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Top up health insurance and ALDs


5-element
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I seem to remember, some time ago (but a search revealed nothing) that some forum members had managed to secure a top-up health insurance which was much less than the normal full amount - because most of their potential health problems were already covered 100% via several ALDs.

I am now attempting to find which insurance companies might provide this kind of cover - none of our local ones is offering this, and they even claim it doesn't exist "c'est pas possible!"...

I know that all mutuelles have rocketing costs, and we are beginning to be seriously concerned about this, as it eats a rather large amount of our modest income. And I am beginning to understand how it is that so many French people now simply do not have a mutuelle cover because of being unable to meet the cost. Of course, if one is truly destitute, then you can get CMU-C - but if you are just above the line, you have to pay and lump it.

 

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We obtained topup policies for the first time 2 years ago, after having none for 8 years. The company didn't ask about ALDs , (which I have), only our ages.

We pay about 120€ pm altogether.

Not sure what degree of cover you need.

I'll pm you with the name of the company if you like. They haven't put our premiums up this year.

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Thank you Pat, yes, I would like to know more about your company.

The bills for us this year amount to about 150 euros pm, the most basic cover. Premiums seem to have gone up steadily, this year too. Perhaps we are a little older than you - I know that my 92 year old mother pays about 100 euros per month for her basic mutuelle cover.

And I am hoping that one of the people who gets a discount on their mutuelle because of their ALDs will  tell their story.

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That is precisely the point, WB: ALDs are covered 100% by CPAM. So, if someone has several ALDs, it is more likely that most of their medical problems will be caused by the ALD, that is very much the case for my husband: most of his medical emergencies and problems are to do with his ALDs, so that a mutuelle doesn't have to reimburse much at all to someone like that. For the mutuelle, a heavily ALD-ed patient is "tout bénéf" -  mutuelles must love their ALD clients  - some of the insurance companies recognise that fact and offer a special deal for a heavy ALD patient. Apparently.
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[quote user="5-element"]

... some forum members had managed to secure a top-up health insurance which was much less than the normal full amount ...[/quote]

I seem to remember SD saying something of the kind in that he, or his wife, received a discount because of ALDs. Though I don't recall him saying that the premium was much less than normal, just that they paid less than they would normally be required to do.

I believe he was with MAAF, if that helps.

Sue

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I remember him saying that yes, but unfortunately it didn't seem to work for me.

Mine actually went up after I was given my first ALD, but that may also because I had just reached 60.

Age seems to be a major factor in price.

I am in the same region as 5e if that counts for anything.

After my experience last year when I learned to my cost that Mutuelles have rather ambiguous phrases that they later interpret to their advantage I changed to one that is more 'transparent' but even with them when I wanted a better level of Hospital cover I noticed them slipping in 'get-out' clauses.

I am sure that you know about Aide à l'acquisition d'une couverture maladie complémentaire 5e as you are French!

The link is here

http://vosdroits.service-public.fr/F13375.xhtml

and the plafond for 2 people is 16067€

In fact a situation is beginning to develop where people fall into the trap of having a bit too much income to be able to claim help, but not enough to be able to afford the costs of certain things.

I know a couple who are on the RSA, so have the right to the CMU-C, which means that dental treatment is free to them and they can have things done that cost too much for those who have to pay  a part to be able  to afford.

While I am a strong believer in helping the most needy there is something odd about one  income sector getting free treatment and the sector immediately above having to go without.

Some people opt for 'Hospital only' Mutuelles, given that even the better ones give very little back in the way of Dental or Opticians' help. 

This reduces the premium considerably.  I believe parsips has this sort of cover but that is for him to say.

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Thank you Sue, I will have a try with the MAAF, although I have a vague recollection that we have a MAAF here which was not helpful (maybe they have franchises, like banks do, so perhaps regional variations?)

Thank you too Norman: alas, me being French does not help: cunning insight about the way to get bargains is not in the genes, [:D] - so I am grateful for your input.

