100% santé glasses and no mutuelle

Can I buy, and obtain a reimbursement for, ‘100% Santé’ glasses even if I do not have a mutuelle?

The 100% Santé scheme is designed to work together with a socalled ‘responsible’ top-up health insurance policy (most fall under this category).

For those on very low incomes, Complémentaire Santé Solidaire provides their top-up free or at a subsidy.

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: 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 ‘designer’ brands.

Corrective lenses for all common eye conditions must also be offered within a ‘100%’ range and certain price caps also apply to these, depending on lens type and strength – for example, from €65 to €235 for the two eyes for unifocal lenses.

The 100% Santé 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 do not have a mutuelle 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 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 small reimbursement from the Assurance Maladie and will have significant out-of-pocket costs.