You have probably heard a lot about mutuelles in France, but these are not the only form of health cover.
The costs and benefits of various top-up health insurance options have been highlighted in a new report.
Most people have some form of complémentaire santé to ‘top-up’ health expenses that social security does not pay for.
GP visits, for example, are only 70%-reimbursed by the state without one.
Figures of around 95% are often cited for such coverage among people in France.
However, a 2019 baromètre report by the Fnim (a body representing top-up providers), looking at the situation in the industry, stated that it had dropped to 90%, with low-income households and young people most affected.
The latter was partly because students are no longer required to have a top-up to claim basic healthcare coverage.
Read more: How are you reimbursed for your medicines in France?
Read more: What help is there towards top-up healthcare insurance in France?
Three kinds of ‘top-up’ providers
While such policies are often called mutuelles in everyday language, this is technically only one of three kinds of provider of these policies.
Strictly speaking, a mutuelle is a non-profit organisation that is funded by, and belongs to, members.
Then there are ordinary insurance companies, which seek to earn a profit for shareholders.
Finally, institutions de prévoyance are another kind of non-profit, responsible for some workplace health schemes.
People on low incomes might benefit from free or subsidised top-up cover under a scheme called complémentaire santé solidaire.
However, France has stopped allowing this for people whose main healthcare rights are paid for by another country under the S1 scheme, including British and EU citizen retirees.
Read more: Low income but refused free French top-up health insurance? Next steps
Collective contracts appear to give best value
In 2021, institutions de prévoyance paid the highest percentage of premiums back out in the form of healthcare services (86%), according to a report from public statistics body Drees.
Mutuelles paid out 81% and insurance companies 77%.
This difference is partly due to the high number of collective workplace contracts, Drees said.
Across all providers, collective contracts appeared to give the best value, returning 86% of premiums in the form of services, compared to 74% for contracts taken out by individuals.
This is probably because companies, that are obliged to provide a subsidised top-up to employees, have greater ability to negotiate.
Institutions de prévoyance also have lower-than-average administrative costs since collective contracts can be managed more efficiently.
Choosing between a mutuelle and insurance company
Other than employees, individuals deciding which top-up to take will usually be choosing between mutuelles and insurance companies.
Delphine Bardou, marketing director at insurance comparison website Réassurez-moi, said: “Contrary to what we might think, [commercial] health insurance contracts are not more expensive than mutuelle contracts.”
Her advice is to “choose the level of guarantees provided in different areas (medicine, dentistry, eye care) and compare the prices, without worrying too much about whether the provider is a non-profit or not.
In the past, there might have been another advantage to a mutuelle: traditionally, if the cost of claims during the year was lower than expected, a mutuelle would refund the difference to policyholders.
Commercial insurance companies, meanwhile, would pay part of the surplus to shareholders as profits, and part would go towards offsetting any future increases in claims.
Recent law changes have led to an increase in reimbursements paid to patients, meaning this is rarely relevant these days, Ms Bardou said.
“Mutuelles no longer reimburse the difference at the end of the year, because the claims are equivalent to the premiums paid.
“In fact, total reimbursements are often higher than premiums, so prices increase year on year.”
Premium increases
A study by consumer group UFC-Que Choisir found that, on average, top-up prices rose by 7.1% between 2022 and 2023, equivalent to a median rise of €126 per year.
Premiums rose 9% with insurance companies, 8.8% at institutions de prévoyance, and 6.9% among mutuelles.
Premiums have shot up 23% since 2019, twice as fast as inflation, the group said, adding that, in its view, most providers did not inform policyholders of price rises clearly enough.
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