Does France’s ‘100% Santé’ scheme cover glasses without a mutuelle?
The scheme was introduced to make eye, dental and hearing aid services more affordable
All opticians are asked to offer at least 35 kinds of glasses frames covered under the 100% Santé
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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.
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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.
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However, you will obtain only a very small reimbursement from the Assurance Maladie and will have significant out-of-pocket costs.
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