So you're still wondering if you really need a mutuelle

I haven't been around on sfn for a few weeks, firstly due to a trip to the UK which was great as we hadn't been for a couple of years and as the kids are a couple of years older the whole english language thing suddenly made a bit of sense and for the first time my 5 year old started trying to speak a little English to communicate with her cousins etc. Her little brother then followed.

So why am I talking about mutuelle? Well, if you're still one of those who thinks that accidents always happen to others read on. the day after getting back from the UK, off I went for the usual saturday afternoon training ride with my mates. 100km in, we decided to take a technical descent nice and slowely for a change (thankfully) but rounding a pretty tight bend I was faced with a citroën ax on my side of the road,the next thing I remember was waking up lying on my back in the middle of the road, another rider on the road next to me and the others around us telling us not to move. Instinct meant I managed to avoid the car but changing trajectory in a tight corner at 40 kmh means the bike and rider just can't stay upright! the result: 3 broken ribs, broken shoulder blade, vertabrae, road rash everywhere, lung slightly unstuck, leg badly twisted but nothing broken etc. etc.

Seeing as I had to have x-rays then a full back scans etc, several days in hospital, nurse to the house every two days to see to the bandages etc. it means that the final bill is going to run into the thousands of €. Yes I have a mutuelle and as I'm a have a licence at my cycling club we're insured via our federation too so it shouldn't cost me a penny. Now if I had to pay everything or even the 30% the state don't pay that'd be a different story :-O

I hate paying out the hundreds/thousands of pounds a year for all the various insurances, there have also been threads here saying they're not worth it, well sometimes they really are, I speak from experience!

Terry, thanks so much for your time on this. It is much appreciated.

Sheila, if you can get hold of this week's Figaro magazine (dated 16/17 November) it has a special section on insurance which includes a page on mutuelles. I found these links in the mutuelles piece: -- a site which says it will help you find the cheapest deal -- Figaro says they have a new offer called Modulango which allows you to pick what you want covered. -- another "find the best deal" site. -- this seems to be backed by Figaro and says it puts you in touch with an expert.

No idea how good any of these are but probably worth a look if you're still searching.

Sheila, if you look on the Useful Links page you'll see a "Compare Mutuelles" section with a few links including one in English. Might give you an idea of what's available.

Incidentally, the 70% only applies when you visit your own 'declared' doctor, if you visit a different one you only have about 40% reimbursed - can't remember the exact figure.

The top ups are useful, I wanted one for 'natural medicine' and could only get it if we did an above 100% rate that had an impressive list of things, some open to interpretation. Thus, some of the scans I have had and the consultants with them have been prescribed but go above and beyond normal diagnostic and palliative medicine, so the mutuelle has paid out far more than the state has reimbursed, thus paid. Find out exactly what you need or want and then add a little extra. No, not cheap but I have saved tens of thousands this year.

OK will try again. Maybe I'll put it into a blog - must get my act together and get back to work. It's as if I have finished my season and my mind (and body) has gone into meltdown and can't motivate me anymore!

The problem with glasses is that the state tarif is something ridiculous like 6€ for the lenses and 15€ for the frames, so 70% is 70% of diddly squatt. It is not always good to change mutuelles as we have a fidelity bonus on glasses now and get extra, especially if we use their partners. Children are reimbursed at a slightly higher rate for glasses - not much help for you Sheila but useful info for others.

Thanks Tracy - FYI if you use the google search box now on the main page, it should find everything!

Thanks so much Tracy. Have emailed my broker (MMA) and will contact CA tomorrow with relevant questions about waiting periods, etc.

Hi Guys, have been trying to find a piece I wrote about mutuelles but can't find it anywhere, so here goes:-

The state reimburses 70% o (on average) of the state tariff. for example with a 100% mutuelle, you see your Medecine Traitant who is conventionee and it costs 23€, the state reimburses 70% which is 16.1€, less the 1€ fofait, your mutuelle reimburses the balance.

If you go to a non-conventionee doctor, he charges 30€. The state reimburses you 70% of the state tariff, still 23€ and your mutuelle reimburses you the balance of the state tarif, ie 6.9€.

If you have 200% insurance, when you go to the n/c doctor, the state reimbursement will be the same but your mutuelle will reimburse up to 200% of the state tarif ie 23 x 200%= 46€ so you will be reimbursed the balance of what you have paid ergo 13.9€. They will pay the balance up to 46€, if you have 300% it will be up to 69€ and so on.

Hope that is clear, have done it in a hurry so please ask if it isn't.

While it's true that the insurer pays a "top-up", remember that in some cases this top-up might be 95% of the cost of the item. Glasses, for example. I think the Secu pays about 10 euros or so, and for my boys the lenses cost 200 each. EACH!!! So I have a mutuelle (through my employment) that pays a lot for glasses, but they have a limit of about 500 or so for a pair. That is often the difference between a good and a bad mutuelle.

The 400% thing is (I think) that they pay 400% of what the Secu reimburses. So if the Secu pays 20% of the actual, and the mutuelle pays 400%, that should mean that you get the 100% reimbursed in the end. Or something.