When you say "In fact a situation is beginning to develop where people fall into the trap of having a bit too much income to be able to claim help, but not enough to be able to afford the costs of certain things." this is exactly it for us. Adding health insurance premium to our local taxes, and this amounts to just over one sixth of our income. Naturally, there are plenty of other inescapable bills beside these two items, so I am beginning to look at possible ways to cut corners. We looked (not thoroughly) into the possible "hospitalisation only" option, but the insurance agent talked my husband out of it - as she would. Maybe I should look again, harder. But you are right that it is tough if you happen to be exactly on the cut-off point between getting  free medical care, and not.

I am also alarmed by the apparent fact that top up health insurance premiums rise steadily as one advances in age. I guess, one ought to be grateful for being still in the land of the living after, say, 65, but I don't believe that means we should line the pockets of insurance companies for the privilege, since we don't owe them for our longevity !

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5-e, try these people:  www.april.fr

I know only too well what you say about the premiums relevant to age!  OH's premium is just under twice that of mine; yet I am the one who claims every month for asthma medication plus all the "stuff" for when I get a chest infection and OH goes to the doctor once a year to get his cert of fitness to play ping pong.

I guess they have to take a stab at probability and, if you are fortunate enough to actually get to a nice old age, society has a way of almost punishing you for it.  Thus, not easy to get year round travel insurance and as for hiring a car, you can really write it off as not at all a good idea[:'(] 

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My parents having arrived in France aged getting on for 80 years old decided to have just "hospital" cover. This has worked very well. My mother now has ALD for dementia and my Dad having had two heart attacks in October this year now has ALD for his heart.  Ten years on from their arrival the hospital only cover has actually been used for the first time this year. It took a while to get the ALD sorted for Dad and in the meantime hospitals had to be paid and three of the five weeks he has had in hospital may not be covered by the ALD as he had severe anaemia and blood transfusions. My mother was admitted to hospital really for our convenience when Dad had the first heart attack but we have had to pay nothing.

They have happily paid he small monthly drug bills over the years. Look seriously at just this cover, we are wondering whether to change out own as we have full top up but are rarely ill!

Mrs H

Edit: Our local (conventioné) hospital charges 857 euros a day for inpatient care plus the daily charge for food etc. Even with the state picking up (I think) 80%  the difference would mount up in the case, for example, of a bad leg break which was nothing to do with an ALD.

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As many of you have remembered it was Sunday Driver and it was MAAF. Armed with his experience I approached our top up provider, AXA, to ask for a reduction given Mrs Benjamin's ALD. No way, was the answer.

A short time after this we discovered that as Mrs Benjamin was also classified as "disabled" so all of her medical costs (bar things like daily hospital fees and prescriptions reimbursed at less than the standard rate (vignette colour) ) were covered 100%. Off I trotted but was again told no way.

As Hereford is thinking we then decided to take Mrs Benjamin off cover at the next renewal date and take our chances. We never paid out anything as it so happens as we were beginning to pay out, like others, quite a lot.

 

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Plenty of food for thought, much of it sounds exactly like I suspected. Just imagine those thieves not even telling you, Benjamin, that Mrs. B did not need a mutuelle cover.

Your own experiences are invaluable, thank you for sharing them.[kiss] Too late for this year, as we did what most people do, i.e. in fear of being without a cover, we just paid...But I swear that next year it will be different.

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There is a school of opinion that argues that it is better to put the money that you would have paid as premiums aside to use as necessary, given that the Sécu picks up quite a large proportion of the bill.

I have seen this well put and justified elsewhere.

I feel that this is easier psychologically for those who already have reasonable savings  and so could  meet any costs if the untoward happened tomorrow, rather than in say 5 years time when there has been time to put away a reasonable sum.

I have never been in that situation and so have always paid a Mutuelle probably more from fear then from arithmetic.

It is also true that the things paid for by a Mutuelle often come into the category that some people would regard as 'extras', a single room supplement for example and the payment of the 18€ daily charge. I know from experience however that I cannot tolerate sharing when I am feeling desperately unwell. The system of double room paradoxically feels less private than being in a larger ward with screens such as I have experienced years ago in the UK. So I have decided that the cost is worth it for me, even with the ALDs I have, but obviously I want to keep costs down

My solution is to have one which is modulable, that is to say I can choose the level of cover for each of several areas, rather than having the same level for all.

