lens, €50 and €420)

    • The contract must be joint and several: the insured cannot be submitted to a health questionnaire or be priced according to his state of health.

    What is not supported by the contract called “responsible”
    • The flat-rate contribution of €2 for each consultation carried out by a city doctor in an establishment or hospital, within the limit of €50 per year per person
    • The medical allowances left to the insured person for medicinal products and medical transport. The amount of the deductible shall not exceed €50 per year per person.
    • The increase in the insured person’s contribution for not appointing a treating doctor or consulting another doctor without a prescription from the treating doctor (‘out of care pathway ")
    • Excess fees where the insured person consults a specialist to whom the law does not allow direct access without going through a doctor.

    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).

    Additional benefits

    The health supplement may offer additional benefits, for example:

    • Third-party payer
    • Assistance service (housekeeping, childcare, etc.)
    • Prevention and support (e.g. screening)

    The rate depends on the contract signed by your employer.

    Your employer may participate in the payment of contributions in whole or in part. Its participation must be at least equal to 50% of the contribution.

    At the end of your employment contract (retirement, dismissal...), you can keep your company's mutual health, under conditions.

    Who can help me?

    Find who can answer your questions in your region

    • Departmental Directorate for Employment, Labor and Solidarity (DDETS or DDETS-PP)

      https://dreets.gouv.fr/

      Search for DDETS on the interactive map by clicking on the department desired.

    FAQ