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Health insurance in France: What you need to know about a mutuelle

The Local France
The Local France - [email protected]
Health insurance in France: What you need to know about a mutuelle
(Photo by DENIS CHARLET / AFP)

Once you have your French Carte Vitale, you may want to look into getting a complementary healthcare plan, or a Mutuelle. Here is what you need to know about top-up insurance in France.

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What are mutuelles?

France’s mutuelles are non-profit organisations which have been in operation in the country for at least 150 years.

Their main purpose is to ensure social welfare but not just through additional health cover, also in terms of pensions, disability benefits and other forms of cover.

READ MORE: How to get a carte vitale in France and why you need one

Mutuelles abide by the code de mutualité, which distinguishes them from health insurance companies in that members don’t have to pay premiums for pre-existing conditions and have a greater say in decision-making as part of this type of co-op or partnership.

While mutuelles are paid for by individuals, they are not private health insurance and don't come up with preferential treatment or access to private clinics.

How does a mutuelle actually work?

If you go to the doctor or hospital in France or have an X-ray or some other kind of test, you'll normally pay up front.

READ MORE: What you should know before having surgery in France

You are then refunded a percentage of the cost via the carte vitale system, usually within a week, either by the French government if you are working or your home government if you are a European or British pensioner qualifying under the S1 scheme.

In general terms the state covers around 70 per cent of the total, although for some serious conditions the percentage of state health cover is higher or even complete.

What a mutuelle does is cover, either partly or completely, the deficit or the part of the cost not covered by the state.

Essentially, a mutuelle is top-up health cover and one of the easiest ways of getting 100 percent health cover, although how much cover you get will depend on which mutuelle you have and how much you were charged.

Recent figures from 2023 for the French insurers' group Mutualité française showed that the average resident in France will have to pay out €490 a year in medical costs not covered by the state - unless they have a mutuelle. And of course for the elderly or people with long term health conditions the figure can be a lot higher.

Not every mutuelle is the same

Depending on the policy chosen, mutuelles can cover most or all of the remaining costs not reimbursed by the state, as well as some selected medical services and the cost of medicines at the pharmacy.

In general terms basic mutuelles will take you up to 100 percent cover but often the next step up, a standard cover offering around 150-175, or 200 percent, won’t cost a lot more and could tie you over for a lot of expensive extras such as dental and optical treatments. 

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Things are made more complicated by the fact that doctors in France can charge more than the base rates set by the state (tarif de convention) based on their category. 

This is known as dépassements d’honoraires and are added on by many specialist doctors.

As for general practitioners, they typically fall into the group of 'category 1' doctors who charge the government-agreed amount (which is most of them) of €25 for an appointment. However, this is set to go up to €26.50 toward the end of 2023.

For a specialist, rates were set at €30 in August 2023, and were expected to go up to €31.50 by the end of the year.

For 'complex' consultations with a specialist, the rate normally would be about €46, but this was expected to go up to €47.50.

When it comes to mutuelles, if you have one that reimburses at 100 percent, this means that it will only cover the base rate (tariff de convention) or €25. To cover up to €40 per appointment, you'll need a mutuelle that reimburses at 200 percent. And the same applies to all medical treatment. Note that more expensive mutuelles will reimburse to 400 percent. More info here.

The mutuelles and complémentaire santé market is fairly flexible in this regard so it’s worth having a search online for the policy that best suits your needs and budget.

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And make sure you look carefully at the rate of reimbursement.

There are plenty if not too many to choose from, so also ask French friends or your local doctor for recommendations to get a better idea and more honest opinion. 

Your company might foot the bill

Since 2016, private companies in France have been required to provide employees with a private health insurance policy known as a mutuelle collective.

By law they have to cover a minimum 50 percent of the mutuelle’s cost and some companies offer workers extended medical cover for their family members as a perk. 

However, if you work in the public sector, you’re job seeker, student, self-employed or a pensioner, this law doesn’t apply to you and you’ll have to opt for a mutuelle individuelle.

So what’s the cost?

Mutuelles are more affordable than private health cover, hence why most people in France have one.

However unlike in Britain, it doesn’t guarantee faster treatment at the hospital or get you access to private doctors and clinics either. It just assists financing the personal contribution element of France’s healthcare.

According to MeilleurTaux Assurances, a family bundle for two adults and two children came out to an average of €1172 in 2022, which represented a rise of six percent due to inflation when compared with 2021. This meant a monthly expenditure of approximately €98.

Data from French insurance comparison site Selectra.Info estimated costs for the year 2023 down for seniors - those between 66 and 75 were expected to pay about €124 per month, or €1,490 per year. Those 75 and older were expected to see a higher bill, closer to €173 per month or €2,070 per year on average.

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Average mutuelle costs for workers aged 25 tended to be lower, averaging at around €28 per month

Another consideration worth noting is that different regions of France have higher and lower mutuelles prices, although this generally affects the rate by around 10 per cent. 

Read the small print

The mutuelles and complémantaire santé market is a competitive one so as mentioned earlier it’s best to ignore the sale pitches and cut to the real deal.

Make sure you read carefully through what your prospective mutuelle offers, in particular the small print of your contract, as this is often convoluted but still very telling.

Watch out for what calculation they use to actually reimburse you. 

Keep an eye out for the cancellation clauses too as they can be quite specific and require notice to be given several months in advance.

If you're not a mutuelle member already, you should probably become one

Unless you’ve got private health insurance or plenty of money stashed away which you’re willing to burn in case of a medical emergency, you’d be better off paying for a mutuelle or top-up health cover in France.

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Keep in mind that healthcare isn’t completely free in France, so fees can run into the thousands of euros if you have to go to hospital.

It’s a case of being better safe than sorry…or in debt.

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Comments (1)

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Anonymous 2019/04/18 14:56
We are Brits, with a carte vitale and mutuelle - is this enough in the event of a no-deal or will the French withdraw the carte vitalle?

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