Thanks for that Suz. That has clarified things for me immensely. As Henry is fond of saying, "at our age we are no longer maintenance free", so I need to look at dentist and optician options as well. I did take the precaution of buying two extra pairs of my prescription glasses before we left Dublin - I am quite short-sighted and any accident to glasses would have effectively made me house bound.

Our insurance agent who is based in Narbonne lives here in Lagrasse, and is reasonably helpful, and even got me a refund on motor insurance earlier this year at renewal, as we hadn't used up all of our mileage allowance. I might go with him for this mutuelle as he is reasonably accessible if we need any help with this policy. Wonder if he has a wood burning stove?

We didn't have to declare anything - it works differently to UK/Ireland. The insurer in France is generally only paying the top up portion not taking on the whole risk of any treatment and I understand their charges increase as you get older but not from what I've seen based on what's wrong with you.

The big difference I also found was the insurers talk about covering 100% 200% 300% 400% of fees. This confused me at first but I understand this is because some consultants can charge above the nationally agreed tarif. Most of these consultants I believe are in Paris or the Cote D'Azur so I'd be surprised if down our way we came across a 500% surgeon.

If the insurer covers you 500% then your policy is likely to be expensive as you can choose an expensive consultant whereas 100% means the consultant/dr/specialist conforms to the Nationally agreed tarif.

Some Mutelles include new glasses, eye tests, dentistry (except cosmetic) etc. so look out for that too, some like ours covers domestic help up to so many hours in the home in the event of hospitalisation & then needing help at home afterwards.

Some insurance will also cover alternative therapies too.

My insurer AXA (Jean Laplanche in Pezenas) is English Speaking - isn't cheap but does give you the information in English which is good for when you are first starting out & are unsure about the system. You will find cheaper quotes with other providers and the choices are endless.

There also exist comparison websites but beware you'll be bombarded with phone calls/emails afterwards!

From what I understand a lot of people change mutelle every year as it pays to keep moving and getting the best price. I need to sort ours next year as it;s crept up a lot but they have always paid out easily & automatically.

Thanks to Tracy, Terry and Ian for your replies. What I'm not sure of is the nature of the cover, what about pre-existing illnesses/conditions? I'm assuming private health insurance in Ireland is similar to that in the UK, allowing you to be seen/treated privately with the insurer usually paying most if not all of the bill. Henry is in fine health, and I've currently (crosses fingers) no problems other than high blood pressure, which is under control via daily medication. In Ireland, we had to declare any illnesses, whether or not you smoke or drank alcohol, etc. I need to insure against any major fees in the event of hospitalisation,m etc. Also, as I'm 56 and Henry is 63, we are not getting any younger here!! :-) So any advice as to what level of cover we should seek, and how to ask about waiting periods, etc., would be appreciated. My French is ok for daily routine stuff, but I am not good on the phone, hence the enquiry to Credit Agricole Britline.

Something else to consider. Once you choose a mutuelle it's not necessarily easy to change, or to cancel.

We had our own for a while, MAAF, when I was not working, and once I got a job with a mutuelle attached MAAF were not keen to let me cancel. I had the family covered with MAAF, and when I joined the new mutuelle MAAF demanded an attestation from my employer to say that I had no choice but to join, thereby allowing me to cancel. So I asked for and received that attestation. Then MAAF came back and said "Ah yes, all well and good, but it's only obligatory for YOU. What about your family? We want an attestation for them too! Ha!". I asked my employer and they said, "Ah, no, sorry, can't help, it's not obligatory for them".

I was kind of stuck, and then I discovered that as if by magic MAAF released us from their clutches. We have had car insurance with them for years, never any problems, and maybe they didn't want to break that relationship by arguing too much about the mutuelle?

Get a quote from April . Don't think they're especially cheap but I've used them for many years, never had a problem and find them very helpful and efficient -- they produced an ambulance in under two hours to get me back from Paris to Lozere a couple of years ago. All it took was a phone call.

Confirm what Tracy said about the BRSS.

Hi Sheila, I think they are referring to the amount of reimbursement you get, is it 100% BRSS, 200% and so on? Also you need to check out the wait period before it is effective. Mutueles differ vastly in how much optical and dental cover they offer as well. Try going directly to an insurance office rather than a broker - my personal opinion is that banks don't tend to do insurance as well as insurance companies but they can offer good value. Much of it depends on how much cover you think you may need, which is impossible to measure.

Hi all. Hope all who reported illness and accidents here on this thread are fully recovered. Can I get some advice please? As I have been asked for a photo for my Carte Vitale, I am assuming we are "in the system" and need to get mutuelle cover. I have received a quote from Credit Agricole (via Britline) - the underwriter is Pacifica - and the quote is €118.84 per month for Formula Essential. The other is a quote via my insurance broker for an MMA policy, €130.46 per month. I'm finding it difficult to "compare and contrast" what is on offer, in particular reference to Base de Remboursement de la Securité Sociale (BRSS). Can anyone throw any light on this? Thanks in advance.

Many thanks Sheila, miss you all on sfn but will drop in from time to time when I can - kiddies settling into new house and new school, OH and I are getting there...!