In my case I chose an elevated level 5 for Hospitalisation, and I could have taken this as an individual module, although the assurers often don't tell you this.

I have level 3 for General medicine and Pharmacy.

I chose the basic level for teeth and eyes, because even the best levels reimburse complicated work  poorly, and  the Sécu + level 1 pays 100 %  for anything essential such as extractions or fillings

This then is the area in which  I have chosen to follow the almost no-Mutuelle route.

To sum up I decided for comfort and security to keep a Mutuelle although I have ALDs, but to limit the cover in areas where I judge the reimbursements not worth the premiums.

My choice was Swisslife and a link to their table of modules can be found on the bottom half of this page

http://www.chronomut.com/swisslife-ma-formule/

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[quote user="5-element"]

Thank you Sue, I will have a try with the MAAF, although I have a vague recollection that we have a MAAF here which was not helpful (maybe they have franchises, like banks do, so perhaps regional variations?)

Thank you too Norman: alas, me being French does not help: cunning insight about the way to get bargains is not in the genes, [:D] - so I am grateful for your input.

When you say "In fact a situation is beginning to develop where people fall into the trap of having a bit too much income to be able to claim help, but not enough to be able to afford the costs of certain things." this is exactly it for us. Adding health insurance premium to our local taxes, and this amounts to just over one sixth of our income. Naturally, there are plenty of other inescapable bills beside these two items, so I am beginning to look at possible ways to cut corners. We looked (not thoroughly) into the possible "hospitalisation only" option, but the insurance agent talked my husband out of it - as she would. Maybe I should look again, harder. But you are right that it is tough if you happen to be exactly on the cut-off point between getting  free medical care, and not.

I am also alarmed by the apparent fact that top up health insurance premiums rise steadily as one advances in age. I guess, one ought to be grateful for being still in the land of the living after, say, 65, but I don't believe that means we should line the pockets of insurance companies for the privilege, since we don't owe them for our longevity !

[/quote]

Hi,

     MAAF do have a hospital only policy, but you have to keep on insisting on it as they are reluctant to market it (low commission perhaps?) --it is called ;

BIORYTHM (a)  Hospitalisation niveau 1 --and covers only the 20% of a hospital bill which may under some circumstances be due ;also the daily "forfait".

      It costs us (70yrs and 55yrs) 23,86€ per month.

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[quote user="BJSLIV"]It would be illegal for a company to offer a discount for ALDs, as they are not allowed to discriminate on the basis of pre-existing conditions. Hence the absence of probing questions. It comes under the heading of Egalite![/quote]

Then it must be my mistake to "remember" that a discount for ALDs  had been agreed for  one or two people on this forum.  I also thought that "discrimination for pre-existing conditions" applied to private health insurance, but NOT to top-up mutuelles.

I do know about the "hospital only" cover, and now will be able to investigate that possibility for next year - but I suspect that, like many people, fear of the unknown might still determine my final choice!

Again, thanks all. [kiss]

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 You weren't mistaken, but I have to say that I was surprised to read about those cases, since it didn't apply in my case, and like BSLIV I don't believe Mutuelles can ask for information about pre-exisiting conditions. An assurance santé can however,as is explained here

http://www.lefigaro.fr/assurance/2012/05/29/05005-20120529ARTFIG00529-mutuelle-ou-complementaire-sante-que-choisir.php

 

La grande différence entre une mutuelle santé et une assurance santé

réside dans le fait qu'une compagnie d'assurance vend des produits pour

en tirer un bénéfice, qui reviendra aux actionnaires de la compagnie (et

non aux adhérents).

Logiquement, les compagnies d'assurance sont

plus «exigeantes» et peuvent demander, par exemple, un questionnaire

médical avant l'éventuelle signature d'un contrat avec un assuré.

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