4. 'Mutuelles' and 'Top Up' Health Insurance
- Limits of State Health System
- How Much do you Pay?
- Does a Top-Up Policy Make Sense?
- Obtaining Voluntary Health Insurance
- Terminating Your Top-Up Policy
4.4. Obtaining 'Top Up' Health Insurance
i. Social Security Registration
Before you can obtain to a voluntary 'top-up' insurance policy you must be registered in the health system, with a social security number.
If you are of retirement age, or early retiree, provided you are covered through an EEA 'S1' health certificate you need to make application to register with the health service to your local Caisse Primaire d’Assurance Maladie, the local health authority.
If you are an employee, your affiliation to the health service will be handled by your employer, who may also offer a company-based scheme of voluntary insurance, called prévoyance collective, covering you and your family. These schemes also offer additional insurance cover in relation to death, incapacity, unemployment and retirement.
If you are self-employed, your health service registration will occur as part of the process of your business registration.
Once registered with your Caisse, you can seek out suitable voluntary health insurance.
These complementary insurance policies are provided by insurers, who are collectively known as organismes de complémentaire de santé (OC).
They may be either non-profit 'mutuelles' or private insurance companies, although do not assume from the nomenclature that the former are necessarily less expensive.
There are several hundred such insurers, but many are reserved for specific professional groups or collective company insurance schemes. Some also serve only a specific geographic area, whether a department or region.
In the case of the private insurers the major players for individual insurance are Covéa, Axa, Groupama, Swiss Life, Macif and Alliancz (and their subsidiaries), whilst the major mutuelles are MGEN, La Mutuelle Générale, Harmonie Mutualite and MNH.
The mutelles control around 56% of the market, with the private insurers picking up around 27%.
The rest of the market is covered by a number of newer entrants, notably provident funds (institutions de prévoyance) and some banks - Credit Mutuel, Credit Agricole (Pacifica) Banque Postale and BNP Paribas.
Approximately 60% of people are insured via a mutual insurance fund (mutuelle), with a further 24% insured via a private fund and 16% in employer/employee schemes.
In terms of finding a suitable insurer, try thumbing through the yellow pages (pages jaunes) of the local telephone directory under Assurances. You might also want to contact a broker (courtier) who will be found in the same listings.
You can also find more information on-line by typing in assurance complémentaire or mutuelles on your search engine.
To get some idea of your likely costs there are a couple of internet portals where you can compare the offers from different voluntary insurers.
In each case you will need to understand French and be capable of completing a simple questionnaire.
You can also obtain a free quote from our competitive English language speaking health insurance partner at Get a Quote.
iv. Level of Cover
Broadly speaking, the level of the guarantee in the contracts is often expressed as a percentage of the official social security tariffs. So a basic contract might offer you 100% reimbursement of the official rate, but as the charges imposed by the doctor or consultant might exceed this rate, you would still be left having to fund some of the costs.
A more expensive contract might offer you 200% to 400% of the official rate, which would cover a greater percentage of your actual costs.
You also need to check to what extent the policy will pick up excess charges (notably those of consultants), which are not covered by the social security system. Some policies will only cover charges at the official rate, leaving you to cover any excess.
Although you might feel that the non-profit insurers would offer the best rates, this is not necessarily the case, so do get quotes from both the mutuelles and private insurers.
If you have a pre-existing medical condition this may determine the route you take, as the mutuelles do not seek a medical questionnaire, whereas this is sometimes required by the private insurers.
Of course, whether a mutuelle or a private insurer, there is a trade-off between the level of cover you seek, and the premiums you are prepared to pay.
Some insurers set an age limit of 65 to take out a policy with them, although in the vast majority of cases, if you subscribe before you reach 65 years, you are permitted to remain with them.
For those 65+ there are specific policies designed for seniors.
As we develop these pages, we will endeavour to provide more detailed guidance on the different contracts and their rates.
We published an article on what you need to consider in selecting your complementary French health insurance policy at Complementary Health Insurance Contracts.
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