Jump to content

Choosing a Mutuelle


Lori
 Share

Recommended Posts

Sorry for the double post.  Hotspot acting up.  Didn't think my last post posted.

Thanks again Sue and Weegie et al.  That makes sense to me.  I presume none of the doctors / dentists round here will be on that list.  Do you know if it is possible to see the list without having a mutuelle with them?  I'll try to search for an answer.

Link to comment
Share on other sites

Yes, it appears you have to be in the system to access the providers in the Saveane program.   Not really a problem as those providers are somewhat less critical than the others (though certainly not unimportant). 

Based on the estimates we are seeing, we are leaning towards Groupama.

Will decide tomorrow.

Thanks to all.

Link to comment
Share on other sites

The only thing that put me off the quote we had from Groupama, (who have all our other insurance) compared with the one we eventually accepted (from Sofica's) was that they did not reimburse co-payments for prescription items which are covered at less than 65% by l'Assurance Maladie.

EDIT: However, at the moment, this makes a difference of only 4 - 5€ per month for the two of us.

Link to comment
Share on other sites

If you don't mind looking again after one year, there are many companies out there offering a big reduction in the first year to attract new customers.

I was hunting in a bit of a panic last year and, in the end, I took a mutuelle out with a company fairly close by in Angoulême.  Even the man at the bank said it was a good, competitive company.  Predictably, after the first year, the rates went back up to "normal" rates.

That was when I jumped ship and signed up with AXA.  Mind you, with our advancing ages, I won't be able to do that many more times.  The number of companies willing to take us oldies is declining and the choice is just not there.  Just as well that, all else being equal, we are happy with AXA as we were given a special rate.

Link to comment
Share on other sites

nomoss wrote the following post at 14 Sep 2020 9:35:

The only thing that put me off the quote we had from Groupama, (who have all our other insurance) compared with the one we eventually accepted (from Sofica's) was that they did not reimburse co-payments for prescription items which are covered at less than 65% by l'Assurance Maladie.

In November last year I was prescribed creams reimbursed at 30% by CPAM where the rest was reimbursed by Groupama .. I did not pay towards their cost.

Edit: mint makes a very good point ref choosing a mutuelle this year and changing next year if they don't come up to the mark. Providing your give the correct legal notice you should have no problem.
Link to comment
Share on other sites

[quote user="suein56"]nomoss wrote the following post at 14 Sep 2020 9:35:

The only thing that put me off the quote we had from Groupama, (who have all our other insurance) compared with the one we eventually accepted (from Sofica's) was that they did not reimburse co-payments for prescription items which are covered at less than 65% by l'Assurance Maladie.

In November last year I was prescribed creams reimbursed at 30% by CPAM where the rest was reimbursed by Groupama .. I did not pay towards their cost.

Edit: mint makes a very good point ref choosing a mutuelle this year and changing next year if they don't come up to the mark. Providing your give the correct legal notice you should have no problem.[/quote]

The quote from Groupama was one to approximate the cover I was offered by Sofica's, so probably other plans they have are more generous.

Link to comment
Share on other sites

nomoss wrote the following post at 14 Sep 2020 20:35:

The quote from Groupama was one to approximate the cover I was offered by Sofica's, so probably other plans they have are more generous.

I apologise but I don't understand your post.

As we live in Brittany we don't have need of expensive 200%/300%/400% cover for anything .. so our Groupama cover is the basic 100% for everything.

Link to comment
Share on other sites

Hi Sue:  as we live in Hauts-de-Seine, prices are much higher than most other parts of France.  So, we would not see much coverage at only 100%BR.  Groupama called me after I submitted my online quote request. 

She was able to put together a module that works pretty well for us at a much better rate than the online rate.  Since we already have our assurance d'habitation with them, we got a better rate (that was what she told us anyway).  She sent us the quote and we've reviewed it.  It is 150€ per month for us both and has pretty good cover; well above the 100%BR

One thing I want to ask you all;  we are very healthy people.  I might visit a doctor 3 times in a year - if that.  Husband is same.  These mutuelles are pretty expensive considering we might get 400 euros cover back based on our health costs over the last 5 or 10 years.  Also, here, unlike in the USA, you can take up a mutuelle and get same day / or at least next day coverage.  So, what stops healthy people from not taking a mutuelle and if they get diagnosed with something that is going to require regular health visits to take a mutuelle before beginning that treatment?

