Top-up, mutuelle - why?

[HugoK]

I received my Carte Vitale a month ago and have been working on getting top-up insurance. There are so many companies providing similar levels of cover at roughly similar prices that it is very difficult choosing between. Rather than try to find recommended companies, I thought I'd look for companies to avoid instead - any suggestions?

In addition, having talked to some British friends in my area, some of them have said - why do you think you need top-up insurance? You can manage quite well without it. I have to say, I am not sure why I think I need it. Can anyone give me a good reason.

[NormanH]

There are two schools of thought on this, and both have been discussed a lot in the past.

Try a search on both Mutuelle and Top-up and have a read.

After that  please don't hesitate to come back with all your questions, but I have typed quite a lot on this in the past and don't want to bore people with repeating myself.

I have a Mutuelle by the way so I am on that side of the fence.

[idun]

In the early days of this board Mazan, a poster I respected a lot, said that instead of having a mutuellist, prefered to put money aside for extra medical costs, and that worked for him.

In our case we have a family and with children, I needed the safety net of having that top up cover.

I was in hospital for 10 days, no operation, in fact they did very little to me, and that cost thousands of €'s. Of which my mutualist picked up about a 5000€ bill, the rest by the state. I personally would not have wanted to have such a big bill to pay out of my pocket there and then.

And I wouldn't want to be looking at less than 300% cover.

It is up to you to do your calculations.

[AnOther]

Assuming you can actually afford one it really depends on your attitude to risk and your ability to pay out privately if or when the need arose.

Also if you are riddled with chronic conditions which are classed a ALD a mutuelle might be of limited benefit.

We have one which costs us about €120/mth which we can comfortably afford and are happy to pay for for the peace of mind it provides but that's our choice. The fact that the majority of French people seem to have one should tell you something though.

My personal take is that if you can afford it then you should have one.

It's all very well saying that you'll put the money in a pot instead to be used when necessary but if doing that presents any sort of financial hardship then practically it's not going to work because you'll end up dipping into it for all sorts of unplanned events, emergency car repairs for instance.

Paradoxically even if you are loaded then the argument against actually becomes even weaker because the monthly cost will represent a smaller part of your budget and outlay, not much more than the cost of a really good meal out perhaps.

It's a discussion which can have no definitive conclusion though.

[EuroTrash]

As for which company - AFAIK there are no rogues. Their quotes will vary according to how they weight the different age groups.

There are some, or one at least (MMA), that offer a policy where, at the end of every year when you haven't made a claim or have claimed below a certain figure, you get a rebate at renewal.

As you say there is an enormous choice of products and providers and there is no right and wrong answer as to which is 'best'. It really is a personal choice which you decide will work best for you, all depends on factors like your age, medical history, financial situation, attitude to risk.

[lindal1000]

I'm on the other side of the Fence in that I don't have one, but we have limited income but a good amount of savings that we rarely dip into.

I have an ALD so my regular doctor trips are covered. I have paid for my dentistry and glasses but then I was used to paying for that in UK, and most mutuelles pay very little for those things anyway.

If you have a bit of cash behind you to cover emergencies then you can always take out a top up policy at a later date, if you find you need it.

[Doodle]

Hi,

We took out top up in 2009 with MMA and very glad we did as in 2010 I had a totally unexpected problem that landed me in hospital for 10 days. 2 x endoscopies, 2 x X-rays, 2 x CAT scans, 1 MRI scan plus all the pills etc came to just over 10,000 euros that included a 300 euros bill for the trip to the hospital 80km away. I paid nothing towards this bill.

The OH had a suspect mole removed (which wasn't suspect on examination) and has had some dental work some of it covered some paid for by choice as a white crown was preferred.

In the UK neither of us had any health issues whatsoever other than the odd cold/flu so did not expect any of the above. However, like it or not you do have to take getting older into consideration and we are very happy to continue with our top-up.

Hope this is of some help to you.

[Patf]

Even with a carte vitale, most costs are only reimbursed 60-70% so you'll always have that extra to pay.

Unless your condition is recognised as an ALD then it's 100%, just for that condition.

And I think most operations are covered 100%, but not the hospital care that goes with them.

