Your 'Mutuelle' or top up health cover explained. Plus how you can improve it


(James Higginson) #1

Health insurance is a subject that often causes confusion so here’s our ‘cut out and keep’ guide
to why you need a mutuelle and even more importantly, how to choose the best policy for your
individual circumstances.

First of all, it’s important to make the distinction between private health insurance (for those who
for some reason are not able to join the French social security system) and mutuelle or top up
insurance which we are talking about today.

Secondly, to be eligible for a top-up health insurance policy you need to get into the system first;
this means you must at least have a temporary French social security number.
So why have a mutuelle?

To understand the importance of a mutuelle it’s essential to understand what the French social
security system actually covers:

For example, during a period of hospitalisation the social security will cover only a fraction of the expenses incurred and you may even have to pay the hospitalisation fees in advance. To give you a real life scenario, a teenager broke her leg and ended-up on at the hospital on Friday afternoon and was discharged on Monday. The total amount to be paid by her parents was 1300€ as she wasn’t insured.
⇨ When you go to the pharmacy with your prescription, most medication won’t be fully refunded.
There are actually five possible levels of refund ranging from 15% to 100% of the real cost.
In both of these scenarios, having a mutuelle with just a 100% rate of top-up cover will make
sure that you don’t have any extra to pay and are not left out of pocket.
If you are fairly healthy and feeling lucky, it’s worth noting that you can also opt for
‘Hospitalisation only’ cover which is usually quite cheap; early retirees will probably be quoted
less than 30€ per couple.

So what about consultations with, for example, your local GP, specialists such as cardiologists,
gynaecologists, blood tests, x-rays or regular trips to the dentist? This is where the fun starts as
they are refunded based on the French social security’s charging and refund scale. A
consultation with the local GP is (currently) 23€ so you get back roughly 15€, leaving you with
8€ to pay from your pocket. This isn’t a huge amount but for anyone with kids or health issues
that mean they need to see their doctor on a regular basis, it soon adds up. Dentistry is
notoriously under-reimbursed; the charging scale for a crown is 106€, with the social security
refunding slightly less than 75€ whereas even the most basic crown costs well over 300€. This
is where a top up policy with a higher % rate comes into its own. For example if you have a
300% policy, the mutuelle will refund three times the social security scale so 3 x 106€, so 318€
plus you get the 75€ from the social security, which if you are lucky, will just about cover your

There are lots of different issues to be considered which will depend very much on your
personal circumstances - whether you wear glasses, your kids need braces, you are prepared
to pay a bit more in the chemist and have a lower premium and so on and so forth. It really is
one area where it is absolutely worth getting professional advice and a tailor made quote.
Fabien has saved us a fortune over the last few years and this is why we are highly
recommending his services to help you sort out the type and level of cover you need, and then
obtain it for you at the best possible price.

Fabien has been providing bespoke insurance services to SF members for the last few years and has excellent testimonials from numerous clients which you can read here. We have been using his services ourselves for the last three years and during this time he has saved us a fortune - we can’t recommend him highly enough! He is perfectly bilingual and will find you the best possible deal, entirely free of charge and will explain the small print of your policy to you in plain English.

Mutuelle assurance query re 100%
(James Higginson) #2