Choosing a Mutuelle

[Lori]

Howdy all of you experts, so we are new to the health system in France.  We have our carte vitales, now we are looking into Mutuelles.  I've found some sites that offer suggestions on how to choose the one that suits your circumstances, but I thought I'd ask here since I'm sure many of you have valuable knowledge on the subject.

We are a healthy couple who rarely visit a doctor (short of regular things like annual GYN exam & Mammogram every two years as advised for me and annual check-up for husband). 

The GP we have chosen charges more than the 25 euro sector fee.  He charges 32 euros for a visit.  Not sure if that matters, but I add it just in case it does. 

We both had our controle by the Dentist this week.  I have a problem tooth (need a root canal and new crown put on .... ouch ...).  No idea what, if any, coverage the carte vitale offers with regards to Dental coverage.  Also not sure if Mutuelles offer much of any Dental or Eye coverage (we both wear glasses).

Any suggestions on how to choose, where to look or what to avoid would be most appreciated.

Thank you !

[mint]

As you live in an expensive area (above tariff) for health care, I think someone like Norman would be the best person to advise you.

There has been some changes to glasses and teeth recently (to the patients' benefit) but they, as well as hearing aids, are costly. 

I have changed our mutuelle 3 times but will probably stick with AXA as they were giving our commune special rates, which will be continued, as a special offer.

Do have an initial quick look online, just to get an idea of costs.  Most sites give a quote.  It's dreary filling in details and be prepared for endless sales letters afterwards but you do get a very good idea of what you get for your dosh. 

I hope Norman comes soon to explain to you how you can choose more cover for some aspects, for example hospital stay, and less for others.  In fact, try a search of the forum as he has explained it very well in several different threads.

[Lori]

Thank you Mint.  I will try to search on the forum for similar subjects.

I have found a few helpful websites that suggest using a comparer site to get quotes from various insurers.  So, I'll likely do that.

Hopefully Norman (or anyone else who is willing) will point me in the right direction.

I'll have a look at AXA too.

[woolybanana]

I think MMA is a big one worth looking at?

There are usually different levels of cover and hence prices for you to choose from. I think the minimum is hospitalisation only, right up to Rolls Royce thrown in. I chose hospital cover only as my main illness is classed as an ALD. And I wouldnt want a roller!

[pomme]

I've used this comparator several times https://mutuelle.dispofi.fr/comparateur-mutuelle-sante

Each time I've ended up back with their recommendation Alptis as offering me the terms which best match my circumstances.

[cajal]

I would suggest you initially do some research to enable you to understand and get your head around the % claims levels offered by the mutuelles.

All medical procedure costs are state approved 'conventionné tarifs. 100% cover from a mutuelle never means that you are guaranteed to get

back 100% of actual costs. It always means that you get back 100% of the

state-approved tarif.

As you are already aware many providers charge more than the state-approved tarif,  so mutuelle policies that refund 120%, 150% etc doesn’t mean they

give you back everything you paid plus half again as a bonus. What it does mean is

they will refund up to 150% of the tarif conventionné which hopefully covers the extra fee charged by your provider over and above the 'conventionné' tarif.

[Lori]

Thank you all !   This is all very very helpful.  Especially the 120%, 150% part.  We read some sites noting that kind of reimbursement and weren't really sure how that worked.  Now, I think we get it.

I will try that compare site to get an idea.

I'm sure I will come back with more questions.  I'll try to search forum also.  I've never actually done that, so presume it is self explanatory - the search option (top right corner).

[Lori]

Well, I tried the comparer site you posted Pomme (thank you).  Really interesting and helpful.  Since I chose to make the quote as a couple and and the devis shows both our names/birthdates, etc.  I presume the monthly price is for both of us... ?

We chose no Optique (will pay for this ourselves as we don't normally change glasses more than once every 3 or so years) and no Médicine douce.  We chose to ask for a quote with 200% hospitalisation coverage and 250% dental.

The best rated quote seems to be from April - of course I've never heard of these companies and will need to try to find some reviews on them.  I also will read the full contract to find out about reimbursement delays, etc.  Here is the rate (which happens to have some Optique and some Médicine douce thrown in):

April Santé Mix Niveau 05 - 04

173^,65€/mois

Date d'effet : 11/09/2020

Principales garanties

• Hospitalisation 250 %
• Chambre particulière 85 € / jour
• Dentaire 250 %
• Soins courants 200 %
• Optique 350 €
• Medecine douce 80 €

Anyone ever heard of this company?  Does the rate sound normal?  Low?  High?  I am in my late 50's and husband is in his early 60's.

Thank you !