I realize that would leave us with only Ameli if we came down with appendicitis or something, but beyond that it is something we have thought about. 

Otherwise, it looks like we'll be paying around 1800€ per year for something that we may get 400 or so back for.  Seems expensive to me.  How did you all work this out?

Thanks !

Link to comment
Share on other sites

1)Don't assume that you can just take a mutuelle and get immediate cover.

Combien de temps dure ce délai de carence mutuelle ?

 

La question du délai de carence n’étant pas régulée par le Code de la

mutualité (au contraire, par exemple, de celle du questionnaire de

santé), sa durée est laissée à la seule appréciation de chaque mutuelle.

Il s’agit donc d’un critère de comparaison important à considérer,

lorsque l’on souhaite s’engager auprès d’un nouvel organisme de

complémentaire santé, par exemple en tant que nouveau senior qui

souhaite arrêter sa mutuelle obligatoire pour en choisir une plus

adaptée. Inscrits par les mutuelles dans le contrat de leurs adhérents,

les délais de carence sont en général de 1 à 3 mois pour la majorité des

garanties qui en font l’objet. Mais cette période de latence peut aller

jusqu’à 9 mois ou même 1 an, pour certains cas comme les frais

importants d’optique, les prothèses auditives et dentaires, ainsi que

pour la maternité, celle-ci étant logiquement connue à l’avance.

 

Exemple du délai de carence mutuelle

 

Prenons un exemple concret pour que vous puissiez bien comprendre le

principe du délai de carence. Si vous avez signé un contrat de mutuelle

qui prévoit un délai de carence de 3 mois pour l’achat de nouvelles

montures et de verres, et que vous perdez vos lunettes 1 mois après

votre adhésion, vous ne serez pas couvert dans le cas où vous achetez

une nouvelle paire en remplacement, immédiatement après leur perte. Pour

faire valoir la garantie de votre mutuelle, il vous faudra attendre 2

mois après la perte de vos lunettes, ce qui permettra de dépasser le

délai de carence.

Sachez aussi qu’il peut exister des exceptions au délai de carence.

Certaines mutuelles peuvent par exemple abroger ce délai dans des cas

particuliers, comme celui d’une maladie infectieuse grave qui a été

contractée après l’adhésion au contrat, ou celui d’un remboursement qui

aurait été pris en charge par votre précédente mutuelle que vous venez

de résilier. Pensez donc à demander à votre future mutuelle si elle

prévoit des cas d’abrogation de ses délais de carence.

2) My Mutuelle covers me for ancilliary expenses that I prefer to be able to have. An individual room in both the Hospital and the convelescent home after during one period of illness which lasted 4 months would have cost me 60€ a day. I also don't have to pay  that out in advance.

I also like the security of knowing that I won't have to think about the cost , but that is a personal attitude.

3) The Idea of a "Mutuelle"  where people pay in when they don't need it is more often questioned by Anglo-Saxons such as the members of this Forum by those than by French people who have often paid in all their lives but are more used to an idea of 'solidarité' and 'fraternité'..

I think that that is a philosophical difference which has nothing to do with the practical question

Link to comment
Share on other sites

Interesting and thank you for that.  I was told in writing there would be no délai de carence.

I was told the policy would become effective the day after Groupama receives the signed devis and Attestation de Droits a L'Assurance Maladie.

Link to comment
Share on other sites

[quote user="suein56"]nomoss wrote the following post at 14 Sep 2020 20:35:

The quote from Groupama was one to approximate the cover I was offered by Sofica's, so probably other plans they have are more generous.

I apologise but I don't understand your post.

As we live in Brittany we don't have need of expensive 200%/300%/400% cover for anything .. so our Groupama cover is the basic 100% for everything.[/quote]

At the end of  2015 we got quotes from a few companies, including Groupama, for similar full cover at 100%.

The prices were fairly close, but I noticed Groupama only covered co-payments for prescription items reimbursed by CPAM at over 65%.

At the time I didn't know how many prescriptions we would be likely to have in this category, so I chose a quote which covered all co-payments.

