How to find the right mutuelle for you
And what to do if you have an issue with your mutuelle
There are essentially three types of organisations selling mutuelles:
True mutuelles. These are non-profit partnerships which redistribute risk among the membership base. The members have a right to participate in the organisation’s governance.
Insurance companies which are commercial companies governed by voting shareholders who reclaim profits as dividends.
Institutions de prévoyance. This is another kind of non-profit partnerships responsible for some workplace health schemes in the context of collective agreements. These are typically joint bodies managed by business owners organisations and unions.
When it comes to commercial firms, some will insure you directly (or are agents for firms that will) and others are courtiers – brokers – offering to negotiate a good deal for you with other firms.
Many providers will offer different levels of cover, suited to different needs. Technically, however, a distinction exists between a contrat d’adhésion, which has fixed terms that are non-negotiable, or a contrat de gré à gré, which refers to one that can be personally adapted to your needs.
Either way, it is preferable to look for a policy which offers good cover in areas you are likely to have to call for and not too many irrelevant extras (mountain rescue, for example, if you do not ski or visit such areas etc).
Your needs depend on your medical habits and history, your family history, the need for particular medications, etc. Your policy should include provisions that reflect your personal requirements regarding potential hospitalisation (eg. cover for a private room if this is important to you); dental care such as implants for seniors or orthodontics for children; optical equipment or care such as cataract surgery; alternative medicine such as osteopathy; pedicures; dieticians; psychologists etc.
The contract should also determine the extent of coverage for elective care such as thermal cures.
Many contracts include exclusions of guarantee which refers to situations or behaviour for which your insurer will not reimburse you.
Before signing up, check reimbursement levels for factors that are important to you; the monthly premiums; exclusions; provisions related to le tiers payant; the extent of the reimbursement period in which you may make a claim, and lastly, the initial waiting period (délai de carence; often 30 days) that you must wait out before your coverage starts.
One piece of information mutuelles must offer is their ‘rate of redistribution’, defined as the amount of reimbursements that are paid back to policyholders in proportion to the amount of money collected from premiums. Given as a percentage, a high figure reflects good value for money.
Consumer body UFC-Que Choisir has in the past criticised some insurers for not providing this. Other failings it noted included some failing to offer a definite quote upon request or, when approached for one, using high-pressure sales tactics to force customers into a rushed purchase.
A growing number of mairies offer residents a mutuelle communale – a grouped offer that is usually cheaper than a standard individual policy. These may appeal to retirees, self-employed workers, students and jobseekers. However, the lowest-income retirees would likely still get a better deal by taking up the state’s complémentaire santé solidaire.
What to do if you have an issue with your mutuelle
If you have problems with your reimbursements from a top-up insurer, there are various médiateurs (mediation services) for the insurance industry. Your insurer should tell you which one is relevant if you ask them.
Otherwise you can find further information at mediation-assurance.org (insurance companies) or mediateurmutualite.fr (for ‘true’ mutuelles).