what is it for and how much does it cost?  Aide-Sociale.fr
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what is it for and how much does it cost? Aide-Sociale.fr

By Frederique / Updated December 29, 2023

Since 2016, all companies have been required to offer complementary health insurance to their employees. If they feel that they are not sufficiently covered, they can take out additional health insurance. This coverage reinforces reimbursements from the CPAM and their traditional mutual insurance contract. This is therefore a 3rd level of coverage, so you should choose your health insurance carefully.

This type of contract has several advantages. Very useful for certain expenditure items such as dental care or optics (often poorly reimbursed), certain contracts also make it possible to cover care often forgotten by basic contracts such as spa treatments or certain vaccines for example.

With a supermutual (also called supplementary), you select the guarantees that you wish to strengthen. For example, you can choose to take out additional dental insurance, without paying for other guarantees. You can also select the people who will be covered by your supplementary health insurance.

Nevertheless, overcomplementaries are not interesting for everyone and have certain disadvantages that you should be aware of. In fact, certain organizations offering supplementary health insurance contracts impose mandatory waiting periods before making the first reimbursements. Moreover, CPAM will only deal with your usual supplement. Therefore, you must contact the supplementary organization yourself to obtain a reimbursement.

To find out more about supplementary insurance, or supplementary insurance, their reimbursement method, their advantages and disadvantages as well as their cost, continue reading this article. We also suggest that you use a mutual insurance comparator available in this section.

What is a supplementary or mutual insurance plan?

A supplementary health insurance contract is not intended to replace your traditional supplementary health insurance, such as company mutual insurance or even solidarity supplementary health insurance.

Good to know : companies are obliged to offer complementary health insurance to their employees. The latter cannot refuse this mutual insurance, except in rare cases of exemption.

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In fact, with a supermutual, you will benefit from a third level of protection for the reimbursement of your medical care :

    • 1st level: compulsory coverage of the CPAM;
    • 2nd level: your classic mutual insurance;
    • 3rd level: your supplementary contract.

A supermutual or supplementary insurance contract is done “à la carte”. You choose the areas in which you want to be better covered and therefore better reimbursed.

Attention : as noted above, this is a 3rd level of coverage. Opting for supplementary health insurance is not interesting for all policyholders. Indeed, if you are a beneficiary of the ACS for example or a municipal mutual, this generates an additional cost that may be difficult to assume. On the other hand, this can represent an advantage when you benefit from company mutual insurance and you wish to complete the guarantees provided.

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What are the advantages of a health supplement?

The objective of supplementary health insurance is to complement your mutual insurance contract.by guaranteeing reimbursements for items where the CPAM and your mutual insurance company do not reimburse sufficiently or not at all.

Thus, a supermutual has several advantages, including :

    • THE reimbursement of excess fees: during a consultation with a sector 2 doctor (such as a gynecologist for example), your health insurance covers the excess fees. The latter is not covered by the CPAM and is only minimally reimbursed by your mutual insurance company (if at all).
    • A better reimbursement for certain expensive treatments: for example, the CPAM and mutual insurance companies provide little coverage for dental, orthodontic or optical care. You can then choose your health insurance by favoring additional guarantees for the care best suited to your needs.
    • A management of so-called alternative medicine care: If you consult practitioners such as homeopaths, osteopaths or naturopaths, be aware that the CPAM does not reimburse this type of care. Most often, mutual insurance companies only cover one consultation per year or impose a ceiling on the amount. The supermutual insurance company can, for its part, compensate for this weakness by fully reimbursing you for your consultations.
    • A supermutual can also take care of spa stays.
    • There support for special conditions in the event of hospitalization, particularly for maternity. In this case, the health insurance company can cover a certain number of procedures that are usually poorly or not reimbursed, such as a single room during hospitalization or coverage for equipment rental in the event of breastfeeding.

Moreover, the majority of contracts are flexible over time. This means that you can be covered from time to time depending on your needs. For example, you can choose an orthodontics option and then modify it by subsequently opting for additional coverage on the reimbursement of a hearing aid.

Depending on the company with which you take out your contract and depending on it, you can choose to insure:

    • yourself only;
    • your children and you;
    • yourself, your spouse and your children.

What are the disadvantages of supplementary mutual insurance?

Despite the advantages of subscribing to a supplementary insurance, supermutual insurance contracts also have many disadvantages:

    • Some supercomplementaries have a significant waiting period : thus, certain contracts impose a waiting period of 3 months after subscription. But this period can go up to 12 months after signing the contract. It is therefore advisable to read all the conditions imposed before subscribing. In return, some additional supplements offer contracts without a waiting period. However, an additional supplement without a deficiency will have a higher cost for the insured.
    • CPAM does not communicate with your health insurance : in fact, exchanges with the CPAM are carried out with your basic mutual insurance company. Therefore, you must send your reimbursement statements to your supplementary organization. This statement must indicate the reimbursement of the CPAM and the reimbursement made by your complementary insurance.

To note : It is important to think carefully before subscribing to a mutual insurance company. In fact, this should make it possible to reimburse the care you need and which is not (or too partially) covered by the CPAM and your traditional supplementary health insurance. A supermutual is only interesting for certain policyholders (those who have company mutual insurance for example and who wish to benefit from better coverage in a specific healthcare position). In certain cases, it is preferable to increase your level of coverage with your traditional mutual insurance or to change your complementary health insurance rather than opting for additional supplementary insurance.

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How is reimbursement carried out with supplementary health insurance?

A supplementary supplement or a supplementary mutual is responsible for supplementing the reimbursements of the CPAM and your basic mutual (depending on the level of guarantee you have chosen). If you want to make quotes to compare prices, find a mutual insurance comparator.

If an ophthalmologist prescribes glasses for you, the CPAM offers you a basic reimbursement, on which the mutual and supplementary insurance rely to define the reimbursement amount.

Let’s take a concrete example for a consultation for 50 euros with a specialist in sector 2 (not approved, therefore with free fees):

    • 1st level : the CPAM reimburses 70% of the conventional rate, or 16.10 euros;
    • 2nd level : your mutual reimburses 100% of the CPAM rate, or 16.10 euros;
    • 3rd level : the additional supplement reimburses 150% of the CPAM rate (up to 34.50 euros maximum), or 17.80 euros in our example. Your consultation will then be fully reimbursed up to the costs incurred.

You will not be able to benefit from a reimbursement greater than the price of your consultation.. The supplementary supplement completes the reimbursement of the CPAM and your mutual insurance within the limit of the initial amount paid during the consultation.

Which organizations offer additional health supplements?

Supermutual insurance contracts are taken out with traditional mutual insurance organizations and in the same way as basic insurance contracts. As with any contract, take the time to compare the different options and the prices offered by each organization. And this in order to make a choice best suited to your needs.

You do not have no obligation to take out your additional contract with the same insurer than for your basic health insurance contract. This can also bring competition into play and make it possible to negotiate better guarantees or pricing conditions. Do not hesitate to compare the price of mutual insurance using the simulator.

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How much does a health supplement cost?

The cost is generally lower than for traditional mutual insurance. However, the prices of supplementary health insurance vary depending on the guarantees, the number of people insured, etc.

To better define the organizations that would suit you best, you can consult a mutual insurance comparator below. In addition, it is strongly recommended to request several quotes, from different organizations and with different guarantee possibilities. This will allow you to better compare prices and offers from each insurer.

We suggest you use a comparison of mutual health insurance. You can get quotes from many organizations to find out which supplement is best suited to your needs. Please note that the simulator below is an external service to Aide-Sociale.fr.

Photo credit: © ursule / Adobe

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