We are in Aude, Groupama possibly have different tariffs for Brittany.

Link to comment
Share on other sites

Lori, I understand your point about paying for a mutuelle balanced against the chance of an "expensive" illness and indeed we paid for years and never having the need to pay.

We decided to pay for a mutuelle after all the thinking some of which you have detailed.  Unlike you, we are Brits and we were used to not paying at the point of use with the NHS.  We decided that, for peace of mind, we'd get the mutuelle and more or less, apart from relatively small sums here and there, we would not have the worry of falling ill and then thinking about payments.

Having said that, my new MT gave me a prescription for some antibiotics that were non remboursable.  I was not overly pleased as I'd never had antibiotics for which I have to pay.  I have had other things, such as levure to take with antibiotics and some special types of dressings for which I had to pay, but never for antibiotics.  Then OH mentioned that the doctor could perhaps get some incentive for prescribing certain medications from the drug companies.  I hadn't thought of that but it is the case that in the UK, GPs could get, if not money payments, then golf weekends, lunches, skiing trips etc from drug companies.

Norman, or anyone else, have you heard of such things in France?

In the meantime, I shall know next time I have any sort of infection, I tell the doc that I'd prefer to have medications for which I do NOT have to pay.  After all, antibiotics come in all shapes and sizes and I feel sure that, with a bit of effort on his part, he could equally have prescribed another one, free of cost to me, that would work just as well[:'(]

Link to comment
Share on other sites

Oh my yes Mint !  In the USA, doctors line their pockets with all kinds of money and pay-offs from pharmaceutical companies.  In the USA, there is a website where you can actually look up this information and see who is getting what from who !! 

We looked up one of my husbands Urologists and in 2018, he earned $260,000 U.S. Dollars off various medical companies !!  That is more than some doctors (even in the U.S.) earn in salary in a year. It can be shocking and is now a matter of public record, for anyone who cares to look it up.

I'm not trying to 'work the system' here at all.  I'm just not really interested in giving huge amounts of money to the insurance companies for little to nothing in return.  After all, even the lowest economical plan at130€ per month is 1560€ per year and in this region would offer us little in reimbursements (due to the high cost factor in this area).  After 5 years, that adds up to 7800€

The plan we were looking at will be 150€ per month = 1800€ per year or 9000€ after 5 years.  These numbers are, of course, not taking into account the annual premium/contract increases that will certainly take place.

We have not spent even 5000 in any currency on health costs for either or both of us in the last more than 10 years.

Hence our reluctance to do so now.

Edit:  It is a tough decision to make.  We are leaning towards waiting until we have lived here one year and can review our out of pocket expenses before purchasing a mutuelle.  Also, we don't expect we will live in this region of France after our 3 year lease ends.  That can change things altogether.

Link to comment
Share on other sites

Lori,

Hubby, been here almost 15 years, never had a mutuelle, relatively healthy but with several ops needed from time to time .. he's just pays as he goes along and has not found it overly onerous.  He's 80.  Meanwhile, I did without a mutuelle for 7 years, until it became obvious I would need a hip replacement, with extra care, so I did take one out, and have continued, with other care needed, though now I have an ALD for the most important problem, the mutelle is saving money hand over fist!   Peace of mind is good, but not throwing money away.  I would recommend seeing how it goes for a year, or if something horrible comes up, you can start it then.

Link to comment
Share on other sites

De nombreux contrats comportent des limites d’âge au-delà desquelles il

n’est plus possible d’adhérer. Celles-ci démarrent souvent à 70 ans.

Tous ceux qui choisissent de se passer d’une complémentaire santé

pour des questions financières, ne serait-ce que temporairement,

doivent en tenir compte pour ne pas être définitivement exclus de la

complémentaire santé.

source

Que Choisir is a bit like a French 'Which' if that still exists..

There is a good article in it about the choice of 'insuring yourself'

Link to comment
Share on other sites

Lori wrote the following post at 15 Sep 2020 10:14:

Interesting and thank you for that. I was told in writing there would be no délai de carence.

I was told the policy would become effective the day after Groupama receives the signed devis and Attestation de Droits a L'Assurance Maladie.