But it's those unexpected things, as others have said. We also had 2 big bills which led to the decision to pay into a mutuelle.

[Val_2]

What happens if you have an accident in your car which none of us knows might happen. Same goes for a domestic accident - could need life saving surgery or extensive continual treatment. A personal choice to make but consider that you could end up paying over €180/day just for a bed without food and treatment when if you are covered might only cost €18/day. My friend got a bill for over €160,000 for six month's hospital stay for her husband after he caught MRSA here after a botched small operation but as they were pensioners with the reciprocal S cover and had a carte vitale for many years in France she only ended up paying around €400. They had no mutuelle and both the hospital and clinic where he was treated went into the cost side of things before further treatment was administered and also took into account the problem caused by the blunder in the first place. Your own house insurance company will probably provide health top up, ours does and very comparable and efficient!

[mint]

[quote user="lindal1000"]I'm on the other side of the Fence in that I don't have one, but we have limited income but a good amount of savings that we rarely dip into.

I have an ALD so my regular doctor trips are covered. I have paid for my dentistry and glasses but then I was used to paying for that in UK, and most mutuelles pay very little for those things anyway.

If you have a bit of cash behind you to cover emergencies then you can always take out a top up policy at a later date, if you find you need it.[/quote]

You need to qualify that last statement a bit.

Depends on the OP's present age if he wants to delay taking out a mutuelle.

Increasingly, companies are refusing to take on anyone over the age of 70.  Just do a google search if you don't believe me.

If you do already have a mutuelle, however, they don't throw you out and the annual increase, at least for our company, are comparatively modest.

[Val_2]

I'm a bit puzzled by that too. Surely if you find you need to take a mutuelle out at a later date because you need it,it won't cover any pre-existing conditions which you may have to want to take insurance out??? I know from elderly friends that their premiums were getting very expensive once they reached 75 and at over 80 for both of them,they were paying a lot more but they were always at the doctors,chiropodists,specialists at least once per week for something or another.They've now returned to the UK as their health is getting very bad and had no family here to look after them. I have read of cases as warnings to folk that without proper health cover here if you need an operation, the hospital are within their rights to ask you to write out a cheque or give a bank cheque to cover your costs up front and even hand over your passport upon entry into hospital so you cannot do a runner. Here all the public hospital bills come via the main Trésor public who can enter your bank account without authorisation to take money.

[lindal1000]

As far as I understand it in France top up insurance is not allowed to exclude existing conditions from their cover although some do have a waiting period before you can make a claim. Our neighbours have just taken out a basic top up after one of them had to have a series of operations (she is 70) and they had no trouble getting cover.

I did say that we have more than adequate savings so I am not so worried about getting a bill. I too have heard stories of huge bills, but never first hand and usually from people who already have top up insurance. Our neighbours bill was about 1000 euros for scans, surgery, 10 days in hospital etc. After that they got the top up.

So far for a basic top up I would have paid out about 1000 euros per year for the three years I have been here in insurance, I have had very little that wasn't reimbursed so for me it makes economic sense..but it is a personal decision as everyone's circumstances are different.

Emergency treatment is reimbursed at 100%.

Now, if we're talking about treatment for the dog.. well I've spent a fortune on him and none of it is reimbursed.

[idun]

As you say Linda it depends on how you want to spend your savings. But I would add that an emergency would be a stroke or heart attack, it wouldn't be say falling on an icy path and breaking your ankle and an arm. Complicated fractures and a long hospital stay, with consequent follow up at home could cost a lot. These things do happen, our friend fell off his very high roof, weeks in hospital and then a reeducation centre...... but he had a mutuelle.

And even if one did get the full 70%  that still leaves 30% to pay plus the rest. As I said, for 10 days our mutuelle picked up a bill for 5000€.

Here is a link to age limits, so it is possible to find things until one is in one's 80's, but at what price?

http://www.linternaute.com/argent/assurance/dossier/comparatif-des-meilleurs-contrats-de-mutuelles/les-limites-d-age-de-souscription.shtml

Personally I would not be without a decent one. I'd rather have 'wasted' money than big bills. And 'wasted' money.........ie we have never ever claimed anything from our house insurance policy, no theft, no fire, no major damage etc, but no way would I not pay that either.

