I joined a mutuel when I first arrived here last year.
Before I didn’t need to buy a mutuel as it was paid for by CMU as we were not making enough money before our pensions.
I paid for it monthly 96 euros per month for nearly a year without claiming anything as I receive my monthly prescriptions free as I have rhum.Arthritis.
It said on the quote I received that I would get 100 percent on everything but when I tried to claim they informed me as the security social gave back a measly amount (as they do) they didn’t have to.
Also I am having a laser operation later this year which will cost me 400 euros.
I emailed them if they could contribute something towards it but they said no.
I had an argument with them regarding 100% and they told me it was 100% of what the security social would pay.
Please could anyone help with these percentages definition.
I want to change my mutuel could I actually get one just for hospilization, scans
Operations etc.
As far as I understand it-there are set costs for operations ect. between the govt. and the providers
That is the 100%. If your surgeon/hospital/practitioner charges more than that sum then if you have 100%cover you will only receive what the set figure is-anything over that figure you pay yourself.So if the set amount for an op is €100 but your surgeon charges €200-with 100% cover you will only get back €100 and you will have to find the other €100 yourself. To get the whole amount back you would need 200% cover. At least that’s my understanding of how the % thing works. If that’s wrong then I’m sure someone will put me right.
That is correct. 100% cover from a mutuelle never means that you are guaranteed to get back 100% of actual costs. It always means that you get back 100% of the state-approved ('conventionné) tarif for each procedure. But many providers charge more than the state-approved tarif, which is, as you say, on the measly side.
That is why you can also get mutuelle policies that refund 120%, 150% etc; 150% doesn’t mean they give you back everything you paid plus half again as a bonus, it means they will refund up to 150% of the tarif conventionné.
Yes you can get hospitalisation only policies.
The choice can be confusing and I have found the best thing to do is to use a local agent so you can talk it through with them and get them to explain the policy options and help choose which is best for you. It sounds as if yours isn’t local if you communicate by email, but they should still be able to advise you.
Anna and Sue’s replies pretty much explain it. It is confusing though and you’d be well advised to contact someone like Fabien who will be able to explain it fully and advise you accordingly.
100% means “all”… NO… frais reels means “all” … am I thick, or what (replies on a postcard )
absolutely agree… very confusing. It must have been explained when we took out our policy… ages ago…but I’ve only recently really got my head around how it works.
We get nothing at all… unless Social pays something (no matter how small)…then Mutelle steps in…
Seems we were well advised in the first place… and have decided to stay where we are…
It is well worth you asking Fabien to explain. Perhaps get your Provider to offer more options/quotes… and shop around a bit too… just to be sure that you get the sort of cover that best suits you.
Well it’s simply a matter of what it’s 100% of, isn’t it.
Tarif conventionné is a known quantity. Frais réels is an unknown quantity because in theory, non-conventionné surgeons and clinics can charge what they like. It would be a brave insurance company that undertakes to refund 100% of whatever you spend, when the sky could be the limit… (and I wouldn’t want to pay their premiums, would you?)
The better the policy (ie the higher the percentage) the higher the ceiling is.
If you need treatment you can always ask the provider what they charge, and try to find one that doesn’t exceed your ceiling for that particular treatment. For instance, if you have 150% cover and the tarif conventionné for the treatment you need is 200€, your ceiling for that treatment is 300€, so you would look for a provider that doesn’t charge more than 300€. If you have 200% cover you would look for a provider that doesn’t charge more than 400€, ie 200% of tc. So the higher the level oof cover you take out, the better your chances of being able to arrange things so you get the full refund.
Hi Barbara, it is very confusing indeed especially considering that 100% means 100% of the real expenses when it concerns hospitalisation costs or medicine but it does only represent 100% of the social security ‘scale’ for anything else.
As you can see in the example the ‘Base de remboursement’ is 25€ for a local GP (Médecin Généraliste) but the social security will only refund 16,50€ from these 25€ (70% of 25€). In that example shall you have a 100% top-up mutuelle you’d get 100% of 25€ minus what’s been refunded by the social security = 8,50€. There is a 1€ forfait deducted on each cares so the actual refund from the mutuelle would be 7,50€ (for that example).
It is usually quite easy to cover consultations, medicine and hospitalisation but medical equipment (wheelchair, hearing aids, etc.), dental cares and glasses are much more difficult (costly) to get covered.
It is of course possible to cover only the hospitalisation and that might be a good option if you don’t have any particular ongoing issue or cares but again it varies on each one’s situation.
Happy to discuss that topic more in-depth if you’d like.
Hi Anna… in my innocence… I had thought that 100% meant just that… Total ! and why shouldn’t we think that… eg if something is 100% natural… it means it has no unnatural additives…
if I say I am 100% behind someone… that means I am totally, absolutely etc behind them… it took me ages to realize that in Mutuelle insurance speke 100% means something very different… in simple language… it just means “the same”…and 200% means twice ( 2 x Social) etc (only up to the actual cost)
Whichever language we use and whatever way it works out… I have noticed that whenever we have medical stuff at “frais reels”… we get the Mutuelle topping up whatever the Social does not pay… so I am very happy with that…
Our policy does have a high premium… but we have more than had our money’s worth over the years… not that that is anything to smile about, as I would much rather pay for a super insurance and never need to use it…
but to be fair, it does mean 100% (of tc). The fact that you can also get 200% cover etc might flag up that 100% is not in fact as high as it gets, and some head-scratching might be needed…
I know, I know… I am admitting to having been completely daft… but there was an awful lot to take in… my French in those days was minimal… and seeing 100% or whatever… told me that all would be well… all would be covered… and I thought no more about it…
Also, I have been astounded by the bonus payments paid on top of the percentages…our Mutuelle must make their money elsewhere… they are not making much out of us…
Absolutely Andrew - well said. There’s loads of info online, just like the Ameli link provided by Fabien above. In addition, the Mutuelle companies are pretty thorough in their T’s&C’s (CGV) - it’s simply a question of taking time out to properly inform yourself and reading the small print - as always!!
PS could someone correct the spelling in the discussion title - ta!
Absolutely Andrew… as in so many cases… the locals understand things 'cos they have grown up with them…some of us immigrants can have a tough time…depending how far-gone we are (age-wise)
am I thick, or what (replies on a postcard 
)
in simple language… it just means “the same”…and 200% means twice ( 2 x Social) etc (only up to the actual cost)
but to be fair, it does mean 100% (of tc). The fact that you can also get 200% cover etc might flag up that 100% is not in fact as high as it gets, and some head-scratching might be needed…