Mutuelles: an overview

Top-up health insurance policies, often known as mutuelles are not compulsory but almost all (about 95%) residents of France have one. 

Technically, not all French top-up policies (also known as ‘supplemental’ policies in some countries) are mutuelles as by the strict definition only those run by non profit-making ‘friendly societies’ should be referred to as such; however many people refer to all top-up policies this way.

A top-up policy may also be referred to as a complémentaire santé because their cover is complementary to that of France’s social security system.

The cost can be offset against taxable income for self-employed people in business regimes that allow expenses deductions under the old Loi Madelin scheme or, for those taking out new policies now, a Plan d’épargne retraite (PER).

Dental and eye health costs used to be poorly reimbursed by the state but this has improved in recent years. Since 2021 the 100% Santé reform (see Chapter 7) provides extensive coverage for a range of dental, hearing or eye care. Even so, to benefit you still need a so-called ‘responsible’ mutuelle policy as well as state cover as the scheme is a partnership between the two. However a good mutuelle, depending on the exact policy terms, will also often be able to reimburse more expensive equipment not covered under this reform.

You may want to look carefully at what is on offer for these categories of coverage when you choose your private policy as some mutuelles have reduced their extended coverage on higher-end equipment as a result of the reform.

Most firms offering mutuelles have a range of options, at different costs, and you should look at what percentage of reimbursement is given for the areas of care you are most likely to need. Cheaper policies focus on hospital stays.

You can take out a policy from, for example, dedicated health insurance firms, some catering especially for English speaking expatriates, branches of high street insurance chains and, in some cases, with insurance firms operating only online. Ask friends, your pharmacist or doctor if they can recommend a provider that suits your needs and ask insurers for a quote (devis) showing the breakdown of what they offer and at what cost.

Companies offering services in English can often be found advertising in The Connexion and its help guides.

Percentages reimbursed (100%, 150% etc) vary for different aspects of healthcare. These percentages refer to the maximum percentage of the fixed state rate for a health service (called the tarif de convention) to which you may be reimbursed. 

You should bear in mind that many services are not covered by the state to 100% of this figure and some doctors charge over and above it (dépassements d’honoraires). You cannot be reimbursed more than you paid in healthcare costs.

If you are married or have children, check whether dependants (personnes à charge) can be included in the policy.

Mutuelles offer cards that can be handed to the doctor or pharmacist with your carte Vitale green health card to organise their part of the payment.

Mutuelles are regulated and may not, for example, charge you more due to your health conditions, but costs can vary depending on factors such as your age and where you live. Policies are more costly the older you are as older people tend to use more healthcare.

A few years ago the government set out standards for so-called ‘responsible’ policies. It said such policies should respect rules including not compensating for the part of the Sécurité Sociale refund that was lost due to a patient seeing doctors without going via their GP, and not refunding the franchises médicales or the participation forfaitaire. The majority of top-up policies are now deemed to be ‘responsible’.

Other required guidelines include not levying extra charges dependent on a patient’s state of health and moderating rises related to age.

There are also certain (high) maximum limits on reimbursement of dépassements (meant to discourage doctors from excessive charging). However, the latter do not apply to doctors who have signed contracts with the state called Optam.

Mutuelle premiums rise each year, usually only moderately, but rises can be over inflation, with insurers often passing on to clients the cost of certain changes required by the government, such as the 100% Santé scheme.

According to the 2025 ‘barometer’ study by insurance broker Réassurez-moi, the average family (two parents, two children) would see their mutuelle costs rise 7.7% in 2025 compared to 2024, from around €1,400/year to €1,508; retired couples 7.7% (from €3,151 to €3,393) and workers 8.2% (from €1,286 to €1,391).

However, it said there was great variation depending on the mutuelle and level of cover, with potential increases being anything from 6% to 20%.

Furthermore, this study was done in a context that had seen the government refer to plans to drop state reimbursement of doctors’ visits and medicines by five percentage points each, which, as of early 2025 was uncertain to take place.

A law obliges all French firms to offer mutuelles to employees with at least 50% of the cost paid for, which the employees must take up (with a few exceptions where the employee is already covered).

A contract is for a given person in a certain address area – this is because typical healthcare costs can vary from area to area depending on how likely doctors are to charge dépassements and how often people go to the doctor.

For example, Ile-de-France, Nord and Pas-de-Calais, Hérault and Vaucluse generally cost more than Brittany, Normandy or Pays-de-la-Loire. Bouches-du-Rhône and Paris are the most costly while the cheapest is Alsace/Moselle which has special rules with better reimbursement from the state, according to a 2022 study by consumer body UFC-Que Choisir.

If you move you should let your insurer know within three months.

A number of communes offer a mutuelle communale aiming to group residents from the area to obtain a policy at a competitive price for them. One provider of these lists the communes it serves.