A range of glasses and dentures will be completely free for patients from next year.
Complementary health insurance providers will be required to pay the difference between the government reimbursement and the actual cost of the items.
Hearing aids will be included from 2021.
The “reste à charge zero” program will not cover all products, but there will be a wide range.
It affects the majority of supplementary contracts – those designated as responsible, meaning they comply with a set of regulations drawn up by the government to ensure capped prices and mandatory levels of cover.
Opticians will be required to have two sets of glasses for sale.
In the range available at no cost, the lenses should cover all general vision problems and be thin, anti-glare and anti-scratch.
There should be 17 frames for adults, with a choice of two colors for each, and 10 different frames for children, also with a choice of two colors. The frames, which must comply with European standards, must cost a maximum of €30.
In the second set are all other products, such as branded frames, where health insurance companies will cover up to €100 of the cost, but not more. The measures will start on January 1, 2020.
Changes to dental appliances mean there will be three options, but these won’t include treatment by the orthodontist, so won’t include braces, which many teenagers are advised to wear.
Total coverage will be available for crowns, bridges and inlays, and ceramic rather than metal crowns will be offered for visible front teeth.
The second offer includes items where the customer contributes but the prices are controlled so that they are not excessive.
The third allows customers to choose any device they want at their own cost, which may include new methods not yet included in the 100% offer.
Crowns and bridges will be offered at 100% from January 1st 2020 and other items will be introduced from January 2021.
There are also changes to the reimbursement of hearing aids as government figures show that only 35% of hearing impaired people are fitted and many are put off by the high prices.
Full coverage of hearing aids will be phased in and no €0 aids will be available until 2021. The delay is said to allow insurers to adjust to what is likely to be an extra €50 million in costs for them.
Coverage will ultimately be up to €1,700 for each ear.
There has already been a mandatory increase in refunds for benefits this year and it will increase in 2020 when the customer will pay €400 for a benefit, reducing to €0 in 2021.
It will cover a wide variety of aids, but customers can pay extra for more expensive models.
Since November 1 this year, assistance has been organized for those with very low incomes to have supplementary health insurance under the Complémentaire Santé Solidaire, a merger of two existing systems.
Coverage will be free for those on very low incomes – a single person earning less than €746 a month – and a contribution will be paid by anyone earning between €746 and €1,007.
On average, it will be €8 a month for under-29s, rising to €30 for over-70s.
Starting December 1, 2020, the law will allow anyone to switch health insurance at any time after the first 12 months.
Currently, you can only change the enrollment anniversary, which is often moved to January 1, unlike other policies which you can now change whenever you want, with notice, after the first year.
Supplementary health insurance is not compulsory, but 95% of people in France have some form of cover.
There are more than 80 leading providers, which fall into three categories:
- Half of the market is covered by mutuelles, which are non-profit and specialize in complementary health care. Often, the word mutuelle is used as a general term for the whole range of such insurance companies.
- General insurance companies, which are for-profit and offer health insurance alongside their other services.
- Institutions de prévoyance, provident funds, which are not for profit and are generally responsible for collective programs in the workplace.
Prices depend on a number of variables: the company you sign up with, your level of cover, income, age, whether you’re working or not and where you live.
Families are often covered by workplace programs. Since 2016, employers in France have had to offer basic health insurance to employees and finance half of the cost.
These are often mandatory, but even if they are not, employees are unlikely to find a better deal elsewhere and other family members can be included in the insurance.
The self-employed can deduct insurance payments from taxable earnings under the Madelin Plan – an accountant can advise.
Temporary workers can have at least €15 a month for their health insurance paid by check from their employer and there is help for those on very low incomes. Retirees are most likely to have to work hard to find a good value policy, as they are more likely to need health care and prices are often higher.
Marianne Bye, of the French National Federation, said companies spread the cost across generations to offer cheaper policies to older people.
Grégory Caret, who helped create the free online service to help people find the best health insurance for consumer magazine UFC-Que Choisir (Quechoisir.org), says a 62-year-old single pensioner could pay between €19 and €300 a month.
Both say it’s essential to research options to find a policy that fits your needs.
The introduction of the ‘reste à charge zero’ range means consumers will likely no longer need to prioritize glasses, hearing aids and dentists when looking for cover.
Both Ms Bye and Mr Caret agree that the products chosen by the government are of good quality and should suit most situations.
However, if you have special needs, you should consider these categories.
Insurance companies have yet to adapt their policies to the changes and there are concerns that premiums will rise as a result.
If you are likely to need specialist treatment, it is important to know that the renewal covers the Secteur 2 doctor’s fees charged by some specialists, particularly in private clinics. These are the rates above the Secteur 1 fees set by the government – currently €25 for a consultation, of which €16.50 is reimbursed by social security and most of the rest by supplementary insurance.
Not all supplementary services cover Secteur 2 doctors, where there is some regulation about the additional fees they can charge, or the third category of non-contractual doctors.
Social security covers 80% of stays in public hospitals or private clinics, with 100% coverage in cases such as pregnancy or long-term illnesses. Supplemental insurance will almost always pay the balance.
You need to check which of the five categories of drugs are included, as only those considered irreplaceable for serious illnesses are 100% reimbursed by social security.
Medicines are given an effectiveness rating, called an SMR. Those classified as imported are compensated at 65%, medium at 30%, low at 15% and the rest at zero.
Different insurances give different reimbursements for drugs.
If you want to regularly see a doctor whose services are not reimbursed by social security, such as an osteopath, you may want to choose a supplemental insurance that pays for this.
When you sign up, you should check when your cover will start. For some services you may have to wait for a period before receiving compensation – for example, a contract may require you to wait six months before receiving payment for dental work.
