Complementary health insurance are insurance formulas that allow insured persons to benefit from more comprehensive coverage. They sometimes take the form of packs intended to accompany the individual in medical or paramedical acts affecting his well-being.
Complementary health, to strengthen health insurance coverage
According to the functioning provided for by the laws that govern social security, in particular the Social Security Code, basic health insurance allows French citizens to finance various medical acts. However, this financing of the Social Security consists of a basic reimbursement: it covers only certain acts, and in the context of the acts covered, it reimburses only a tiny part of the costs incurred.
The payments granted by the health insurance are calculated according to a reimbursement basis, which is not always in accordance with reality. For a physiotherapy session, for example, the Sécu reimburses for insured persons under the general scheme 60% of a basic rate of 16.13 euros. In fact, this rate can go up to 30 or 40 euros, which leaves a large remainder (co-payment) that must be borne by the individual.
The complementary health, sometimes called mutual health, consists of a contract offering the insured to take over following the intervention of the health insurance. Thanks to this type of contract, offered by provident societies, mutual societies or insurance companies, the co-payment is considerably reduced, sometimes up to 0. As for the complementary health with well-being options, it affects reimbursement items that do not take into account health insurance at all. For example, alternative medicine acts (acupuncture sessions, thalassotherapy, etc.) or comfort options in the context of hospitalization are not supported.
Complementary health and well-being: what services to expect?
Insurers and other organizations offering complementary health contracts aim to offer policyholders formulas adapted to their real needs. Intervening as third-party payers, they regularly design packages attractive enough for everyone according to their profile. In this sense, the possibility of personalization is one of the main assets that can be associated with complementary health contracts including wellness options.
To assist the insured with regard to the preventive acts to which he resorts, a complementary health insurance may offer the reimbursement of all or part of the costs incurred for a flu vaccine, for podiatry sessions or for registration to a gym or a sports club. On the side of so-called alternative medicines, known to help the individual feel better about himself, acts of sophrology, acupuncture or homeopathy can be reimbursed by a complementary health. Home help is also part of the services offered by insurers.
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