mutuelle

Health questions, information, advice, French health system, mutuels....

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sue and paul
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mutuelle

Post by sue and paul »

A cold call just now has prompted this post. Basically I was asked if we had considered our mutuelle needs in view of the new Social Security reforms. Naturally I said nous avons tout ce qu'il nous faut, merci.

But....erm....what Sécu reforms?
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Kate
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Post by Kate »

In theory, this shouldn't affect you as it concerns early retirees to France for whom the DHS intend to stop paying their costs.

Where it might concern you is if you travel to the UK for medical care as they are trying to stop this 'health tourism' as they call it and will be charging for it in the future.

As far as I understand it, there are no intentions to change health care arrangements for pensioners, just early retirees.
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Dylan
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sue and paul
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Post by sue and paul »

Thanks girls. I did know about that. Was just panicked into thinking there was some French Sécu reform that I didn't know of. As if I'd go to UK as a health tourist. I dread getting ill there!.

Though, as bona fide really old people, all our healthcare here in France is funded (by reciprocal agreement within the EU) by the UK, and our EHIC is issued from there. So how, if we're actually in the UK, would it change anything if we needed more than just basic health care, which I think is now all that is being offered by the new system?

I could be being a bit fick, but I don't understand :cry: and anyway I aim to stay healthy when over there on our brief visits
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Sue
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Post by Sue »

I really dont understand all this healthcare thing. If its all paid for by UK under a reciprocal agreement why do we need a mutuelle. I have tablets for 3 different things all of which are 100% so why is our mutuelle costing us an arm and a leg. Should it not have gone down when I started receiving state pension? I also dont understand how retirement age expats within the eu will have to pay for treatment, if necessary, when we hold an EHIC card given to us by the UK. I certainly wouldnt go to he UK looking for treatment it would have to be an emergency!! Am I being fick too.
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Kate
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Post by Kate »

Your mutuelle is to cover everything that isnt covered by your 100% For example, if you need treatment or medication that is not linked (sometimes difficult to prove of course) to the condition for which you have been granted full secu cover, your Mutuelle pays it. I know of some people who have cancelled their mutuelle (remember it's not obligatory) because between them they have most things covered by the secu - not a happy position to be in as it means that they have so many different and difficult problems, poor things, - but so far they havent regretted it apparently. It wouldnt be my advise to do something like that as you never know....

If you really are paying a fortune for your Mutuelle, you should be shopping around. They vary enormously. Check out some of the 'made to measure' insurances mentioned in this article (not updated with latest info) http://www.anglophone-direct.com/New-article,2160?
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CMU

Post by magicnumber6 »

Your question: "If its all paid for by UK under a reciprocal agreement why do we need a mutuelle?"
If you have reached UK state pension age and are in receipt of an S1, then under EU law you will be entitled without further cost to the cover that is provided by the EU state that you live in. However, the level of cover can vary. In France you will get the same cover as a French national. The CMU covers the health costs as deemed by the state.This table shows the cost of the treatment which the actual cost is what the Government says, it does not oblige a hospital / Doctor to charge that amount. In fact in many cases professionals often charge more! This table of tarrifs also has a % of cover that the CMU will pay, the balance you must pay. Example; hip replacement state fee £10000 at 80%, so CMU will pay £8000 only, you pay the balance of the treatment. again the actual cost may be say £12,000 (what the hospital charges), so you would have to pay £4000!
The mutual insurance is to cover the short fall. However, be aware the mutuelle insurance is based on the govt table, so if you have a 100% mutuelle cover that's 100 of the £10,000 in the above example! Therefore if wanted to be covered comprehensively then you may need a mutuelle with say 150% cover.
If your income is low, (last figure was about 11,500eu PA) then you could apply for the CMU-complelmentary, which is where your are covered for 100% without additional cost.
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Post by Sue »

Thanks for that so easily understood explanation. The only thing I am confused on is the amount payable by the mutuelle. We have a 125% Policy. A couple of years ago I had to have a hearing aid (which cost just under 2,000€) the state made a contribution of something in the region of 120€ and the mutuelle 150€ ie 125% of the state amount. Does this mean if I was hospitalized at a cost of 10,000€ the state would pay 8,000€ and the mutuelle
10,000€ i.e. 125% of the state contribution.? Figures dont balance here.
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Post by martyn94 »

It doesn't work like that. Your mutuelle makes up what the Sécu doesn't cover, up to a maximum of 125% of the conventionné rate. Hearing aids are reimbursed at 60% of the conventionné rate by the Sécu and (in your case) at 65% of the coventionné rate (125 minus 60) by your mutuelle. Hospital costs get a higher percentage covered by the Sécu - 80 per cent - and so would attract correspondingly less from your mutuelle - up to 45% of the conventionné rate (125 less 80). - if the gross costs exceed the 125% threshold. There is no substitute for looking up the rates and doing the sums.
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Post by Allan »

martyn94 wrote: There is no substitute for looking up the rates and doing the sums.
Where can you lookup the rates?
magicnumber6
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CMU - trarifs

Post by magicnumber6 »

http://www.vivinter.fr/index.php?option ... 20&lang=fr

This site gives details. From the table for example; if you see a generalist then the state say the consultation fee is set to 23eu and the CMU (state) will pay 70% of that. The balance you pay! As said if you chose a generalist who charges say 123eu, the state will only pay 16.10, so your mutuelle cover needs to be a percentage higher than 100% of the CMU tariff.
The best mutuelle insurance covers are 200%.
Just a side note, the last column for Alsace Moselle, is a special case. if you live in the region (still has references to German Law, don't ask, lol!).
Hope all this helps!
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Post by Kate »

That's brilliant Magic. Really clear and useful. Thank you so much, Really helpful for me to update the above article.
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sue and paul
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Post by sue and paul »

A few months ago, ie last year (must get used to saying that !) I sat with our helpful Generali agent and she talked me through the proposed costs/refunds for 300€+ planned dental treatment. As a result I chose wisely what I would have done, and was refunded all except about 12€ from combined state and Generali pots. What I'm saying is - talk to your insurer before spending, if poss. This certainly applies if you are planning to be hospitalised eg for an op as all your costs will then be paid up front
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Post by Sue »

When I think about it our mutuelle cant be bad. When I lost the hearing in one of my ears overnight I had wonderful treatment. At least 6 appointments at Centre Hospital Perpignan which involved all sorts of different tests and examinations. Scan. Hyperbaric treatment at Clinique St Pierre and before I could do that a lung x-ray at Centre Hospital. Then on Dr's recommendation 3 visits to a top specialist near Beziers. Total cost, nothing. I could have gone for a state hearing aid but I am afraid vanity won out and boy did we have to pay for it!!
Dylan
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Kate
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Post by Kate »

More info here on the early retiree situation
http://www.french-property.com/news/fre ... _s1_cover/
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