May 26, 2024

What you need to know about Health Insurance In France : Mutuelle

What are mutuelles?

France’s mutuelles are non-profit organisations which have been in operation in the country for at least 150 years.

Their main purpose is to ensure social welfare but not just through additional health cover, also in terms of pensions, disability benefits and other forms of cover.

Mutuelles abide by the code de mutualité, which distinguishes them from health insurance companies in that members don’t have to pay premiums for pre-existing conditions and have a greater say in decision-making as part of this type of co-op or partnership.

While mutuelles are paid for by individuals they are not private health insurance and don’t come up with preferential treatment or access to private clinics.

How does a mutuelle actually work?

If you go to the doctor or hospital in France or have an x-ray or some other kind of test, you’ll normally pay up front.

You are then refunded a percentage of the cost via the carte vitale system, usually within a week,

In general terms the state covers around 70 per cent of the total, although for some serious conditions the percentage of state health cover is higher or even complete.

What a mutuelle does is cover, either partly or completely, the deficit or the part of the cost not covered by the state.

Essentially, a mutuelle is top-up health cover and one of the easiest ways of getting 100 percent health cover, although how much cover you get will depend on which mutuelle you have and how much you were charged.

Recent figures for the French insurers’ group Mutualité française showed that the average resident in France will have to pay out €235 a year in medical costs not covered by the state – unless they have a mutuelle. And of course for the elderly or people with long term health conditions the figure can be a lot higher.

Not every mutuelle is the same

Depending on the policy chosen, mutuelles can cover most or all of the remaining costs not reimbursed by the state, as well as some selected medical services and the cost of medicines at the pharmacy.

In general terms basic mutuelles will take you up to 100 per cent cover but often the next step up, a standard cover offering around 150-175, or 200 percent, won’t cost a lot more and could tie you over for a lot of expensive extras such as dental and optical treatments. 

Things are made more complicated by the fact that doctors in France can charge more than the base rates set by the state (tarif de convention).

This is known as dépassements d’honoraires and are added on by many specialist doctors.For example while most GPs will charge the base rate for appointment of €25 some will charge €40.

If you have a mutuelle that reimburses at 100 per cent that will only cover the €25 tariff de convention. To cover all of the €40 you’ll need a mutuelle that reimburses at 200 per cent. And the same applies to all medical treatment. Note that more expensive mutuelles will reimburse to 400 percent.

The mutuelles and complémentaite santé market is fairly flexible in this regard so it’s worth having a search online for the policy that best suits your needs and budget.

And make sure you look carefully at the rate of reimbursement.

There are plenty if not too many to choose from, so also ask French friends or your local doctor for recommendations to get a better idea and more honest opinion. 

Your company might foot the bill

Since 2016 private companies in France have to provide employees with a private health insurance policy known as a mutuelle collective.

By law they have to cover a minimum 50 percent of the mutuelle’s cost and companies also tend to offer workers extended medical cover for their family members as a perk.

Employees are in fact expected to join the scheme unless they have a valid reason for not doing so.

However, if you work in the public sector, you’re job seeker, student, self-employed or a pensioner, this law doesn’t apply to you and you’ll have to opt for a mutuelle individuelle, which tend to offer less cover.

So what’s the cost?

Mutuelles are more affordable than private health cover in the Kenya, hence why most people in France have one.

However unlike in Kenya, it doesn’t guarantee faster treatment at the hospital or get you access to private doctors and clinics either. It just assists financing the personal contribution element of France’s healthcare.

According to 2016 results by France’s Personal Insurance Price Index (IPAP), average yearly mutuelle costs range from €350 to more than €1,200.

Data from French insurance comparison site found that for over 60s average annual expenditure is €2,500, roughly €212 a month.

For families where the parents are around 35 and their two children are between the ages of 7 and 3, a family bundle costs around € 90 a month, or €1083 per year.

For a 25-year-old worker on the other hand monthly mutuelle spending is around €26.

Another consideration worth noting is that different regions of France have higher and lower mutuelles prices, although this generally affects the rate by around 10 per cent. 

Read the small print 

The mutuelles and complémantaire santé market is a competitive one so as mentioned earlier it’s best to ignore the sale pitches and cut to the real deal.

Make sure you read carefully through what your prospective mutuelle offers, in particular the small print of your contract, as this is often convoluted but still very telling.

Watch out for what calculation they use to actually reimburse you. 

Keep an eye out for the cancellation clauses too as they can be quite specific and require notice to be given several months in advance.

If you’re not a mutuelle member already, you should probably become one

Unless you’ve got private health insurance or plenty of money stashed away which you’re willing to burn in case of a medical emergency, you’d be better off paying for a mutuelle or top-up health cover in France.

Keep in mind that healthcare isn’t completely free in France, so fees can run into the thousands of euros if you have to go to hospital.

It’s a case of being better safe than sorry…or in debt.

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