France’s medical system is comprehensive in its coverage, however there are several areas that can be confusing to newcomers.
An example of this is the way that doctors in France belong to one of three ‘sectors’.
These sectors relate to the fees they can charge for appointments and whether they have an agreement or not with France’s social security system (conventionné or non-conventionné).
This agreement in turn affects the level of social security reimbursement the patient receives following an appointment.
As a reminder, fees for several medical appointment types increased in December 2024.
The sector that each doctor belongs to can be seen when a patient makes an appointment.
If using an app or website such as Doctolib, you can filter search results by the professional’s sector.
Below, we look at reimbursement differences between the sectors in detail.
Sector 1 and 2: conventionné doctors
Medical professionals in sector 1 have all signed an agreement with Assurance Maladie, France’s state health insurer.
They can only charge fees that Assurance Maladie sets out as part of national rules (known as tarif de convention or TC) and they cannot go above these except in exceptional circumstances, for example, if a patient insists on a home or out of hours visit.
It means that patients seeing a sector 1 GP or specialist should have the cost of their appointment covered by a combination of state-coverage (70% of the cost for a medical visit in most cases) and their mutuelle (top-up insurance) if they have one.
If they have a mutuelle they will only pay a non-reimbursable ‘€2 contribution’ out of their own pocket, which is deducted by Assurance Maladie from their reimbursement and is not refunded by mutuelles.
Note that patients in France often have to pay for an appointment in advance and are then reimbursed afterwards by both their mutuelle and Assurance Maladie.
This makes sector 1 professionals the cheapest and often most in-demand medical professionals, and an appointment with such a doctor can sometimes be hard to obtain depending on where you live in France.
Sector 2 professionals also have an agreement with Assurance Maladie, but may charge a variable extra amount on top of the standard state tariff.
Reasons for choosing such a professional could include wanting to see a doctor quickly when no sector 1 doctor is available, or that the local doctor with the expertise you need is in sector 2 (many specialists are in this sector, for example).
An appointment with a sector 2 doctor will be partly-covered by Assurance Maladie, based on 70% of a fixed state tariff which is often a lower amount than the sector 1 fee unless the sector 2 doctor has also signed up to Optam (Option pratique tarifaire maîtrisée).
This is an agreement in which the professional promises to charge only ‘moderate’ extra amounts.
The remaining amount will be fully or partially covered by the patient’s optional mutuelle depending on the policy, meaning the patient may be left with out of pocket expenses to pay at the end.
Mutuelle coverage ‘tops up’ the patient’s reimbursement based on a percentage (100% , 150%, 200% etc) of the sector 1 fee (the TC) but cannot surpass the actual fee.
Note that this percentage does not apply to the overall cost of the appointment, but to the amount remaining after social security reimbursements are deducted.
This means, for example, a 100% mutuelle reimburses the same amount for a sector 2 doctor as for an appointment with a sector 1 doctor and not more.
It does not refund 100% of the total cost of the appointment but 100% of the costs remaining after the standard social security reimbursements (for an appointment at the TC rate).
As a result in the case of a sector 2 doctor who charges more than the TC the patient will face out of pocket expenses.
A mutuelle providing a 200% rate will provide full coverage for appointments that cost up to twice as much as the TC base rate, a 150% mutuelle 1.5x the base rate, and so on.
However, note that this is a maximum coverage rate, and mutuelles will only ever cover you up to the remaining costs of your appointment – they will never pay you excess money and leave you ‘in profit’ after visiting a medical profession.
The majority of mutuelles offer at least 100% coverage, as do those provided by a person’s employer, but it is always best to check the reimbursement rates of a policy.
You can read more about mutuelle rates in our explainer article here.
Here are some examples to show the differences:
An appointment with a sector 1 GP costs €30.
Assurance Maladie covers 70% of this (€21), and a ‘100%’ mutuelle covers the remaining 30% (€9).
However, the €2 contribution is deducted from the reimbursement paid to you by Assurance Maladie
Result: Patient is left paying €2 from own funds.
An appointment with a sector 2 GP (with Optam) costs more than €30 – in our example €45 – but perhaps is available to see more quickly.
Assurance Maladie covers €21 (based on the sector 1 tariffs) but deducts the €2 contribution, reimbursing €19 in total.
A mutuelle offering ‘100%’ reimbursement would only contribute a further €9 in coverage.
This is the same amount as for an appointment with a sector 1 doctor, as the ‘100%’ corresponds to top-up insurance payments of the remaining costs after social security reimbursement for such a visit, leaving the patient out of pocket by €17.
A patient with a mutuelle offering ‘150%’ coverage would be fully covered aside from the solidarity fee, as the cost of this sector 2 appointment (€45) is 1.5x (or 150%) the cost of base (TC) fee for a sector 1 doctor (€30).
A mutuelle offering 200% would also fully cover the appointment, but would not refund the patient any more than the 150% tariff, so as not to ‘pay’ the patient more than the appointment cost.
If the theoretical appointment costs €60 however, the patient would only receive full reimbursement with a 200% mutuelle (as this is twice the cost of a sector 1 appointment) and be left out of pocket if they had a 150% mutuelle.
Doctors in sector 2, despite being free to set their own fees, do not generally charge excessively high amounts because they need to stay competitive with sector 1 counterparts.
Sector 3: non-conventionné doctors
The third group of doctors belong to sector 3, and have not signed any contract with Assurance Maladie.
It means they are completely free to set their rates, and only a very small fraction of appointment costs are reimbursed by social security.
The costs of these appointments may either be covered by a patient’s mutuelle or self funded.
Certain specialists are more likely than others to operate in this sector, such as psychiatrists, due to demand and the nature of their appointments which differ from other healthcare professionals.
Note that whichever their sector, when a doctor prescribes any medicine this is reimbursed at the same rate.
