To find the best mutual it is not enough to look for the best price. The most economical contracts logically have the lowest coverage. However, a mutual must first and foremost meet the personal needs of the insured.
Before trying to determine your care habits, it is important to fully understand the percentages that appear on the guarantee tables. This can be confusing:they are linked to the care agreement rates set by the Health Insurance, and not to the actual expense of the insured. That is to say, a rate of 100% of the reimbursement basis (BR) does not mean that the remainder to be paid will be nil:on the contrary, it is a rate that provides only payment of the moderating ticket, leaving the cost of any excess fees to the insured . Here is an example of a consultation billed €40 by a general practitioner:Social Security reimburses €17.50 (minus €1 flat-rate contribution), which represents 70% of the convention rate or reimbursement basis set in the case present at 25 €. Mutual insurance with coverage of 100% BR implies the reimbursement of an additional €7.50, i.e. the amount necessary to reach €25 (the co-payment). The insured must pay the remaining €15. With a 200% BR guarantee, he would be covered up to €50 for this same consultation, but since the reimbursement can never exceed the actual expense, this reimbursement would be capped at €40 in the example above.
Once this principle has been assimilated, it is possible to compare the guarantee tables of mutual insurance companies and identify, according to your budget, the contract which offers the best levels of reimbursement according to your needs.
If specific needs are taken into account when choosing a mutual insurance company, certain guarantees are essential and necessary for everyone.
This is the case of the hospitalization guarantee, which must even constitute one of the main concerns of the future member. A stay in a care facility can indeed generate significant costs . At the public hospital or in a contracted clinic, hospitalization is covered up to 80% by Health Insurance. The remaining 20% correspond to the moderating ticket to which must be added the daily flat rate of €20/day which is also the responsibility of the insured or his mutual insurance company. Thus several expenses in the hospital are not reimbursed by the compulsory scheme, this also concerns the excess fees of the surgeon and the anesthesiologist. On arrival, several hundred or even thousands of euros could be claimed from the insured in the absence of complementary health insurance. A major financial risk!
It therefore seems essential to subscribe to a minimum level of guarantee in hospitalization of 150% BR. If your finances allow it, even opt for coverage of 200% BR, you will thus be very well reimbursed for the excess fees of Optam practitioners since the latter have undertaken not to exceed twice the rate set by the Social Security.
Routine care corresponds to everyday medicine . Mutuals assimilate them to fees for medical procedures for general practitioners and specialists, paramedical fees (nurses, physiotherapists, chiropodists, orthoptists, speech therapists, etc.), medical imaging, medical transport, laboratory analyzes and examinations, medicines or even medical equipment (prostheses, non-hearing and optical devices, etc.). Most common treatments are very well reimbursed by Social Security and mutual insurance companies, even for basic contracts. On the other hand, if you are dealing with practitioners who practice overcharges, then you will have to bet on a 200% BR guarantee instead to limit your remaining charge as much as possible.
Note:the level of guarantee for routine care is very often correlated to that of reimbursement for hospitalization.
When they think of mutual insurance, most policyholders see its usefulness in reimbursing glasses or dental crowns. However, for this equipment, being well covered by complementary health insurance is expensive. Today it is possible to choose an entry-level mutual insurance company with minimum guarantees in these areas while benefiting from optical, dental and audiology equipment at no extra charge thanks to the 100% health reform. To benefit from it, all you have to do is accept the materials and equipment provided for in this reform. For high-end equipment, on the other hand, it will be necessary either to count on high guarantees (and therefore an expensive mutual insurance company), or to agree to personally finance part of the expense. A trade-off to be made because it can hold many surprises for the insured who will quickly realize that taking out insurance with high guarantees in all areas is rarely profitable...
To carry out all these calculations and find the mutual insurance company best suited to your needs and your budget, there is only one solution:compare! By using a mutual health comparator, you will be able to make the right decisions to find the contract that offers the best contribution/reimbursement ratio.
