Who can benefit from a mutual insurance company and how?

Why take out a health insurance policy?

The Health Insurance only reimburses part of the medical care, often leaving the insured with a ” co-payment“, or even high costs in the event of hospitalization, dental or optical care. A complementary health insurance policy therefore allows you to Supplement these reimbursements and avoid unexpected expenses.

Example: A consultation with a specialist at 60 € is reimbursed at 70% of the base rate (e.g. €30 if the agreed rate is €50). Without a mutual insurance company, the remaining €30 is at your expense, and even more so if the doctor applies fee overruns.

Employees: a mandatory but advantageous mutual insurance

Since the ANI (National Interprofessional Agreement) law of 2016, all employees in the private sector must benefit from a company mutual insurance company.

Who is concerned?

• All employees, as soon as they are hired, on permanent contracts, fixed-term contracts of more than 3 months, apprentices.
• Even part-time workers or temporary workers can benefit from it.

What are the advantages?

• Partial coverage by the employer (at least 50% of the contribution).
• Guarantees often more interesting than an individual mutual insurance company.
• Possible coverage for spouse and children (optional).

Exemption Cases: An employee can refuse his company’s mutual insurance if he is already covered by his spouse’s or benefits from the Complementary Health Solidarity (CSS).

Students: what solutions after the age of 18?

Until 2019, students had to join a Student Social Security. From now on, they remain attached to the general scheme and can choose a mutual insurance company adapted to their needs.

Available options

Good to know: Some student mutual insurance companies offer specific packages for Alternative medicine (osteopathy, psychologists) or the reimbursement of glasses and dental care.

Self-employed workers and liberal professions

Unlike employees, self-employed workers do not benefit from a compulsory mutual insurance company. They must therefore take out an individual complementary health insurance.

What are the advantages for them?

• Tax deduction Membership fees thanks to the Madelin law.
• Choosing a Tailor-made mutual insurance depending on the needs (hospitalization, dental, optical).
• Access to the Complementary Health Solidarity (CSS) subject to income conditions.

Please note: Some organizations such as the Social Security for the Self-Employed (SSI) offer offers dedicated to self-employed people and craftsmen.

Retirees: how to choose the right health insurance after the age of 60?

After retirement, Company health insurance is no longer mandatory, but it is often possible to keep it (Évin law). However, the rates may increase significantly.

What solutions?

Good to know: Some local authorities offer Municipal mutual insurance companies at reduced prices for seniors.

Job seekers and people in precarious situations

Without a job, it is sometimes difficult to finance a mutual insurance company. Fortunately, help exists.

A dismissed employee may keep your company health insurance for up to 12 months (if dismissal without gross misconduct).

This state aid replaces the CMU-C and theACS. It allows you to benefit from a free or reduced-price health insurance according to income.

Conditions to benefit from it:

• Less than €9,719 in annual income for a single person (2023 ceiling).
• Free or reduced membership fees (e.g. €30/month maximum for a couple).

Example: A CSS beneficiary has not No out-of-pocket expenses on hospitalization or essential dental care.

How to subscribe to a mutual insurance company?

Employees automatically receive their company health insurance when they are hired.

To choose an individual mutual insurance company, comparators allow you to compare offers according to the care needs, age and budget.

Insurers and mutual insurance companies offer contracts adapted to different profiles.

The application for Complementary Health Solidarity is made online on Ameli.fr or in CPAM with proof of income.

A mutual insurance company for every situation

Whatever your situation, there is a suitable mutual insurance company:

• Employee? Your company offers you one.
• Student or self-employed? Several options exist at reduced prices.
• Senior? Bet on a mutual insurance company with good hospitalisation and optical guarantees.
• Low income? The Complementary Health Solidarity allows you to be covered free of charge.

Last tip: Always compare offers to find The best value for money according to your real needs!