Did you know that employees can, in certain circumstances, opt out of the company health insurance plan despite its mandatory nature? Since employer-sponsored health insurance became compulsory in France, mandatory company health insurance has become standard practice. However, specific exemption cases do exist and are strictly governed by URSSAF and the French Social Security Code.
What is an exemption from enrolment in the mandatory company health insurance plan?
In principle, the company health insurance plan is mandatory for all employees. However, some employees may request an enrolment exemption, allowing them not to join the collective plan offered by the employer.
Eligible individuals:
- The employee themselves
- Dependants (spouse, children) where their enrolment is mandatory under the plan rules
This request must be submitted in writing and supported by documentary evidence. It may only be accepted if it falls within a case provided for by law or by the governing document of the scheme (unilateral employer decision or collective agreement).
Why join the company health insurance plan?
Even where an exemption is available, the mandatory health insurance plan often offers significant advantages:
- More comprehensive coverage than individual policies
- At least 50% of contributions funded by the employer
- Potential employer contributions for dependants
It is possible to hold two health insurance plans : claims are transmitted to one insurer first, and any remaining out-of-pocket costs can then be submitted to the second. Total reimbursement will never exceed the actual expenses incurred.
What are the exemption cases?
Employee already covered by another health insurance plan:
- Their spouse’s health insurance plan as a dependant, whether the coverage is mandatory or optional. This also applies to spouses working for the same company, provided that the employee requesting the exemption joins their spouse’s cover as a dependant.
- A so-called Madelin group insurance contract.
- The Alsace-Moselle local health insurance scheme.
- A supplementary health insurance scheme provided through CAMIEG (Caisse d’Assurance Maladie des Industries Électriques et Gazières).
- A supplementary social protection scheme for state employees or local authority employees.
- Complémentaire Santé Solidaire (CSS).
Employee covered under an individual policy: The exemption applies until the expiry date of the individual contract and concerns health expense reimbursement only.
Fixed-term employees or apprentices:
- Fixed-term contract or assignment of ≤ 3 months, or part-time employment (≤ 15 hours/week): Exemption possible, even without individual coverage, with potential eligibility for the “health insurance payment” to fund individual supplementary cover.
- Fixed-term contract ≥ 12 months: Exemption possible upon proof of alternative supplementary health coverage.
- Apprentices: Exemption available where contributions represent at least 10% of gross salary.
These cases are not exhaustive. It is essential to refer to the unilateral employer decision (DUE) or collective agreement to identify the exemptions available within your company.
How can employees opt out of the company health insurance plan?
Employees must:
- Submit a written request (signed declaration)
- Provide the required supporting documents
- Comply with the applicable deadlines: upon hiring, when the cover is implemented, or according to the terms set out in the governing legal document
The request must be renewed annually to remain valid. Employers are required to retain these documents to justify non-enrolment in the event of a URSSAF audit.
What Has Changed Since April 2024
Since 19 April 2024, employees may be exempt from the company health insurance plan if they are already covered under their spouse’s plan, even where this coverage is optional. A ruling by the French Court of Cassation simplified the process by removing the requirement to provide evidence that the alternative coverage is mandatory.
This makes the process easier for employees and avoids the need for employers to amend the governing documents of their scheme.
Implications for Employers
Employers do not need to amend existing unilateral employer decisions (DUEs) or collective agreements, even where they refer to the requirement for proof of mandatory coverage. It is now sufficient for employees to declare that they are covered elsewhere, regardless of whether that coverage is mandatory.
However, it is recommended to:
- Update internal documentation (employee handbook, HR intranet)
- Inform employees about the new rules
- Train HR teams on managing exemption requests
What About Income Protection Insurance?
Unlike company health insurance, no exemptions are available for income protection schemes (disability, death, dependency). These benefits cover major risks and are generally mandatory for all eligible employees.
Mandatory company health insurance is an essential component of employee social protection in the workplace. However, certain exemption cases allow employees to opt out of the company health insurance plan, provided that they comply with the applicable legal requirements and internal procedures.
For employees, this can provide valuable flexibility in specific situations. For employers, it requires sound administrative management and clear communication.
