Can we do without Mutual Health Insurance?

Can we do without Mutual Health Insurance?

Subscribing to mutual health insurance is sometimes a significant expense for small budgets. However, can we reasonably ignore this insurance and consider living without mutual insurance?

The point on the advantages and disadvantages of not having mutual health insurance.

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Doing without mutual health insurance: Is it legally possible?

Since 2016, employees in the private sector must benefit from their company ‘s mutual health insurance , at least 50% of which is financed by their employer.

If you are in this case, you can only refuse to join this collective mutual fund under certain conditions:

You were already present in the company before the implementation of the collective health contract: you can then apply for an exemption in writing;

You have individual health insurance on your side: you can refuse collective insurance, but only until the next expiry date of your individual contract;

You are an apprentice, on a mission contract, on a short-term or very part-time contract;

You are a beneficiary of the ACS (ex-CMUc);

You are already a member of a mutual company contract, as a beneficiary (you are, for example, affiliated to your spouse’s mutual company which imposes coverage for beneficiaries).

In these very specific situations, or if you do not have salaried status (ie if you are self- employed, student , civil servant, unemployed , retired , etc. ), you can choose not to have mutual insurance.

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Living without mutual insurance: what are the risks ?

Should you have mutual insurance or not, when the law does not require it? It all depends on your health needs, the doctors you consult…

and the risks you accept to run in the event of unforeseen care which can sometimes, in the end, weigh more heavily on your budget than a health insurance contribution.

If nothing obliges you to take out individual health insurance, the latter is indeed highly recommended. In fact, Social Security reimbursements generally only partially cover the real cost of health expenditure:

70% most of the time. Part of the health costs therefore remain the responsibility of each insured person: this is called the co-payment.

Moreover, excess fees charged by sector 2 and sector 3 doctors are never covered by Social Security.

The role of a mutual is precisely to cover, in part or in full, the rest to be paid in terms of health costs, which can sometimes be very high.

Example: for a classic consultation with your general practitioner, the price of which is set at €25, Social Security will reimburse you €16.50

(70% of the basic price, i.e. €17.50, less €1 of flat-rate contribution) . The remaining €8.50 will therefore be payable by you.

But with mutual insurance, you are reimbursed €7.50 (€8.50 – €1 flat-rate contribution deducted by Social Security)!

Another major benefit offered by mutual health insurance is to allow you to benefit from the 100% Health system in terms of optics, dental prostheses and hearing aids;

health posts whose prices are particularly high. This measure allows everyone to have fully reimbursed equipment, thanks to the joint coverage of Social Security and complementary health insurance.

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Not having mutual insurance therefore prevents you from taking advantage of this opportunity.

I don’t have mutual insurance: which offer should I choose to remedy this without sacrificing my budget?

Are you convinced that living without mutual insurance is a risky bet?

To be effective and constitute a truly useful expense, your mutual health insurance must be chosen with care, according to your profile and your health needs .

You are in good health? Do you consult exclusively doctors who do not practice excess fees? You do not have recourse to alternative medicine care not reimbursed by Social Security?

You can then opt for a standard mutual health insurance offer, the cheapest , guaranteeing the coverage of 100% of your co-payment.

Do your usual doctors apply fee overruns? Would you like to be able to benefit from comfort services in the event of hospitalization? Do you have children who will soon need orthodontic treatment?

It is therefore in your interest to take out a mutual health insurance contract ensuring, at least for the guarantees that are a priority for you, a reimbursement of more than 100 %.

A cheaper mutual fund, but with little coverage, will not be economical.

Can we combine a company mutual and an individual mutual?

Under the ANI law, private companies are required to offer their employees complementary health insurance.

But if this legislation allows everyone to have mutual insurance, the collective guarantees offered are not always adapted to everyone’s needs.

If necessary, is it possible and interesting to double your company mutual insurance with individual complementary insurance ?

What to do if the guarantees of your compulsory collective mutual insurance are not satisfactory?

Since January 1, 2016, all companies in the private sector must implement complementary health insurance for their employees.

The tariffs are often advantageous for the latter, especially since their employers have the obligation to finance their contribution at a minimum of 50%.

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However, this system has certain drawbacks:

the guarantees, set collectively, cannot always take into account the specificities of each employee, despite the possibility of subscribing to individual reinforcements which is sometimes offered to them.

As the cases of exemption from company mutual insurance remain fairly limited, another solution then consists in resorting to a second complementary, or additional health insurance , taken out personally.

Can I subscribe to several supplementary health insurance , that of the company and an individual mutual?

Yes! There are no legal restrictions for the employee, who can combine two mutuals to meet specific health needs;

by keeping their original mutual and subscribing to a second personal complementary insurance.

He can thus benefit from better reimbursement for orthodontics, optics, dental care or even consultations with doctors who charge overruns.

The advisability of this accumulation must be precisely evaluated: if it makes it possible to improve reimbursements, it also supposes paying a double insurance contribution.

How much and how is one reimbursed when one has two mutual health insurance?

In concrete terms, a single mutual insurance company can be linked to health insurance and benefit from teletransmission.

This means that it is up to the insured to send his second mutual insurance company his proof of expenses (invoices, service statements from the company mutual insurance company, prescriptions);

to obtain his reimbursements, within the limit of the expenses incurred.

Example: to change a pair of glasses, the costs of which amount to 300 euros after reimbursement by Health Insurance, it is possible to have two mutual insurance companies play;

within the limit of their reimbursement ceiling and the total amount of expenses incurred. If the first mutual reimburses the optical costs up to 100 euros and the second, up to 250 euros;

the first complementary will reimburse its flat rate of 100 euros.

And it will then be up to the insured, with supporting documents, to request the second mutual insurance company to be reimbursed for the remaining 200 euros.

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