Mutuelle assurance query re 100%

(Jack Brown) #1

My wife is retired and due to previous medical problems is now in receipt of 100% from CPAM.
She is still paying the normal top up rate for her mutual (about 70 euros a month)
Can anyone advise me if there is a cheaper way to effect a top up to give her full medical cover

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(Graham Lees) #2

There are some things that cent pour cent from CPAM doesn’t cover but your mutuelle does seamlessly in concert with CPAM (so youo may not be fully aware of just what good value you get overall).

Beyond that. other things, like TV in your hospital room are not covered by CPAM but the Mutuelle does.

70€ per month doesn’t seem to me to be excessive but @fabien will be in a better position to advise you on this.

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(anon71231711) #3

Yes, Fabien’s your man!
Basically it just comes down to finding the company that will give you the best deal.
But if the 70€ a month really is for full top up (100% cover from a mutuelle is nowhere near full cover, I trust you realise that - 150% or 200% would give you a higher level of cover) then that might be hard to beat, sounds very cheap to me.

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(Jack Brown) #4

Thanks Graham for the fast response. The TV in a hospital room is not a problem, it’s the actual cost of the room that is important, I am aware that the Doctor is free, but I don’t know about prescriptions etc. Ideally a list of what is or is’nt covered would be perfect

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(stella wood) #5

Hi Jack
Affection de longue dureée (ALD) is allocated for a particular serious medical condition… and only covers whatever medical treatments are specific to that condition.

You will need to check your Insurance Paperwork to see what levels are topped up. As ALL other medication ( plus Eyes, Ears etc or treatment in or out of hospital) will NOT be covered (and this includes any medication which may be needed to counteract the adverse reactions to said ALD medications.)

Speak with @fabien. He will ensure that you pay no more than you need to, but that you do pay enough to get the cover you want (and need).

and, of course, the Hospital or your Doctor can answer your specific questions about room costs/charging etc …and that will put your mind at rest.

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(James Higginson) #6
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(Jack Brown) #7

Thank you James. I understand that the difference between a CPAM payment and the actual cost of say a hospital bed could be enormous,but, can this difference be made by a private insurance costing a lot less than 800 plus euros per year
Forgive my ignorance on the subject, but things become slightly less clear when you become an octogenarien

(James Higginson) #8

Hi Jack

I will defer to @fabien as he really is a superstar in this field!

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(Fabien Pelissier) #9

Thanks Graham, I’m happy to see you here after my email exchange with Vanessa :wink:

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(Fabien Pelissier) #10

Hi Jack, actually there are no discount applied for when you are ‘ALD’ (100% from CPAM) because that’s not how it works in France, I mean the idea here is that everyone pays the same whatever his or her condition. In other terms, you pay the same price whatever you are fit and healthy or one feet from the edge :wink: That’s what we call the ‘Esprit mutualiste’.

So basically, ALD doesn’t change the premium but it might change your needs in terms of top-up health insurance and therefore in some cases the policy can be adjusted to better match the updated situation (but that’s very unusual to be honest).

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(Jennifer Pache) #11

Hi Jack
I know that maybe this will not concern you, as we do not live in France. I joined this site primarily as we were thinking of moving there, as we are just over the border.
I think you are very lucky to have a fee of only 70 euros a month. I live in Switzerland, my husband and I are both retired - both Swiss Citizens. Between us we pay nearly 900 CHF for medical aid a MONTH. Compulsory, and the cheapest we can find. We have to pay this until we die. If one of us would develop a serious med condition, we could go to our A.I. (disability), or the social services, but they would not give us a cent as long as we have some of our retirement money in the bank. My husband has had to continue working now, after the pension age of 65, as long as he can, just so we can afford to live. Much more tax to pay every month, but without that we would not even be able to afford the rent of our flat, and monthly expenses. Our retirement money, and pension money was not very high, as we came back to Switzerland very late, at the age of 50 - so had to start anew, after living in South Africa for 25 years. Hope you find a way out of your predicament. Best Regards. If you are interested you can look at these 2 sites :
https://www.expatica.com/ch/healthcare/Getting-healthcare-in-Switzerland_103130.html, https://www.ssa.gov/policy/docs/progdesc/ssptw/2014-2015/europe/switzerland.html

(Julia Garrick) #12

Hi Fabien. Could you tell me whether someone (me) with an ALD 100% with protocole de Soins, and covered by the CMU at 100% should need to take out a Mutuelle? I am covered by the Mutuelle from my previous job until this summer, but I don’t know whether i need to be covered after this as I don’t really understand what the extra charges could be if I were hospitalised for my ALD. Thank you

(anon71231711) #13

I think what you need to consider, Julia, is that you may also need treatment for other medical issues that are unrelated to your ALD. There won’t be any extra charges for treatment for your ALD, but without any mutuelle, you will only receive partial reimbursements for any non-ALD-related treatment.

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(Mandy Davies) #14

Hi Julia

You say you are covered 100% by CMU. Does that mean you have the CMU-complémentaire because your income is low? If this is the case then you should be covered 100% for everything and shouldn’t need a mutuelle. This is the whole point of the CMU-complémentaire, of course, to allow the very poor full access to medical care.

(Fabien Pelissier) #15

HI @Julia_Garrick, actually if you were to be hospitalised for anything in regard to your existing condition you wouldn’t have anything to pay except for some optional costs like the single room or the TV obviously.

If you are also eligible for the CMU it’s good to understand that the CMU is acting exactly as if you had a 100% Mutuelle so you can always top it up but the overhead won’t be interesting in most cases. The only thing that might be worth considering is an hospitalisation only policy to cover these optional costs but that’s clearly not something mandatory and shouldn’t be much of a concern in your case.

Hope that answer your question(s)?

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(Julia Garrick) #16

yes, CMU complementaire. Low income due to loss of job, due to ALD :frowning_face:

(Julia Garrick) #17

Yes, than you very much indeed, you have put my mind at rest.

(Mandy Davies) #18

Looks like Fabien has answered your question. Really no need for a mutuelle - unless you really wanted a private room in hospital etc. As you are on such a low income now I doubt that’s a priority for you. Everything will be covered whether it is for your ALD illness or not.

Sorry to hear you lost your job because of illness. I wish you the best of luck.

(Julia Garrick) #19

Thank you very much, Mandy.

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(Loujack50) #20

Hi Fabien! Just a quick query. We have the basic mutually which does not cover a single room in hospital. My husband is in rehabilitation for 3 weeks and they don’t have double rooms, only singles. Will we still have to pay if there is no choice? Thanks.