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

[james]

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
costs!

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.

[Dominique_Rogers]

Hello Fabien, Just to say thank you with providing us with a sensible and reliable health insurance, very impressed with their services. I just had a cataract operation and it was all very good.
I am thinking of changing my house insurance do you have anything?
cordially
dominique Rogers

[fabien]

Thanks for the lovely feedback @Dominique_Rogers it means a lot to me really! I’ll get in touch over email for your house. Cheers,

[Peter_Goble]

My wife and I are retired and settled in France in 2015, intending to stay here for our remaining years. I found out, by reading the accounts of others like us, and much to our surprise, that our Cartes Vitales wouldn’t necessarily cover the costs of hospitalisation, for example following a fall at home.

Fabien explained in detail what happens in such circumstances, and how we would be wise to insure ourselves against the consequences of such an accident. It was an eye-opener, and we were very grateful for his wholly disinterested advice. His approach to this service is professional, personalised and prompt: a man with whom it is a pleasure to do business; and his proposals must be the best value-for-money in a competitive market.

My wife and I strongly recommend Fabien for a bespoke and carefully considered response to all and any of your indemnity concerns.

Thank you Fabien!

[fabien]

Many thanks for that unexpected wonderful comment! I’m please to know you’ve enjoyed my services / advises and would be happy to help again shall you need my expertise in the future. Thank you again,

[susan_Craig]

Hello Fabien How do we get on touch for advice please? Regards

[Stella]

Click on his name and send a Message… click this link @fabien

[susan_Craig]

Thanks Stella

[Peter_Goble]

Hi Fabien, and you do merit my comment. For your information, my Credit Agricole conseiller told me today, that if I had sought the bank’s help with a Mutuelle on the same terms as you proposed it would have been declined, as their policies had an age cut-off at 74 years.

You certainly know your business, and saved us a lot of worry.

[fabien]

Thanks again for your support and for reporting that in here Happy to be at your service and hopefully I’ll live up to the reputation as long as possible

[fabien]

If that doesn’t work or can’t reach me there is a landing page on SFN to get in touch as well it’s located here => http://insure.survivefrance.com/contact

[susan_Craig]

Thank you Fabien,

Just trying to decide what to do as we have owned a house here for almost 3 years and have now started letting a gite on our property…We have a home in England so this is our maison secondaire - We are thinking of becoming residents. We are retired aged 70 & 72 …Our home in the UK would then become our maison secondaire. I read your response to someone else re taxes as we will have to start paying anyway on our gite earnings here in France but if we do become residents we will also be looking at what kind of health cover we will need here?.

I saw that someone else was looking at becoming an ME and saw the appropriate tax rates and relevant abatements on earnings in this sector.

Will be in touch again soon

Regards

Susan & David Craig

[Aquitaine]

If you are retired won’t you be entitled to an S1?

[Peter_Goble]

David, it has been explained to us that our S1 certainly provides us with basic medical cover such as MT visits where we are substantially (but not fully) reimbursed for the charges we pay, for prescriptions where we again get rebates on the charge for medicines, and for Xrays and ultrasounds etc.

If, however, we had to be hospitalised following a fall leading to a fractured hip, and had no appropriate Mutuelle cover, the hospital would require a very large cash advance against the provision of a hospital bed and attendant basic care, and more for medical or surgical management (the whole range), none of which is covered by the Carte Vitale.

The case is different for a limited number of medical emergencies, but not all urgent ones.

For détail one would need to consult an expert (e. g. Fabien qv) but from the evidence I’ve seen from others who have been caught out, I would not take the risk of finding out in a crisis.

[maggi_bloice]

I have been arranging our own cover re mutuelle’s for many years - I just go online - downside is that you have to enter your full details to get a quote and the older you get, the more expensive it gets. My husband has 100% cover for most things but as was explained to me - this does not cover things outside his ALD status. He has been in hospital here many times and we have never had to pay a penny up front even with the most basic cover - we were like most Brits grateful for the assistance of the local broker who spoke english. However as the years went by, what was initially a reasonable amount of money per month turned into an ever increasing amount for the most basic of cover - so I decided to do some research - now when I send for quotes - it is followed up by the inevitable phone call follow up - I to my shamr do not speak French very well but its surprising how quickly they get someone who does at the other end of the line - lets face it, its a lucrative and very competitive market with some of the most complex rules and regulations going. I for instance did not realise until I spoke to the insurance agent who sold me the topup policy for next year how complex these things are but I have saved myself a fortune over the last 6 years I have been arranging these policies myself - one of the deals offered me 2 months free and the 3d payment payable on the 30th day of the month - as at that time there was a possibility of me having to go for complex surgery I wanted a policy with excellent hospital benefits - another one I arranged because I knew I wanted varifocals and dental prosthesis treatment and it offered an incredible deal at the time. I always ensure that the seller understands I am looking for the best deal - and as far as I am concerned - that’s the way I am ie what’s best for us at the time - not with whom I am dealing with. If I was well off I simply would not buy these policies - I shudder to think how much I have paid over the years - just in case - just look at the returns from mutuelle’s etc from you bank, in most cases it does not make for pleasant reading. The lady I have just organised my latest policy with was charming, told me I did not have to wait 8 weeks prior to cancelling my contract at the end of the year but could do it anytime - its such a complex market - and unfortunately in France there. are no IFA’s ie folk who are legally obliged to give you best advice and work for you and not a company. The lady concerned spoke excellent english and spent lots of time with me looking at all options and gave me excellent advice - my husband is now 83 so this is when topup cover begins to get expensive, however we are paying 163 euros for the both of us for 2019 for again an excellent policy - her name is Laure Ducasse from a company called Compareo.com.

