Supplementary health and welfare in the State civil service

Verified 25 July 2024 - Directorate for Legal and Administrative Information (Prime Minister)

If you work in the public service of the state, there are progressively mechanisms put in place to improve the payment of medical expenses, if you are ill, injured or on maternity leave (health), and your compensation terms, when you are unable to work (welfare). We present you the regulations on supplementary health and welfare.

Complementary health

One health complementary, commonly referred to as mutual, is intended to to supplement the social security cover for medical expenses in the event of sickness, accident or maternity.

Since 1er january 2022, your employer administration will repays a portion of your mutual insurance contributions.

The amount of such reimbursement shall be fixed at €15 per month regardless of your working time (full-time or non-full-time, full-time or part-time).

This refund is paid to you every month.

You can benefit from this lump sum reimbursement if you contribute to a mutual insurance scheme that covers medical expenses caused by illness, maternity or accident.

Beneficiaries of the lump-sum refund

You can benefit from this refund whether you are civil servant (trainee or holder) or contractual.

You can benefit from this refund if you are in one of the positions or the following:

  • Activity
  • Secondment or mobility leave
  • Parental Leave
  • Availability for health reasons or unpaid leave for health reasons
  • Caregiver leave or parental leave or family solidarity leave
  • Situation or leave of any kind giving rise to payment of remuneration or salary.

Amount and payment of the lump sum refund

The amount of the refund shall be fixed at €15 per month.

The repayment is maintained until the end of the month in which you cease to be in one of the positions or situations giving rise to the repayment.

When you return to work in a month, the refund is made for the entire month.

If you start or change employers in a month, the refund is paid by the new employer for the entire month.

You must report any changes in circumstances that may affect your refund entitlements.

Your administration can monitor your situation at any time.

Process for claiming reimbursement

You must send a request to your employer administration.

You can use this request template to do this.

Model application for a flat-rate refund of supplementary social protection contributions for health

You must attach a certificate from your supplementary protection body.

This certificate shall specify whether you are an individual beneficiary or entitled a supplementary social protection contract which is responsible and jointly and severally liable to cover the costs incurred in connection with maternity, sickness or accident.

If you are entitled to a collective agreement concluded by an employer other than the State, the certificate indicates that you do not already benefit from the care of that employer.

From 1er january 2025, state administrations will propose collective agreements supplementary health insurance to cover medical expenses caused by maternity, sickness or accident (health risk).

Membership to this collective agreement is obligatory except in special circumstances.

Agents concerned by the obligation to join

If you are employed and remunerated by a State administration, you must adhere to the collective agreement signed by your employer administration.

No age requirement is required.

You continue to benefit from the collective agreement if you are in one of the following situations:

Other possible beneficiaries

Répondez aux questions successives et les réponses s’afficheront automatiquement

Retired

If you are newly retired, you can apply to join the collective agreement signed by your last employer administration if you complete the 2 following conditions :

  • You were a member of the mutual insurance company subscribed by your administration at the time of retirement
  • And you receive a pension from the State Pension Service (SRE), theIrcantec: titleContent, of theAgirc-Arco: titleContent or the Special Pension Fund for Workers in State Industrial Establishments (FSPOEIE).

You must apply for membership within one year of your retirement.

If you are retired on the implementation date of 1er a collective agreement entered into by your last employer authority, you can apply to join this agreement.

Membership is possible if you had fulfilled the conditions required to join the collective agreement as a pensioner if the agreement had been entered into on the date of your retirement.

You must apply for membership within one year from the date on which you are informed of the entry into force of the collective agreement and the possibility of joining.

Spouse of a public servant

If you live as a couple with an active or retired beneficiary, you can apply for membership, as aentitled, the collective agreement of his employer's administration or his last employer's administration.

No age requirement is required.

