Is there a cap on extra charges for healthcare?

I am confused about how the various charges taken off health reimbursements are calculated. I thought they would stop being payable after an €100 cap but month after month they never are. B.A.

29 November 2016
By Oliver Rowland

We are not sure exactly which charges you are referring to. If it is the non-reimbursed parts of your healthcare costs generally, then the answer is no, there is no ‘cap’ to these.

For example the cost of seeing a GP (médecin généraliste) is always reimbursed on the basis of 70% of €23 (minus a further €1 ‘participation forfaitaire de €1’) meaning there is always 30% left for you, or your top-up health insurance policy, to pay. This applies no matter how many times you see a doctor in a given year (note that reimbursements can be worse than usual in France if you seek medical treatments or appointments without going via your own designated médecin traitant – GP).

There is, however, a cap on the participation forfaitaire de €1 which is levied on each doctors’ visit or medical procedure, with a ceiling of €4 a day for ‘acts’ by a single doctor or blood test lab and €50 per calendar year per person. Mutuelles do not usually reimburse this charge, which was brought in to discourage people from consulting too many different doctors unnecessarily.

You, or your mutuelle, may also have to pay dépassements – extra money on top of standard fees, which certain doctors (‘secteur 2’) are allowed to charge.

Then there are fees called franchises médicales, which are a small additional levy on each box of medicine (also for ‘paramedical acts’ and medical transport). These are also capped at €50/year and at €2/day for paramedical acts and €4/day for transport and are also not usually covered by mutuelles. This money goes to fund cancer and Alzheimer’s research and palliative care.

Finally there is also the forfait hospitalier, an €18 daily charge for hospitalisation, which is not reimbursed by the state but may be reimbursed by mutuelles. This does not have any annual cap.

So, if you are paying more per year in participation forfaitaire de €1 and franchises médicales, there may be a problem and you should query this, otherwise the calculations could be correct.

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