[fabien]

Hi @maggi_bloice, I read your comment and I’d like to bounce on a few remarks you’ve made mostly the following ones:

• You say that you don’t have to wait 8 weeks prior to canceling your policy. Beware of that kind of statement as the cancelation process is regulated by law (code des assurances) and is as follow for the top-up health insurances: You have to give the insurer a 2 months notice before the renewal date sent using a registered letter. If you’re being told anything else this is up to the guy’s (girl’s) word only so they can change their mind anytime (or if your contact changes that simple).
• I completely agree that insurances are not profitable for the customer and that’s actually why I usually advise to go for the bear minimum to cover what an insurance is for => unexpected risk / emergency that wouldn’t be covered anyway. So 9 times out of 10 you’d be loosing money but the one that aren’t would have been in a very ugly situation otherwise… this is the notion of risk, you are either risk avert or not Insurances are not for the bold if you prefer
• Insurance is a very lucrative business => Maybe 10 years ago but the regulators have strictly limited the commercial abuse so nowadays I’ll be 100% transparent we are only paid 10% of the premium most of the time (and we have to do all the paperwork, customer support, claim management, legal compliance, competitive analysis, etc.). Knowing that the average car / house policy is 300e per year I let you do the math Don’t get me wrong, some brokers / insurers still have deals from the “old times” but their numbers are diminishing and we tend to flatten the space.
• You mentioned there is no IFA in France to regulate bad commercial behaviour or make sure we present you with the best policy but that’s not true. In France the regulator is the ACPR and its role is to make sure we don’t present you with the more lucrative offer but rather the most suitable for you. So in short we are legally obliged by the ACPR to provide best advice.

I’m not trying to argue but just to bring some light to our field that has evolved a lot and which is no longer as people think it is because / thanks to the regulating body (the ACPR).

Cheers,

[maggi_bloice]

Perhaps I did not clarify the situation regarding the cancellation - I assumed wrongly that one has to wait until 2 months before the contract end date to cancel a policy but this is not the case - it can be cancelled sooner ie in my case in June for my contract renewal date on the 1st of January 2019 - gives me more time to research - and I always send by registered poste and keep the proof then to be extra sure I follow up. The Loi Chatel process does not always apply - in my case Allianz with my particular contract send out their Avis d’echeance in the first week in December (premium for following year) thus too late to cancel in their case for the particular top up I purchased. In the process of researching for suitable health cover I have come across some of the most hard sell sales people ever - often harassed by their managers, but that’s a price I am willing to pay to get the best deal. I have nothing but praise for the lady who sold me my latest policy - I class her as well read in her line of work. She has sold me an excellent policy at a good price that will suit our needs for 2019. Regards commission - that is low, perhaps that’s why the industry is so hard sell - they need to survive in this highly competitive market. As an IFA in the strictly regulated UK during my working life - you do not need to tell me about paper work - horrendous (and I was not on a personal commission base).

[fabien]

You can actually cancel a policy even when the 2 months notice has run out if the premium has increased even (and especially I would say) if they send the renewal notice late (résiliation pour augmentation de prime).

Luckily there are still some people / brokers / insurers that are doing they job properly and conscientiously (I like to think I’m one of these but only customers can judge me on that ). As the saying goes: you get the service you paid for! If you don’t need any service at all (you got it all understood / covered) then online websites like lesfurets, assurland, etc. are clearly the best solution as you won’t find a cheaper alternative with a broker (our prices are the same).

The only edge a broker has compared to these websites is the quality of service when selling the policy & afterwards (policy & claim management) which most of us do for free as well and add an extra layer of service on top of the insurer’s. So for those how don’t value / need that extra layer of service (which include respect of privacy, no cold calling, etc.) then online brokers are the way to go definitely and that’s 100% ok from my perspective.

[graham]

I have to say that, having been in business (now retired) on my own account for more years than I care to remember, I was perfectly capable of looking after my own interests in the past but now, in a foreign land with differences likely to catch you out, I feel far more content leaving these matters to an expert such as Fabien.
Yes, I suppose I could save a few Euros doing it myself but the penalties for getting it wrong are immense!
The savings sometime are a false economy; as an unrelated example, we have a Kubota ride on mower (which is a superb tool given the amount of grass we have to cut weekly) and it needed a new battery. So we saved a few bob (over the genuine Kubota part) by buying locally.
The battery had to be adapted so that it would fit the cradle in the frame (which then invalidated the guarantee) and when it leaked acid all over the frame we had to have it replaced after only 1 year. The Kubota part may be more expensive but in the long run it will save us money. The moral being not to be penny (or centime) foolish but pound (Euro) wise! A salutary lesson for us.