Child or grandchild of a Crown agent

You can apply to join at any time, as the person entitled, to the collective agreement of the employer authority of an active beneficiary or the last employer authority of a retired beneficiary if you the following 3 conditions:

  1. You are the child or grandchild of an active beneficiary or retired beneficiary
    Or you are the child or grandchild of the person who living as a couple with an active beneficiary or a retired beneficiary
    Or you have been assigned by court order to an active beneficiary or a retired beneficiary or to the person who lives in a relationship with that active beneficiary or retired beneficiary
  2. You are fiscally dependent on one of the beneficiaries of the collective agreement and do not benefit from any other supplementary social protection in respect of a professional activity
  3. You are under the age of 21
    Or you are under the age of 25 and are a student or on an apprenticeship contract or a job seeker
    Or you're recognized as disabled by the CDAPH: titleContent no age requirement.

Widow or orphan child of a public official

The surviving spouse or orphan child of a deceased active or retired beneficiary who receives a survivor's or orphan's pension, may apply to join the collective contract of the last employer's administration of the deceased active or retired beneficiary.

The application for membership must be made within one year of death.

The spouse receiving a survivor's pension as a former retired official of the State on the date of entry into force of 1er a collective agreement concluded by the last employer authority of his deceased spouse may apply for membership of that agreement.

The application for membership must be made within one year from the date you are notified the possibility of joining.

Staff exempt from joining the collective contract

You're excused the obligation to adhere to the collective agreement entered into by your employer administration in the following cases:

  • You benefit from the complementary health solidarity (C2S - ex CMU-C). This exemption is available until the date you cease to benefit from C2S
  • You have a supplementary personal health on the effective date of 1er a collective agreement entered into by your employer's administration or on the date of your recruitment, whichever is later. In this case, you are exempted from joining the collective contract until the expiry date of your individual contract, within the limit of 12 months
  • You are recruited in CSD: titleContent and you have a supplementary personal health
  • You are covered, including as a beneficiary, by a other collective agreement (supplementary company health, supplementary sickness insurance scheme for the electricity and gas industries, supplementary territorial or hospital collective health, collective cover for the military).

You can waive your exemption at any time and apply to join your administration's collective agreement without any premium increase.

Guarantees offered by the collective agreement

The collective contract for supplementary health at least provides the following guarantees:

  • Entire user fee on consultations, documents and benefits reimbursable by the Health 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.

The collective contract may provide for additional or supplementary guarantees minimum guarantees and/or optional guarantees.

These guarantees must apply in the same way to the different categories of beneficiaries (assets, pensioners, beneficiaries).

The employer administration takes charge 50% the cost of a theoretical monthly contribution, referred to as equilibrium contribution.

Foresight

One supplementary provident is intended to to supplement the compensation paid, by the administration and possibly by the CPAM: titleContent, during sick leave or in case of disability.

It may also provide for supplementary benefits, to those provided for by law or decree, in the event of the death of a public official for the benefit of his rights-holders.

From 1er january 2025, state administrations will propose a collective contract of provident schemes to cover the long-term sick leave (LSW) and the leave of absence due to serious illness, non-occupational disability and death.

Membership to this collective agreement is optional.

The employer's administration shall inform the employees of the conclusion of the collective agreement and of the date on which it takes effect.

The employer's administration shall pay part of the amount of the staff members' contributions. The amount of this contribution will be fixed at €7.

If you are employed and remunerated by a State administration, you can join the collective agreement signed by your employer administration if you are official (trainee or holder) or contract.

No age or health condition is required if you are applying for membership within 6 months which are:

  • The effective date of the collective agreement entered into by your employer authority
  • Or the date of your hiring, if you are hired after the effective date of the contract entered into by your employer authority.

After this period of 6 months, your contract membership may be subject to different pricing based on a medical questionnaire.

If you are off work on the effective date of the collective agreement, you can apply for membership of the collective agreement.

However, the provident society may refuse to take charge of the consequences of a disease contracted before your membership or the subscription to the collective contract by your employer administration if this organization complies with the following conditions:

  • The previous disease(s) for which no follow-up action is taken shall be clearly indicated in the certificate of acceptance of the collective agreement
  • The provident society provides proof that your illness predated the subscription to the collective agreement by your employer's administration or your membership in the collective agreement.