We believe this is true of Groupama throughout France ..

When we first arrived in France at the age of 55 we took out minimum Hospital cover .. IIRC very little per month.

When OH started having heart problems we quickly swapped to comprehensive cover. And, very stupidly, we ignored the advice of our agent (who advised 100% cover) and so we took out 200% cover .. which cost us a lot more than it should have .. when we really didn't need that much cover at that time.

The level of cover you need is complicated .. it very much depends on your individual health needs .. plus your geographical location.

If you are both healthy at present then perhaps consider basic hospital cover .. there would be no reimbursement for Drs appointments .. just cover for inpatient ie overnight hospital cover so no outpatient costs covered either ..

OR .. put the equivalent cost of such a cover in a savings account (ouch, low % at present) each year until you genuinely need such cover ?
Link to comment
Share on other sites

Thank you Norman.  Some of our devis's did note an age limit.  However, the Groupama devis very clearly noted there was NO age limit.  Their offer seemed much less riddled with rules (other than the obvious ones you can't avoid). 

Sue - you have suggested exactly what my husband suggested.  Put the 150€ aside each month (instead of paying Groupama) for heath costs.  At the end of the first year, re-review to see how we feel.  We did - and still are  - discussing maybe taking only hospitalisation cover.  Yet since neither of us has ever been in the hospital (except when I had our daughter), even that is hard to imagine.

Judith - we are thinking like your husband thinks.  We'll see what happens after the first year ends.  We'll pay as we go if things arise during the first year.

Thank you all !!  Your advice has been tremendously helpful.

Link to comment
Share on other sites

Another vote here for putting the money aside each month, Lori - maybe choose one of the Livret options to earn a little interest but still have it accessible. Reassess each year.

Having said that, two things I'd say:
1) While understanding you're not coming from the NHS, we have found that France hospitalises for tests for the same symptoms that the NHS would send you home with - advising a couple of paracetamol and bed and to come back in a week if you haven't recovered. The stays are longer too. Also, one may have a history of very good health but that doesn't stop you being in a car accident or having a bad fall.

2) The single occupancy room upgrade is worthwhile in my OH's experience. He's had a couple of hospital stays where he's had 'roomies'. The roomies were not always congenial - a bit deaf and want tv on games shows all day or refuse to have a window opened. Unlike the UK, there are no curtains between beds - which does probably make hygiene sense. OH shared a room with one guy who had dementia, flailed around a lot and on one occasion, knocked OH's drip stand to the floor until he (the room mate) was restrained and then he shouted and cried. A hospital stay is stressful enough without...

Another occasion: while a curtain provides no buffer against sounds it does stop your eyes being inexorably drawn to the guy a few feet away who is having an enema administered. On that occasion, I wondered why I found OH lurking in the corridor looking paler than usual - until he explained. We spent that visit in the family room. [;-)]

Edit:
<< I was told in writing there would be no délai de carence.

I was told the policy would become effective the day after Groupama

receives the signed devis and Attestation de Droits a L'Assurance

Maladie.
>>

This is exactly how it panned out for a friend a couple of years ago. Their CPAM attestation arrived, they took it into... Aviva I think... and their cover was effective immediately. They were claiming within a week with no quibbles at all.

Link to comment
Share on other sites

This discussion is very interesting for me; as my wife and I are in the process of researching for a mutuelle. So far we find the amount of information on the sites for various levels is mind-boggling. After ploughing through the various offers we quite like La Poste who we bank with, they have always been very professional in all their dealings with us over many years. What does amaze us is the costs as we have been used to the fact that up to now we have free health care in the UK. So the idea that some on here have put forward, "self-insurance" is interesting and we will look into it.
Link to comment
Share on other sites

Sadly Catalpa, while we were living in the South of France (for 13 years), many of our friends suffered very similar unpleasant experiences with non private rooms.

At that time, husband was working in the middle east and we had private (round the world) medical coverage through his employer.  So, I did not ever have CPAM or the need for a mutuelle during those years.  Quite different now that husband has retired this year.

During the time down South, our daughter had to have two slightly minor surgeries.  We were fortunate that she was given a private room on both occasions and we chose a private hospital (the same one) for both surgeries.  However, as you say, care and hospitalisations are quite different from one country to another. 

