Reader question: Can I buy, and obtain a reimbursement for, ‘100% Santé’ glasses if I do not have a top-up health insurance policy? T.F.
The 100% Santé scheme, introduced over recent years to improve affordability of eye, dental and hearing care, is designed to work together with a so-called ‘responsible’ top-up health insurance policy. Most policies fall under this category.
For those on very low incomes, the Complémentaire Santé Solidaire system provides their top-up insurance for free or at a subsidised cost.
So you cannot fully benefit from the 100% Santé scheme, aimed at making sure people are not out of pocket for a pair of glasses, if you have no top-up.
All opticians are asked to offer at least 35 kinds of glasses frames covered under the 100% Santé, also called Class A products, as well as being free to offer others, called Class B.
In Class A, frames should be priced at not more than €30 but should be of good quality, though they will not be in luxury ‘designer’ brands.
Corrective lenses for all the main eye conditions must also be offered within a ‘100%’ range and certain price caps also apply to these, depending on type and strength of the lenses – for example, from €65 to €235 for the two eyes for unifocal lenses.
The 100% Santé system is intended to combine a good-quality offer with capped prices, half of which is reimbursed by the social security and half by a ‘responsible’ top-up policy. If you have no mutuelle (top-up insurance), you can buy the same glasses and benefit from the caps, but they no longer come under the 100% Santé scheme.
In this case, you will only be reimbursed by social security at a rate of 60% of certain very low ‘base’ amounts. For example, for adults, these are €2.84 for frames and for lenses from €2.29 to €24.54.
So, yes, you can buy the same range of products, and can ask for a quote from the optician including items from this range.
However, you will obtain only a very small reimbursement from the Assurance Maladie and will have significant out-of-pocket costs.