When choosing your company health insurance for your employees in France, you hear about the responsible contract, the care package and the coordinated care pathway. Responsible contracts were introduced in France following a reform of the French statutory health insurance. It is important to understand what they involve in order to choose the right health cover and advise your employees in France.
Why were responsible contracts created?
In 2016, the French statutory health insurance decided to bring in a reform in order to raise French people’s awareness of spiralling health costs and to reduce the deficit accumulated by the public system. In addition, combined with the fact that company health insurance became compulsory, this reform enabled a large number of French people to access better cover.
In 2019, the 100 % Health reform was indeed added, requiring health insurers to cover in full, with no out-of-pocket cost, a set of labelled offers on glasses, dental prostheses and hearing aids. In practical terms, this means that healthcare professionals agree to market 100 % Health offers, guaranteeing the absence of any out-of-pocket cost for your employees.
How do you recognise a responsible contract?
The public health system has published a detailed set of specifications to be followed so that the health insurer can display its responsible label. A number of minimum guarantees are imposed and certain reimbursements are either refused or compulsorily accepted. The insurer can therefore neither reimburse more than provided for, nor less than the minimum threshold. Almost all health insurance contracts on the French market are responsible today.
Optimal reimbursements require your employees to follow the coordinated care pathway, meaning they must choose a referring doctor (médecin traitant) and cannot consult a specialist directly (with the exception of gynaecologists, dentists, ophthalmologists and paediatricians) without having seen their general practitioner first. They must also check on the ameli.fr website whether their doctors have signed the OPTAM agreement (the controlled-fee practice option), as their reimbursement will be lower if they choose a doctor who has not signed up to OPTAM.
The responsible health insurance reimburses the co-payment (ticket modérateur, that is what remains after the social security reimbursement) and the daily hospital charge (forfait journalier) in the event of hospitalisation. It never covers: the one-euro flat-rate contribution applied to procedures and consultations, the medical deductibles, or the surcharges and extra fees when the insured person does not follow the care pathway.
Why choose a responsible health insurance contract for your employees?
As an employer, it is strongly recommended to opt for a responsible health insurance contract. You will thus benefit from an exemption from social charges on the share of the contribution that you fund. In addition, be aware that the tax applied to a responsible contract is 7 % versus 14 % for non-responsible contracts. Likewise, for your employees, the share of the contribution that they fund will be deducted from their taxable income.
Please note: as an employer, you must fund at least 50 % of the health contribution. You can choose to go beyond this and offer the health insurance to your employees: a helping hand that makes all the difference in terms of employer brand.
