How to get employee affiliation to the company health plan right?

Affiliation is the process that attaches an employee to the company’s group health and/or death and disability contract, so that they benefit from cover on top of social security. Since 2016, group health insurance has been compulsory, and employees must be covered from the very first day of their employment, with no length-of-service condition. Otherwise, the company is exposed to penalties from URSSAF and risks losing the tax and social advantages linked to the group health plan. For the details of the set-up obligations, the employer can consult the dedicated URSSAF fact sheet on supplementary health cover.

Depending on your insurer and your administrator, several affiliation methods exist, from the fastest to the most traditional:

• 100 % digital affiliation. The employer initiates the affiliation online, then the employee receives a link to send their documents (bank details, certificate of entitlement) and confirm their membership. This is the fastest and most secure method, and it respects the confidentiality of the employee’s data.

• Online affiliation by the employer. The company enters all the data itself via its HR account, after collecting the bank details and the certificate of entitlement. The employee does not have to intervene, and the employer ensures that everyone is correctly affiliated.

• Paper form affiliation. The employee fills in a form together with their bank details and their certificate of entitlement. This method remains possible but is not recommended: longer processing times and a risk of manual data-entry errors.

Important point: unlike death and disability cover, affiliation to the health plan does not go through the DSN. It is carried out directly with the insurer. To understand how the DSN, conversely, handles social declarations, see our article on setting up the Nominative Social Declaration.

For death and disability cover (incapacity, disability, death), affiliation is automatic from the employee’s first day of presence, and they contribute compulsorily through payroll. The employee can, however, fill in a beneficiary designation form if they wish to name specific people for the death benefit; otherwise, the contract’s standard beneficiary clause applies. The rules on any refusal are set out on Service-Public.fr.

Among the main waiver cases:

• the employee already covered by an individual policy at the time of set-up (until their policy reaches its renewal date);
• the employee covered as a dependant by their spouse’s compulsory group contract;
• short fixed-term and assignment contracts (depending on their duration and the existence of cover elsewhere);
• very short part-time workers and apprentices whose contribution would represent a disproportionate share of their salary (at least 10 %);
• beneficiaries of the Complementary Health Solidarity scheme (CSS).

Please note, a useful development in case law: since a Court of Cassation ruling of 7 June 2023, an employee covered as a dependant by their spouse’s health plan can request a waiver even if this cover as a dependant is optional.

This is where your security lies in the event of an audit. In the event of a URSSAF audit, the employer must be able to provide, for each exempted employee, a valid and up-to-date waiver document. It is therefore essential to keep rigorous track of exempted employees and to ask them for a regular update of their situation.

In practical terms:

• the waiver request comes from the employee, in writing (declaration on their honour);
• it must state the body that covers them and specify that they have been informed of the consequences of their choice;
• certain supporting documents (an individual health policy, for example) must be renewed each year.

Finally, check that the waiver cases you accept are indeed provided for in your Unilateral Decision of the Employer (DUE) or the act that establishes the scheme.