[mint]

You are right about pre-existing conditions; they are NOT taken into account.

Age is a different matter altogether.  This age factor has been discussed in the past on the forum and you will be able to research it.  Your choice of mutuelle is limited once over 70 years old and you will pay more.

I should know as my OH is in his 80s and we have been here 7 years.

[Hereford]

Indeed Mint existing conditions are not taken into account but it won't mean that you can take out a Mutuelle once you have actually got a nasty complicated fracture and are in the hospital!

We do know some people who just have "hospital cover" but pay themselves for other things. A possible compromise.

[Jonzjob]

In my humble opinion insurance of any kind is never needed and is a total waste of money.

Until you need it that is or of you want peace of mnd?

A couple of years back I spent a sudden 15 days in hospital and I think the only dept I didn't visit was the gynecology. I even had some kind of radio active gunk injected and scanned and I lost count of the xrays? Final bill was 0€ and the mutual and CPAM picked up the rest. The hotel bill, as they called it, was several thousand, can't remember the number, but more than we wanted to fork out..

You oays yer money and you takes yer choice [:D]

[EuroTrash]

'Mutuelles' are by law not allowed to take pre-existing conditions into consideration.

There are also private companies that offer top-up insurance and they will take your medical history into consideration. If you have a better than average medical record and tick their boxes for being a good risk they might offer you a better quote than a mutuelle. If you have ongoing problems, obviously you would be better off going to a mutuelle.

[Benjamin]

There is something wrong with your neighbour's €1.000.

Over four years ago, when Mrs. Benjamin used to attend CHU Nantes for three quarters of a day as an outpatient every month, the daily charge for "accomodation" alone (24 hrs.) was something like €750. That was without any charges for actual treatment.

On the other hand, if you are classified as disabled, then there are no charges whatsoever except for the "extras" (TV, telephone etc.) that you may chose to have.

[idun]

Jonzjob, you did make me smile, I had forgotten that they did take me to the gynae unit when I was in hospital. In there for 10 days with nothing wrong with me. I was ill the first day, incidentally.  Telling them I was no longer ill, was of no use at all, they took no notice.

 I used to have two long walks in the ground every day, and yet when they took me to the gynae unit, I was put in a wheel chair, wheeled right through the building and put in an ambulance to go to the next building along, back in a wheel chair and the same process taking me back.

I never did leave the grounds when I had my walks, as I thought, IF I am ill, as they believe I am and I leave the grounds and collapse, it'd get too complicated for words, an ambulance taking me to les urgences when I already had a bed in the place.

They did however make me ill for months, but that is something else entirely different.

[mint]

[quote user="Hereford"]Indeed Mint existing conditions are not taken into account but it won't mean that you can take out a Mutuelle once you have actually got a nasty complicated fracture and are in the hospital!

We do know some people who just have "hospital cover" but pay themselves for other things. A possible compromise.

[/quote]

Premiums, as with all insurance, are sometimes put up as a result of users who make fraudalent claims or who take up a mutuelle for their own agenda.

I knew a chap who, knowing that he would need a hip replacement from his doctors in the UK (whose books he managed to remain on whilst living in France), took out a mutuelle with Swiss Life for just the one year, you guess it, the year of his hip replacement.

For the rest of their 5 year stay in France, they managed to use the medical services on both sides of the Channel.

Not only that, AFTER they had sold up in France, they seemed not to have handed back their Cartes and she came back and had bilateral cataract removal in a private clinic in Cognac, giving their old address there to the clinic.

Sometimes the blame for high premiums cannot be entirely laid at the door of the mutuelle providers [:@]

[lindal1000]

According to chu Nantes

Hospital fees include:

•hospital stay fees (on day per day price basis);

•the fixed daily hospital charge;

•an additional lump-sum if you request a private room.

The hospital stay fees:

In general, excluding exonerations and special cover schemes, 80% of hospital stay fees are reimbursed. You must pay for the remaining 20% which can be reimbursed by your top-up medical insurance.