I've never forgotton my hospital stay in Athens, Greece (or the care leading up to the birth).  I felt I could write a book about that experience.  In the end, I went into labor, but baby's head never turned to the birthing position.  Plus, doctor was on a Greek Island for a medical seminar for the next two days.  So, they put me in the private hospital (that was planned for all along), put me in a suite that was like an apartment.  It had two bedroom areas, two bathrooms (one for the patient and one for her husband/partner) and a kitchen corner.  It was lovely.  They put me on medication to stop the contractions until my doctor could arrive (3 days later).

Then, doctor decided he did not want to try to turn the baby (cord was wrapped around her neck).  So, C-section it was.  The day before the surgery, the doctor said depending on who was the Anesthésiste on call the next day, would determine whether I get a General or an épidurale.  Apparently, he did not trust one of them.  So, I ended up with a General; probably better all the way around.

My American friends were always mortified that when visiting the GYN in France, you totally disrobe and usually right in front of the doctor.  No drapes or exam robes to put on.  You is just nekked.  Even my American GYN doctor was shocked by this.....

Ha ha.  Now, those of you who have managed to trudge throught this entire post, know far more about me than most people...

Yes, Nick, the costs are not small change.  And there is SO much to read about basic and mutuelle coverages, it gave me a headache on multiple days. 

Edit:  Oh I should add (since this is about insurance), the private hospital where our daughter was born (Mitera) did not accept our insurance (which we knew would be the case), so we had to pay for my care and stay in cash and file the forms to our insurance company).  We were a bit petrified how much it would be.  Turned out the be the equivalent of 3000 U.S. Dollars.  Husband brought a brief case full of cash to the accounting dept. at the hospital.  We still laugh about that.

Link to comment
Share on other sites

NickP
This discussion is very interesting for me; as my wife and I are in the

process of researching for a mutuelle. So far we find the amount of

information on the sites for various levels is mind-boggling. After

ploughing through the various offers we quite like La Poste who we bank

with, they have always been very professional in all their dealings with

us over many years. What does amaze us is the costs as we have been

used to the fact that up to now we have free health care in the UK. So

the idea that some on here have put forward, "self-insurance" is

interesting and we will look into it.

Remember too that French pensioners continue to pay contributions  to the health system out unlike in the UK where NI contributions are no longer levied after retirement. These can be as much as 9.3 % of income above a certain sum.

So these are just for the basic cover before the cost of any Mutuelle.

Link to comment
Share on other sites

Lori, the fact that you and your daughter survived your Greek experience is a testament to what a pair of strong ladies you were[:)]

I was sent to a private clinic by my MT who referred me to the gyné there and it happens that he is part of the very well-thought of cancer team in  Périgueux.

In my experience, all the docs I have seen, including MT, gyné, onco, radiothérpeute, etc have all the use of an adjoining room to their consulting room.  And they generally discreetly leave you to change in this second room.  With my gyné, because we are like long-time acquaintances, I normally call out, OK, I'm ready.  But all the others leave a decent amount of time for you to disrobe.  My chest specialist is a woman, and the warmest woman you could ever meet.  With her, I just pull off my top and bra while she busies herself at her desk and she comes to do the necessary when I sit on the couch.  I suppose, being a pneumono, it is generally only the upper body that you expose so there isn't the same sensitivity about undressing.

This coming op will also be done in the same clinic but in the intervening 3 years, they have built a HUGE extension so now it is all modern and soulless but looks very clinical.  I have ordered a room that is not the lux version even though the mutuelle is paying.  The last time, my single room cost nothing because the gyné ordered it for me but it would have cost only 55€.  This room I have chosen for next month is 77€ and as I am expected to only stay the one night, it wouldn't have altered my lifestyle even if I were paying!

Most of our practitioners here, specialists and generalists are conventionée and even their déparsement honoraires are, IMO very modest.

Link to comment
Share on other sites

Following my application to Credit Agricole Britline for a quote for a mutual, I was told I was too old but they would happily insure my wife, I won't repeat on here to you gentle folks my reply, but it is on social media. ??? Let's see how they like it up 'em as Corporal Jones used to say.
Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

×
×
  • Create New...