Good news on glasses, crowns and hearing aids

.... But you should still shop around for the right cover

1 November 2019
By Jane Hanks

A range of glasses and dental prostheses will be absolutely free for patients from next year.

Top-up health insurance providers will be obliged to pay the difference between state reimbursement and the actual cost of the items.

Hearing aids will be included from 2021.

The “reste à charge zéro” plan will not cover all products but there will be a wide range.

It affects the majority of top-up contracts – those labelled responsable, meaning they adhere to a set of regulations drawn up by the government to ensure limited prices and obligatory levels of cover.

Opticians will be obliged to have two sets of glasses on sale.

In the range available at no cost, lenses should cover all general sight problems and be slim, anti-glare and anti-scratch.

There must be 17 adult frames on offer, with a choice of two colours for each, and 10 different frames for children, also with a choice of two colours. Frames, which must respect European standards, must cost a maximum €30.

In the second set are all other products, such as designer frames, where health insurance companies will cover up to €100 of the cost, but no more. The measures will begin on January 1, 2020.

Changes to dentistry appliances mean there will be three choices but this will not include treatment from the orthodontist, so braces that many teenagers are advised to wear will not be included.

Total cover will be available for crowns, bridges and inlays, and ceramic rather than metal crowns will be on offer for visible front teeth.

The second offer includes items where the client contributes but prices are controlled so as not to be excessive.

The third allows clients to choose whatever appliance they wish at their own cost, which might include new methods not yet included in the 100% offer.
Crowns and bridges will be on offer at 100% from January 1, 2020, and other items will be introduced from January 2021.

There are also changes coming for the reimbursement of hearing aids as government figures show that only 35% of people with hearing problems are equipped and many are deterred by high prices.

Full cover for hearing aids will be introduced gradually and there will be no aids available for zero euros until 2021.The delay is said to be to allow insurance firms to adjust to what is likely to result in an extra €50million cost to them.

Cover will eventually be for up to €1,700 for each ear.

There has already been an obligatory increase in top-up reimbursement for aids this year and this will rise in 2020, when the client will pay €400 towards an aid, decreasing to €0 in 2021.

It will cover a wide choice of aids but clients can pay extra for more expensive models.

From November 1 this year, help for those with very low incomes to have top-up health insurance is organised under the Complémentaire Santé Solidaire, an amalgamation of two existing systems.

Cover will be free for those on very low incomes – a single person earning less than €746 a month – and a contribution will be paid by anyone earning between €746 and €1,007.

On average, it will be €8 a month for anyone under 29, rising to €30 for over-70s.

From December 1, 2020, the law will allow anyone to change health insurance at any time after the first 12 months.

Currently you can only change on the anniversary of signing up, often moved to be January 1, unlike other insurances which you are now free to change when you wish, with notice, after the first year.

Top-up health insurance is not obligatory but 95% of people in France have some form of cover.
There are more than 80 leading providers, which fall into three categories:

  • Half of the market is covered by mutuelles, which are non-profit-making and specialise in top-up healthcare. Often, the word mutuelle is used as a catch-all term for the whole range of such insurance firms;
  • General insurance companies, which are profit-making and offer health insurance alongside their other services;
  • Institutions de prévoyance, provident funds, which are non-profit-making and are generally responsible for collective workplace schemes.

Prices depend on a range of variables: the company you sign up with, the level of cover, income, age, whether you work or not, and where you live.

Families are often covered by workplace schemes. Since 2016, employers in France have had to offer basic health insurance cover to employees and fund half the cost.

These are often obligatory but even if they are not, workers are unlikely to find a better deal elsewhere, and other family members can be included in the insurance.

The self-employed can deduct insurance payments from taxable profits under the Madelin plan - an accountant can advise.

Temporary workers can have at least €15 a month towards their health insurance paid by a chèque santé from their employer and there is help for those on very low incomes. Retired people are most likely to have to work hard to find a good-value policy as they are more likely to need healthcare and prices are often higher.

Marianne Bye, of the Fédération Nationale de la Mutualité Française, said companies spread costs across the generations to offer cheaper contracts to older people.

Grégory Caret, who helped set up the free online service to help people find the best-value health insurance for consumer magazine UFC-Que Choisir (Quechoisir.org), says a 62-year-old single retiree could pay from €19 to €300 a month.

Both say it is essential to research options to find a policy to suit your needs.

The introduction of the “reste à charge zéro” range means consumers will probably no longer have to make glasses, hearing aids and dentists a priority when looking for cover. 

Both Mrs Bye and Mr Caret agree products chosen by the government are good quality and should suit the majority of cases.

However, if you have particular needs, you will have to look at these categories.

Insurance firms have not yet adapted their policies to the changes, and there are concerns that premiums will go up as a result.

If you are likely to need specialist treatment, it is important to know your top-up covers Secteur 2 doctor’s fees charged by some specialists, particularly in private clinics. These are the rates which are above the Secteur 1 fees fixed by government – currently €25 a consultation, of which €16.50 is reimbursed by the social security, and most of the rest by top-up insurance. 

Not all top-ups cover Secteur 2 doctors, where there is some regulation on the extra fees they can charge, or the third category of non-conventionné doctors.

Social security covers 80% of stays in public hospitals or private clinics, with 100% cover in cases such as pregnancy or long-term illnesses. Top-up insurance will nearly always pay the rest.

You need to check which of the five categories of medicine are included, as only those considered irreplaceable for serious illnesses are reimbursed at 100% by the social security.

Medicines are given an efficiency rating, called the SMR. Those classified as import-ant are reimbursed at 65%, moderate at 30%, low at 15% and the rest at zero.

Different insurances give different top-ups for medicines.

If you want to go regularly to a medical practitioner whose services are not reimbursed by the social security, such as an osteopath, you might want to choose a top-up insurance that pays out for this.

When you sign up, you should check when cover will start. For some services you may have to wait for a period before being reimbursed – for example, a contract might make you wait six months before you get the payment for dental work.

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