[Lori]

Okay, after reviewing the garanties, I see this plan includes Maternity (don't think so ...) and Orthodontics (nope).  We certainly don't need these coverages.  Seems crazy to pay for them - unless plans that don't include them cost more.  Stranger things can happen.

I do not see a place where you can 'remove' and of the garanties.

[mint]

Yes, we were with April for about 10 years.  Never any real problems.  However, when I tried to get a lower quote for me, they never replied despite many requests.  Like Wooly, I THOUGHT that I'd see what is involved with hospitalisation only and all I wanted was a devis, I wasn't even sure I wanted to change!

I have heard that April was an expensive company, but your quotes seem to me to be not a bad deal at all.

I don't envy you, shopping around for a mutuelle.  I found it a soul-destroying exercise[6]  But please don't be discouraged by my experience[:)]  We are DECADES older than you and Mr Lori!

BTW, if you want to have a look at the sort of flexibility Norman has talked about, do look at SwissLife.

Good luck, Lori!

[nomoss]

[quote user="woolybanana"]  ............  I chose hospital cover only as my main illness is classed as an ALD. And I wouldnt want a roller![/quote]

The main snag with hospital cover only is that so many operations nowadays are carried out on an out-patient basis (chirurgie ambulatoire) where the patient is hospitalised for less than a day, and are not covered by every mutuelle - at least by not by either of the two we have used, which both defined hospitalisation as actually occupying a bed overnight.

EDIT

It is possibly because of our advanced ages, but I have found almost every procedure either of us has had was reimbursed 100% by our CPAM.

This applied only to the actual operations, so we still needed the mutuelle to reimburse the many tests and procedures related to it, which required several prior visits to the hospital.

[Judith-aka-Judith]

I foudn that nearly every mutuelle allowed for maternity, regardless of age!  Special plans for seniors (which presumably excluded maternity), were highier subscriptions than standard ones, and not always the best cover, and I have heard of April, but have had not experience of it.  Getting quotes for dental and optical, and yes you do not normally need glasses every year, but I found very complex lenses such as mine were, and still are when I buy varifocal, gave you basically nothing back and not worth the price you might pay to include them.

[Catalpa]

[quote user="Lori"]I'll try to search forum also.  I've never actually done that, so presume it is self explanatory - the search option (top right corner). [/quote]

There are two search options - the one you've spotted top right searches the whole of Complete France (I think) but if you want to confine your search to previous forum topics, you need the search box on the left, underneath Join the Forum and FAQ Code of Conduct.

As far as choosing a mutuelle is concerned, I have no current advice to offer as our cover is via the company (French) OH works for and it is some years since we needed to get comparitive quotes for ourselves.

[Lori]

Thank you all.  I will search accordingly Catalpa, thank you for that info.

I've read until I can read no more for today...  I will resume tomorrow.  I think I have been quite enlightened though.

Off to think about dinner.

[mint]

 Nomoss, our policy specifically says hospi for ambulatoire procedures:  so VSL, anaesthetiste, room for the day, etc. 

We also have hospi in the house:  I suppose when you for whatever reason need care at home; so carers, special equipment.

Also, after you leave hospital and can't manage for a while, you could have someone in the house for a limited amount of time (can't remember how many days without checking up).

Judith, I can understand why plans for seniors might be higher as most mutuelle premiums do go up considerably with age.  In fact, at OH's age, choice is limited as many companies do not accept people over 70 or 75. 

I am particularly happy with our deal; the special offer was around 30% less and will always be 30% less than other policies with AXA not taken out during the special offer period.

Plus, we have a dedicated person that we can contact by phone or mail and she knows our names and where we live and is happy to come and talk to us in our own home if we asked.

 

[nomoss]

[quote user="mint"]

 Nomoss, our policy specifically says hospi for ambulatoire procedures:  so VSL, anaesthetiste, room for the day, etc  ..............................  [/quote]

Is that part of a hospitalisation only policy?

From what you said previously I had the impression you had a policy covering all treatment.

[NormanH]

I have Swiss life as it has a "modular" system where one can choose the level of cover for the various areas.

It seems very expensive (I pay 182€ a month) but it has always paid out and even advances the costs so I never have to pay out and claim back (for the single room in hospital for example) as I had to with my previous Mutuelle.

https://www.swisslife.fr/Particuliers/Proteger-ma-sante/Assurer-mes-remboursements

This is NOT a recommendation for Swiss Life, just an explanation of why I chose the company 10 years ago.

Don't forget  that  there are "genuine" Mutuelles which are forbidden to ask for a Medical history, and others which are just businesses and will try to worm it out of you  when they give you a quotation

" toutes les compagnies d'assurance ne soumettent pas la souscription d'un contrat à un questionnaire de santé. Quant aux mutuelles, le Code de la Mutualité leur interdit purement et simplement d'y recourir.'