The collective provident contract shall cover the long-term sick leave (LSW) of the official, the leave of absence due to serious illness of the contract, invalidity of non-occupational origin and death.

Répondez aux questions successives et les réponses s’afficheront automatiquement

You're a public servant

In case of long-term sick leave (LSW), the contract shall provide for payment of a supplementary benefit assuring you 100% of your remuneration on the 1re year off, then 80% the 2e and 3e years.

Guaranteed remuneration includes the index treatment and bonuses and allowances maintained on long-term sick leave.

This supplementary benefit is paid to you after deduction of the amounts paid by your employer's administration.

This additional benefit may not cover the waiting period.

Reminder

If you get a residence allowance and the family treatment supplement (FTS), these 2 remuneration elements are paid to you in full during the entire duration of your CLM.

The collective agreement provides for the payment of a supplementary benefit in the case of release disability pension of non-professional origin and in the case of automatic availability for health reasons on account of invalidity of non-occupational origin.

This additional benefit shall be at least equal to 10% of your remuneration, excluding any mark-up for third parties, provided that the total amount you receive does not exceed 80% of your remuneration.

The remuneration taken into account includes your index salary and your bonuses and allowances maintained on long-term sick leave.

This top-up benefit is paid to you until you reach the age of 62.

The collective agreement provides for the payment of a death capital to the dependants of a deceased official or to the beneficiaries designated by him.

The amount of the death capital shall be equal to the gross remuneration which the official has received in the last 12 months.

The compensation elements considered are as follows:

  • Index salary corresponding to the index held by the official on the day of his death
  • Residence allowance
  • Family treatment supplement
  • Premiums and allowances.

The amount of the death capital shall not be less than €13,600.00.

If the deceased official had not completed one year of service on the day of his death, the remuneration to be taken into account shall be that to which he would have been entitled if he had completed one year of service.

The collective contract provides for the possibility for agents who so wish to to take out additional guarantees at their own expense.

These guarantees shall cover the sick leave and the long-term leave (CLD).

These guarantees cannot cover the waiting period.

The contract may also provide for other guarantees such as funeral expenses and loss of autonomy.

Please note

In Mayotte, the collective contract may include the adaptations necessary for its implementation.

You're contractual

In case of leave of absence due to serious illness, the contract shall provide for payment of a supplementary benefit assuring you 100% of your remuneration on the 1re year off, then 80% the 2e and 3e years.

Guaranteed remuneration includes the index treatment and bonuses and allowances maintained on serious sick leave.

This additional benefit is paid to you after deduction of the amounts paid by your employer administration or your CPAM: titleContent.

This additional benefit may not cover the waiting period.

Reminder

The residence allowance is paid to you in the same proportions as your index salary and the family treatment supplement (FTS) you are paid in full for the duration of your sick leave.

The contract provides for the payment of a supplementary benefit in case ofinvalidity of non-professional origin allowing you to collect:

  • 50% of your remuneration for a disability of 1re category
  • 80% of your remuneration for a disability of 2e category
  • 80% of your remuneration for a disability of 3e category, excluding mark-up 40% for third parties.

Guaranteed remuneration includes your index salary and bonuses and allowances maintained during a period of serious sick leave.

This supplementary benefit is paid to you until your retirement, after deduction of the amounts paid by your CPAM: titleContent.

The collective agreement provides for the payment of a death capital to the beneficiaries of a deceased contractual partner or to the beneficiaries designated by him.

The amount of the death capital shall be equal to the amount of Last 12 months of gross earnings of the agent.

The collective contract provides for the possibility for agents who so wish to to take out additional guarantees at their own expense.

These guarantees shall cover the sick leave.

These guarantees cannot cover the waiting period.

The contract may also provide for other guarantees such as funeral expenses and loss of autonomy.

Please note

In Mayotte, the collective contract may include the adaptations necessary for its implementation.