There are cases where you may be exonerated from the remaining 20%:

•in the case of a long-term illness, conditions conferring exemption or poly-pathology;

•in the case of disability recognised by the social security system;

•after the 31st day of hospitalisation;

•if a procedure costing € 91 or more, or a K50 grade procedure is carried out. (In this case, a standard cost of € 18 is charged, to be paid by the patient or the insurer providing his/her top-up medical cover);

•in the case of pregnancy (as from the 1st day of the 6th month of pregnancy until 12 days after the birth);

•for newborn children aged less than 30 days;

•for treatment provided in relation with an occupational accident or industrial disease recognised by the social security system.

The fixed daily hospital charge:

This corresponds to the services such as accommodation, meals, etc. In most cases, it is not reimbursed by the French social security medical insurance system. This sum is due for each day you spend in hospital, including the day on which you are discharged. It can be paid for by your top-up medical insurance.

. Accordingto Ameli.fr the day charge is fixed at 18 euros and that is not reimbursed. Other charges are reimbursed at 80%. So..if the hospital charge 450 euros per day hospital stay fees 80% of that is reimbursed making a daily charge to be picked up by you of 90 euros, plus 18 euros accommodation fee..so for a few days in hospital 1000 euros is about right. Not saying that is insignificant but it is a years payment to a mutuelle and significantly less than the cost of the dog's surgery! If you are in hospital more than 31 days it is reimbursed at 100%.

[Benjamin]

According to your earlier post your neighbour only took out a top up mutuelle after her operation/stay so to talk about a 20% charge just would not be the case.

 

[Patf]

In addition to all the info. above, charges for various types of medical care vary a lot between areas and hospitals.

There was an article about this a few months ago in our local paper - if a hospital etc is having economic problems they can put up their charges and hard luck for the payees. Then it's up to the local CPAM and mutuelles whether cough up or not.

Having lived in the UK and got used to the system there (whatever people might moan about waiting times etc) it's difficult for us to get used to the completely different system here, where you never know where you are.

[NormanH]

All this has been gone over many times before in the Forum as I said in my first post.

All that is happening now is that the same old errors are being trotted out by both camps.

Please READ previous threads[:'(]

[Chancer]

The mutuelles dont need to resort to publicité mensongère whne they have got you lot to spread their misinformation for them.

All these huge bills that you think you would have had to pay were you not to have had a mutuelle, they are just part of the smoke and mirrors, after 9 years in France without a mutuelle and having been carted away in an ambulance several times, having two extended stays in hospital with multiple operations and another overnight stay for a booked coloscopy including medical transport there and back I can tell you categorically that you would have to try very hard or be very unfortunate to end up paying anything more than Pocket money.

I dont doubt that those without any cssurance maladie cover at all , no social security number, no EHIC etc will be billed before they can do a moonlight but you will have to convince me with some facts that if you hadnt had a mutuelle you would have had to pay any proportion of those costs, most essential and emergency treatment is covered 100% as is most non urgent procedures like carpal tunnel treatment, another one to add to my list which I forgot.

All I have ever paid is 30% of the €22 out patient and pre-op consultations, 30% of prescribed medicines  (outside of the hospital), about €22 per day forfait journalier for the room (cheaper than a F1 and includes food) and on one occasion whne they made a cock up and wouldnt admit it €400 towards an operation, I had had the same one the week before and paid nothing, at my out patients appointment they found they had botched it up so kept me in and operated again the next day and trop bon trop con I ended up paying 20% for them putting right their own surgical mistake but really the mistake was an admin one but my French and my patience werent up to the fight, all in all it was a small price to pay.

I am not saying dont pay for your mutuelles, if you can afford it and it gives you peace of mind even if its only a percieved risk then for you its money well spent but for those on limited means who are having to make a tough choice all the scare stories really are counter productive.

The french are far worse though, 99.999% of them think that I am insane, they justify their mutuelles just on the grounds of glasses and dental work not to mention their love ov visiting the medecin and being prescribed 20 different items each time, they say to me "look at my lunettes, if I didnt have my super duper mutuelle they would have cost me €400" I show them mine, they agree that they are as good if not better than theirs and I then tell them that they cost me $10, were ordered from California, made in India, shipped to the UK via Holland then resent to France in less than 10 days included in the price.

Then they really are convinced that I am insane.