[mint]

Yes, nomoss, a policy "as normal" but hospi as a supplementary benefit.  At little more cost, in our case, than a just for hospital policy.

[Judith-aka-Judith]

Mint, yes, I know why senior mutuelles are more expensive .. -;

NormanH, I looked at Swiss life, as you say, expensive, but indeed, you can pick and choose options, which I like.  Still couldn;t get rid of some things though (like maternity!!). 

Whatever you do with these, it's always swings and roundabouts, but the point about a true mutuelle will not ask about previous medical history is something that I did not know, and is a point well noted.  Thanks.

[Lori]

Thank you Norman (and everyone).  We did get an online devis from Swiss Life, choosing what worked for us, but the price was a good bit more than the April plan that actually offered higher percentages, higher payouts and coverage for several things that Swiss Life did not include in their offers.

Also looked at MMA but their coverages were also less (percentage wise, payout wise and overall coverage wise) than April for more money.

So, at this point April is looking pretty good.  A rep did call me on the phone to ask if I had questions.  I told him I was just on page 13 of the Conditions Generale, so had not compiled any questions yet.  We now have a few.  He said he would call me back on Monday to answer questions, explain benefits, etc.

We're still discussing it all.  Good to know they aren't suppose to ask you for a medical exam, though I don't think we'd have a problem doing that.  So far, the devis's do not state any medical exam is required.

[Weegie]

We are with Swiss Life.  A useful point to remember is that when you have signed up with whatever Mutuelle you decide, if they haven't already suggested it, ask them to inform your local CPAM that you are with them.

Swiss Life do it, and I expect other Mutuelles too.  It means that your CPAM automatically informs your Mutuelle that they have made a disbursement and your Mutuelle makes the payment without you having to make a claim.

Your Mutuelle has to inform your CPAM.  You cannot do it yourself.

Again this is for CPAM Dordogne.  Presumably the arrangement applies nationally.

[suein56]

Lori wrote the following post at 12 Sep 2020 10:25:

Also looked at MMA but their coverages were also less (percentage wise, payout wise and overall coverage wise) than April for more money.

So, at this point April is looking pretty good.

We have been with Groupama for a number of years and are very pleased with our cover and their premium.

The other benefit I found helpful, especially in the early days, was them having an agency in our closest small town .. so 10 mins away max. I still find it helpful to speak face to face in some circumstances .. though most stuff can be done on the phone or online.

[Lori]

Thanks Sue.    We had Groupama insurance for 13 years when we lived in the South of France.  We had our two cars and our home covered with them.  They paid out extremely well when our house was hit by lightening and a huge amount of damage was caused.  They were OUTSTANDING. 

They also took care of everything when an elderly gentleman hit my car in Carpentras (his fault) causing 4000€ worth of damage.

We stayed with them for our daughter's apartment while she was a student here in Paris.  Then, when we moved to our current location, we kept our rentor's insurance with them.

I am now looking at their site.  I thought they would be one of the most expensive, but at first glance the senior plan looks pretty good.  I did note that they mention several times this term: "les professionnels de santé Sévéane"   Is this some sort of network of doctors?  Do you know?

[suein56]

Lori wrote the following post at 12 Sep 2020 15:29:

Re Groupama ..

I am now looking at their site. I thought they would be one of the most expensive, but at first glance the senior plan looks pretty good. I did note that they mention several times this term: "les professionnels de santé Sévéane" Is this some sort of network of doctors? Do you know?

It's a network of practitioner partnerships .. for example Optic 2000 work with them in our small town to offer huge discounts on good quality glasses, lenses and hearing aids .. some dentists work with them too (though ours doesn't).

Some chiropractors work with them too.

But not Doctors as in 'médecin traitant' per se.

[Lori]

Thanks Sue.    We had Groupama insurance for 13 years when we lived in the South of France.  We had our two cars and our home covered with them.  They paid out extremely well when our house was hit by lightening and a huge amount of damage was caused.  They were OUTSTANDING. 

They also took care of everything when an elderly gentleman hit my car in Carpentras (his fault) causing 4000€ worth of damage.

We stayed with them for our daughter's apartment while she was a student here in Paris.  Then, when we moved to our current location, we kept our rentor's insurance with them.

I am now looking at their site.  I thought they would be one of the most expensive, but at first glance the senior plan looks pretty good.  I did note that they mention several times this term: "les professionnels de santé Sévéane"   Is this some sort of network of doctors?  Do you know?