CHANGES TO THE REIMBURSMENT IN THE FRENCH HEALTH SYSTEM
This was one of President Macron’s promises during the presidential election and for once, a politician is good to his word!!You might have noticed that in the French system, 100% cover does not actually mean 100% of the cost covered but 100% of the price set by the French health system. This means that French people could not afford to go to the dentist or get hearing aids. Between 25 and 30% of people who got a quote for crowns, glasses or hearing aids did not get it due to what it would have cost them. For that reason, Mr Macron has come up with a reform called “réforme 100% santé”. So, how will it work for you??
- What is concerned by this reform and for when:
It concerns 3 aspects of the health system: Teeth, glasses and hearing aids and the law will be fully implemented in 01/01/2021. But it will be done gradually over 3 years. The changes will be implemented by all 3 entities concerned: The French health system, the top up insurance company and the medical professionals. So, everybody makes an effort but as you will see below, the effort is more for some than others!!
- How will it work for teeth:
It depends on the material, the type of work and which tooth it is. It only concerns dental prosthesis or crowns. All teeth are concerned but if it is a back tooth (molar tooth) the material must be metal instead of ceramic.
The price set by the health system today is 107.5€ for a crown, in 2020, it will be increased to 120€. In 2018, professionals had no cap on prices they can charge, in 2019 maximum price is 530€ and in 2020: 500€. If you have a 100% cover today for teeth, your top up will reimburse you 30% of 107.5€ (32.25). In 2020 the reimbursement will be 416€ (30% of 120€ + 380 (500-120)).
- How will it work for glasses:
Same here, depends on the type of glasses you want (frame and lens). There are 2 types, class A and Class B. Class A will be fully reimbursed in 2020. But you can choose frames at class B and lens at class A or vice versa. There are so many types of glasses that it would be too lengthy for me to explain!
- How will it work for hearing aid:
Same here, depends on the equipment you take, so don’t expect the latest super hearing aid!! The price set by the health system today is 300€ per ear, in 2020, it will be increased to 350€, in 2021, it will be 400€. In 2018, professionals had no cap on prices they can charge, in 2019 maximum price is 1300€, in 2020: 1100€ and in 2021 it will be 950€. If you have a 100% cover today for hearing aids, your top up will reimburse you 30% of 300€ (90). In 2021 the reimbursement will be 670€ (30% of 400€ + 550 (950-400)).
- What obligations/innovations:
With this law, there are a few obligations for professionals such as obligation to give you more than one quote on their work and one of the quotes must be one at 100% reimbursed. So, for hearing aid, that means they are obliged to have a hearing aid that fits the criteria for 100% reimbursement. Authorisation for Glasses shop to renew the eye doctor prescription within 5 years and do an eye test themselves invoiced at 10 € max. Level of cover for top up insurance companies must be standardised with example of reimbursement in € instead of percentages. Creation of a quality questionnaire for glasses and hearing aids shop. Creation of an entity in charge of checking that this new law is respected by medical professionals and insurance company! As if!!
- Contrat Responsible/ contrat non responsable: Note that this reform only applies to state approved top up contrats called “contrat responsable”. So, if you have an Eco or HOSPI Only cover with us, Allianz, you will not benefit from the 100% santé reform. Obviously, “contrat non responsable” are cheaper but can work just as good as long as you don’t care about cost for teeth, glasses and hearing aids and are only looking for basic cheap cover. So, to make sure you can benefit from the 100% santé reform, make sure you have a “contrat responsable”. It is written on your contract.
Conclusion: This new law is mainly implemented for people who could not afford to have the work done so don’t expect best quality crowns, glasses or hearing aids but still better than nothing at all. Also please note that the effort here will be mainly done by top up insurances which apparently have agreed not to increase their premium by too much!! Which brings here the opportunity to tell you that Allianz do a very good top up. With most top up health insurance, the covers are based on levels (level 1 to 6 for example) which means that if you want the best hospital cover, you will also pay for the best dental and optical cover. With Allianz, you can pick and choose what you want which makes it cheaper!
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