This post will aid you in the processes of how to subscribe to a good mutual health insurance in France.
Define your health needs.
Being able to compare the different mutual online is a significant advantage. Fast and free, comparators provide access to a wide range of complementary health insurance.
But before subscribing to mutual insurance, it must be adapted to your profile. For this, we therefore advise you to take stock of your most important items of expenditure in terms of health. Indeed, if you consult specialists it is necessary to look at the box of reimbursement concerning the overruns of fees. Or if you regularly call on an osteopath, for example, look at the reimbursement box for alternative medicine to find out how high you can be reimbursed.
Taking stock of your health needs is therefore an important step in finding the right mutual insurance contract that suits you. There are a multitude of contracts on the market today and this first step will help you see more clearly.
Take a look at the basic guarantees offered by complementary health insurance. There are 4 main groups of essential guarantees to have in your contract: hospitalization, current medical care (doctors, medicines, analyses, etc.), optics (frames, glasses, lenses) and dental (prostheses, implants, orthodontics …). But also remember to look at the optional guarantees in order to have the best possible protection.
Depending on your needs, you will therefore need a mutual insurance company to supplement Social Security reimbursements . What needs are you going to focus your research on? To determine your needs and, by extension, the guarantees you will need, remember to take stock of your health expenses over the last 6 months, or even the past year if you have the courage!
Define your health budget
The contribution of a mutual is calculated according to many criteria . Of course, the price of your mutual health insurance depends on your insured “profile”. That is to say that the contribution is calculated according to:
your age (the older you get, the more expensive the contribution, because the risk of illness or accident is higher: think about comparing the offers of mutual health insurance for seniors or mutual health insurance for retirees );
your place of residence (if you live in Paris or Marseille the price of your health insurance will be different). Indeed, in Paris for example, it is statistically proven that people consult doctors more often and consume more drugs, but this is also explained by the fact that doctors in the Ile-de-France practice higher prices with overruns . The contribution will therefore be higher than in other towns because the mutual insurance companies intervene more in the reimbursement of health costs;
the composition of your household (if you are insuring alone or with your spouse or your beneficiaries). It is obvious that if you are alone or several to be insured by the mutual, the contribution will be more or less expensive.
The price of your mutual will also take into account the formula, and therefore the level of guarantees, that you will choose. If you opt for a basic formula, which reimburses a minimum, the contribution will be lower than for a high-end formula, which will reimburse much better.
Finally, the contribution varies according to the guarantee options you select, such as the reimbursement of alternative medicines or spa treatments. The more options you select, the higher your dues will be, as it will reimburse you more fees.
One of the first criteria for choosing your mutual is therefore obviously the price, and all these elements will make it vary. To help you find the contract that corresponds to your budget, we advise you to define the maximum amount that you are ready to pay each month for this item of expenditure.
You will be able to compare the different levels of reimbursement offered by the mutual insurance companies with the amount of the contributions. This will allow you to find the contract more quickly with the best contribution / coverage ratio.
Compare to find the best mutual health contract
First of all, what is mutual health insurance for ? It’s simple, it takes over from Social Security when the latter does not reimburse you in full for a health expense and in fact, is very important if you have many medical expenses to assume.
But which mutual insurance contract to choose ? To find the best offer, we simply advise you to compare them well. More than 500 organizations offer mutual health or complementary health (all types combined: mutual, insurance, provident institutions). And each organization offers several formulas, to adapt to your needs. Surely there is one on the market that suits you!
As a general rule, the French subscribe to mutual health insurance to meet the need for reimbursement of optical care (for 68% of French people with mutual insurance), dental care (for 60% of the contracts taken out), or even in the event of hospitalization ( for 47% of French people with mutual insurance).
To choose the right mutual insurance company, you must know your needs and your budget : only 52% of French people believe that they understand their mutual insurance company well and have chosen it knowingly, and 33% find it very difficult to understand the content of their mutual health insurance contract. . Finally, 15% acknowledge that they do not understand their mutual health insurance at all!
To compare the offers on the market, it is necessary in most cases to be accompanied or, at least, to be helped . Online comparators allow you to have a direct and simple overview of mutual. So don’t hesitate to use them!
