In this guide, you will learn how the health mutuelle works including the benefits, eligibility, costs, and procedures of getting a health mutuelle in France.
What is a mutuelle?
A mutuelle is a non-profit organization that provides health insurance to its members. It is supplementary health coverage in addition to CPAM’s base coverage.
In France, a mutuelle is based on the principle of solidarity, which means that the members contribute according to their income and receive benefits according to their needs.
If you are an employee, a mutuelle will be offered to you through your employer. Employees are not required to interact with the mutuelle directly in order to receive one.
Types of mutuelles
There are different types of health mutuelles in France, depending on the sector of activity, the profession, or the status of the members. Some examples are:
These are mutuelles that are linked to a company or an employer. They are mandatory for all salaried workers in France since 2016. The employer pays at least 50% of the premium, and the employee pays the rest. If you are an employee, this is likely the type of mutuelle you will be a member of.
These are mutuelles that are dedicated to students. They are optional for students who are enrolled in the French public health system (CPAM).
These are mutuelles that are designed for seniors or retirees.
These are general mutuelles that are open to anyone, regardless of their occupation or situation.
These are mutuelles that are specific to a certain profession or sector, such as teachers, civil servants, farmers, or artisans.
What does a mutuelle cover?
A mutuelle covers the part of your medical expenses that is not reimbursed by the French public health system (CPAM). The CPAM covers between 60% and 100% of your medical expenses, depending on the type and severity of your condition. Then, the remaining percentage is called the “ticket modérateur”, which you have to pay out of your pocket or with your mutuelle.
For example, if you visit a general practitioner who charges €25 for a consultation, the CPAM will reimburse you €17.50 (70% of €25), and you will have to pay €7.50 (30% of €25) as the “ticket modérateur”. If you have a mutuelle that covers 100% of the ticket modérateur, you will not have to pay anything. If you have a mutuelle that covers 50% of the ticket modérateur, you will have to pay €3.75 (50% of €7.50).
Note, that may still be required to pay at the end of your medical appointment, of which you will be reimbursed within 1-2 weeks.
A mutuelle may also cover other expenses that are not covered by the CPAM at all, such as:
- Dental care
- Optical care.
- Alternative medicine: such as acupuncture, homeopathy, osteopathy, or chiropractic.
- Hospitalization: The CPAM covers 80% of your hospitalization costs in public or private hospitals. You have to pay 20% as the ticket modérateur, plus a daily fee of €20 (forfait journalier) that is not reimbursed by the CPAM. A mutuelle may cover part or all of these expenses.
Companies who offer mutuelles
There are many companies who offer mutuelles in France of which you may be a member of. Some of them are:
- Harmonie Mutuelle: This is the largest mutual health insurer in France, with more than 4.5 million members.
- MGEN: This is the leading mutuelle for education, research, and culture professionals in France, with more than 4 million members.
- Mutuelle Générale: This is the third largest mutual health insurer in France, with more than 1.5 million members.
- ADREA Mutuelle: This is a regional mutuelle that covers more than 1 million members in 12 regions of France. It offers personalized plans and options for individuals, families, professionals, and companies.
- Alan: Lastly, this a tech focused option launched in 2016 that has become very popular amongst startups.
Who is eligible for a mutuelle?
Anyone who is legally resident or working in France is eligible for a mutuelle. You do not need to have a specific health condition or income level to get a mutuelle. However if you are an employee your employer must offer you a mutuelle to join.
Prerequisites to getting a mutuelle
To get a mutuelle in France, you need to have the following prerequisites:
- A valid residence permit or visa that allows you to live or work in France
- A social security number (numéro de sécurité sociale) that identifies you in the French public health system (CPAM)
- A health insurance card (carte vitale) that proves your affiliation to the French public health system (CPAM) and allows you to access health care services
- A bank account (“compte bancaire”) that allows you receive your reimbursements. Unfortunately some may insist on a French IBAN.
How do I get a mutuelle?
To get a mutuelle in France, you need to follow these steps:
- Your company will offer you to join a mutuelle.
- You will receive the contract (“contrat”) and pay the first premium (“cotisation”) out of your first payslip. You will receive a confirmation letter (“lettre de confirmation”) and an insurance certificate (“attestation d’assurance”) from the mutuelle company.
- Signin to your CPAM account and link your mutuelle with your CPAM account. This will allow them to coordinate with your mutuelle for your reimbursements.
- Receive your membership card (“carte de membre”) from your mutuelle company. This will prove your affiliation to your mutuelle and allow you to present it at medical appointments if you are asked for it. However it is not always needed, because the mutuelle and CPAM should be connected.
How does the health mutuelle work with CPAM?
The health mutuelle works in coordination with the CPAM to reimburse your medical expenses. The process is as follows:
- When you visit a health care provider you present your health insurance card (carte vitale) and sometimes your membership card (carte de membre) to the provider. The provider will scan your cards and send the information to the CPAM and your mutuelle electronically.
- The CPAM will process your claim and reimburse you a percentage of your medical expenses, depending on the type and severity of your condition.
- Your mutuelle will receive the information from the CPAM and process your claim as well. Your mutuelle will reimburse you the remaining percentage of your medical expenses, or the part that is not covered by the CPAM at all.
- The reimbursement will be transferred to your bank account within 1-2 weeks.
How do I receive a reimbursement?
Either 1-2 weeks after the medical appointment, or never if you didn’t pay anything during the appointment.
For example, if you paid out of pocket directly at your medical appointment, it is called a deferred payment (“tiers garant”).This means you will receive a reimbursement directly into your bank account in 1-2 weeks. Your mutuelle and CPAM account are connected so everything should go smoothly. However you may be given a document (“feuille de soins”) that you can share with your mutuelle for proof of treatment (either by mail, app or website).
The choice between direct payment or deferred payment depends on several factors, such as:
- The type of service or treatment that you receive
- The type of health care provider that you visit
- The agreement between the provider and your mutuelle
Generally, direct payment is more common for services or treatments that are covered by both the CPAM and your mutuelle, such as consultations, prescriptions, or hospitalizations. Deferred payment is more common for services or treatments that are not covered by the CPAM at all, such as dental care, optical care, or alternative medicine.
Is a mutuelle mandatory?
A mutuelle is mandatory for salaried workers and self-employed workers in France since 2016 and 2018 respectively. They have to get a mutuelle d’entreprise or a mutuelle professionnelle that is linked to their employer or their profession.
A mutuelle is optional for students, seniors, or retirees in France if they are enrolled in the French public health system (CPAM).
However, even if a mutuelle is optional, it is highly recommended to get one, as the CPAM does not cover all your medical expenses, and some expenses can be very high.
How much does it cost?
The cost of a mutuelle depends on several factors, such as:
- The plan and the options that you have chosen
- The type and number of people that you want to cover
You pay for your mutuelle directly out of your payslip each month. The premium is deducted from your salary before tax, which means that you pay less income tax. Additionally your employer pays for 50% of your premium.
Finally, according to Le Lynx, the average monthly premium for a mutuelle in France in 2020 was €61.50 for an individual, €125.50 for a couple, and €167.50 for a family.