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What is health insurance

Health insurance is none other than the sickness branch of social security. It was set up to cover the risks of diseases of all kinds and therefore the consultations and care. But also to cover expenses in case of pregnancy, to provide coverage in case of temporary disability, or in the event of death with a funeral package.

However, to be properly cared for, it is important to take different steps. Affiliation to social security is the first step to be taken. Indeed, the latter is a mandatory scheme, being a state body that supports health insurance. To benefit from health insurance, it is therefore important to become an affiliate, and thus pay social security contributions. All people living in France for more than three months and having a regular situation can therefore access this type of coverage. Afterwards, it is also possible to subscribe to a complementary mutual to obtain good coverage and access to specific care.

A health insurance card will then be issued to the insured to enable him to be identified by the devices in place. This vital card contains all the information needed to properly deal with the case of an insured person as well as his / her beneficiaries (people who benefit from the insured’s health cover: the members of his / her family). This card must be presented each time an insured goes to a doctor for a consultation which thus avoids sending care sheets, but also allows policyholders to benefit from third-party payment in some cases.

To receive medical expenses while traveling in Europe, a European health insurance card is granted to insured persons. He can enjoy all his rights with his insurance even if he is traveling. In case of frequent travel outside Europe, arrange for international health insurance is essential to be well covered in case of glitches during a trip.

The difference between mutual and insurance


A priori, there is not much difference between a mutual and insurance, especially in terms of their actions. It is at the level of the system of their status that the difference arises. Indeed, a mutual is based on the codes of mutuality when for insurance, complementary insurance companies are governed by the Insurance Code. Thus, a mutual is a non-profit organization whose principle is based on the solidarity of members who pay dues. These are not based on the health of the members. The contributions of an insurance company are calculated according to the state of health of each insured, following a questionnaire of health.

Refunds


With regard to social security, it reimburses all or part of the expenses incurred for medical expenses for medical consultations, medications, hospitalization expenses, dental expenses, fees for consultations and care. ophthalmic and others. A mutual reimburses the insured according to agreed rates already in place.
In the case of mutuals, they reimburse expenses for medical expenses that have remained the responsibility of the insured after a refund of social security. This is what we call the co-payment. The reimbursement of user fees is based on rates agreed by social security. Depending on the contract chosen with the mutual, the reimbursement rate can vary from 100% to 400%.

Mutual


The choice of a mutual must be based on various criteria, in the first place the guarantees that the contract proposes. The basic guarantees are often common to all mutuals, we must look at additional guarantees to make the difference. Then there is the level of coverage that varies according to the mutuals. The offers are not the same, so everyone can see what suits him. We must also see if there is access to third-party payment service to facilitate the various regulations and finally see if it is interesting for the subscriber to choose a supplemental health. The amount of the annual contribution depends on various factors such as the contract chosen as well as the composition of the household and its income. In all cases, the choice must be made according to the real needs of the subscriber. There are different types of mutuals for different categories of people. Thus, there are mutuals for students, for employees for mutual company, for people exercising a liberal activity for mutual professional, for officials for mutual officials …

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