Beware of exclusions and waiting periods
As explained previously, in your contract there are the basic guarantees, the optional guarantees (which have an additional cost) but there are also exclusions of guarantees . This corresponds to situations or behaviours for which you are not covered by your mutual insurance contract. To find out what these exclusions are, you must refer to your contract, there is often a paragraph called “warranty exclusions”.
The exclusions of guarantees are always more or less the same with most mutual:
the treatments practiced by certain establishments , such as thermal cures, thalassotherapy or other specialized centres, (but which can sometimes be requested as an option)
surgical procedures deemed non-essential , such as cosmetic surgery for example,
detox cures or sleep cures ,
treatment that occurs following faulty behaviour on the part of the insured (fights, suicide attempts, involvement in military operations, etc.).
Read this paragraph carefully so as not to have any unpleasant surprises.
Do not confuse subscription date with effective date. It is not because you take out complementary health insurance that the next day you can change your pair of glasses, for example, and be reimbursed. This is called the waiting period. This period varies according to the contracts, so read this condition carefully to find out for how long you will not be covered. This generally varies between 1 and 3 months.
Can we take out mutual health insurance at any age?
At retirement age, employees in the private sector who previously benefited from a collective contract in their company lose this advantage . Admittedly, the Evin law of 1989 requires the organization that covered them to offer them a new contract and limits the applicable price increases (50% maximum). But, in any case, they will have to pay more (especially since their employer will no longer participate in the payment of the contribution) for less guarantees than during their working life. Hence the interest of going to see what the competition offers. But for a senior, everything is no longer possible. Some organisations, such as Les Ménages Prévisons, Groupama, Axa, etc. accept new arrivals at any age.
But many companies and mutuals set an age limit for subscription. From 65 years for Mutuelles Mieux Etre, AG2R, La Poste, AGF, Generali, Macif Mutualité… The latter, however, admits new members up to the age of 70, provided that they have already previously been Macif members (in auto insurance , comprehensive home insurance, etc.). MGEN Filia (mutual fund open to people outside the scope of MGEN, the National Education mutual fund, and to Maif members) even sets the age limit at 50, but can raise it to 70 by decision of its board of directors.
Other organizations set a higher age limit for everyone : 70 years for Aviva/Norwich or for Maaf Santé (beyond that, membership is possible on condition of justifying a previous contract of less than three months), 75 years for GPA… Or offer specific contracts for seniors, such as MMA (Classic Health contracts are reserved for those under 66, 65-80 year olds can take out Senior Health guarantees); or even modulate the age limit according to the guarantees, excluding the oldest high-end guarantees: 75 years for high-end Gan contracts, the low-end remaining accessible without age limit; 65 years old for high-end, 80 for low-end at La Mondiale, 64 for high-end at BNP-Paribas, no limit for low-end…
The documents to be provided to finalize the subscription to the mutual
After having defined your health needs, defined your mutual budget, compared the rates of mutual insurance as well as the different contracts and guarantees, you can make your choice and subscribe to the best mutual insurance company.
So comes the time of subscription, and to validate your file the organization needs a certain amount of information and documents concerning you.
Here are the elements to provide to your mutual insurance company so that it can send you your final contract:
your personal information and that of your beneficiaries (surnames, first names, age, family situation, etc.),
your social security number and that of your dependents , as well as the scheme on which you depend (CPAM or MSA)
your banking information for the payment of contributions and the reimbursement of your expenses directly to your bank account,
a medical questionnaire , in some cases.
That’s it, you’ve completed all the steps for subscribing to your mutual! You can now benefit from optimal health coverage, adapted to your needs.
A few days after the finalization of your file, you will receive your health insurance card . The latter must be presented during your medical consultations but also in pharmacies, so remember to always have it with you. This mutual insurance card will allow you to benefit from third-party payment, which will prevent you from having to advance your health costs.
Finally, remember to update your vital card as soon as your mutual insurance takes effect to allow remote transmission between your Social Security organization and your complementary health organization, which will save you from having to send a care sheet to your mutual insurance company. . To update your vital card, you can go to a pharmacy, health insurance reception points or certain health centres.