Mutuelle - what level of cover is needed?

[Daft Doctor]

Hi, I'm on the point of sorting out mutuelle cover for myself, my wife and my son.  There is a bewildering choice of cover levels, both for outpatient and inpatient care.  Fact is I've no idea what proportion of GP's, consultants and hospitals adhere to the national tariff, so I've no idea what is an appropriate level of cover.  Just wondered if you wise French residents out there could help guide me a little, based on your own knowledge and experiences.  As you can see we live in Haute Savoie.  Many thanks in advance. 

[suein56]

A hugely simplified view.

It is generally accepted that 100% cover should do the trick for Hospitalisation, surgery and everyday matters if you live outside Paris. As this then includes the total cost of visits to the Doctor (!) - except for the 1 euro excess - full reimbursement of medicines - except for the 50 cent excess per packet etc.

Then there are the questions of eyesight and dentistry; the CPAM reimbursements are low so, if you wear specs, then you might want to choose a category B, or even C, level of cover from your mutuelle for that area. Ditto if you have problem teeth, as, again, CPAM cover for dentistry work is poor.

It is an incredibly complex subject but at least you can change options if you find you have not chosen the right amount of cover in one area.

Sue

[NormanH]

Welcome to the Maze!

Make sure that you understand what is meant by 100% 300% etc, as you may well need more than seems logical. Basically remember that the % refers to the tariff allowed by Social security, not the price charged which may be much more.

There have been a number of threads about this in the last year which I will try to dig out.

Most Mutuelles cover

Hospitals

Medicine de Ville (consultations, X rays  Physio etc)

Dentist and Opticians

Pharmacy

Some will include cover for such things as osteopaths and cures

I am with Swiss Life who allow a sort of à la carte approach, that is to say you don't have to have the same level of cover for all sectors, and you can add in a couple of modules for things you might like as options. (cures, homeopathy etc)

http://www.swisslife-direct.fr/particuliers/sante/ma-formule-swiss-life-600004.html

As a guide I have level 5 for Hospitalisation and Medecine de Ville, but am at a lower level for Dentists and Opticians which can  bump up the price quite a lot.

I pay 110€ a month, but am 65 and have just changed

As I have 3 ALDs most of my medical costs are at 100%, but I have taken out a high level for hospitals to cover extras that I like to have, such as being sure that all costs will be met at their real cost for a long period.

There are often not very clear limitations on such things as how much will be paid for a room and for how long

Generally make sure that you read the small print. I wanted cover for a single room, and thought I had it with my previous insurers, but it turned out to be limited to surgical wards, which I was in but not for the convalescent home afterwards which they deemed to be 'medical', which is why I havev upped my cover on this more transparent system

I know cooperlola and ANO have assurers they can recommend

As for the prices charged by specialists Dépassement des horaires there was a survey in April

http://www.lemonde.fr/sante/article/2012/04/10/enquete-sur-ces-consultations-au-prix-fort_1682940_1651302.html

which confirms that the most blatant examples are in the large cities

[idun]

100% cover will do the trick for hospitalisation?  I would never say that, that is very very basic and would not take into account using cliniques, which as far as I am concerned is also hospitalisation. And let's face it, sometimes one uses cliniques because that is where the specialist you see also does their surgery. And sometimes one's GP refers you to someone at a clinique.The cliniques we have used always have surgeons who want extra...........those depassement d'honoraires, I have even paid these in a state hospital.

And those recommendations and referals, in our case it was because these surgeons/consultants had excellent reputations and we never thought to ask if it they worked at the hospital or clinique.

 

And the percentages, well for teeth, hearing and eyes, calculating simple percentages isn't always the best, as there are other calculations that they do, which can have better reimbursements. 

 

 

It is a minefield. There is an Argus that you can read Daft Doctor.

 

[Daft Doctor]

Thanks indeed for the advice.  I now think that until the end of 2012 and for only a little bit extra, I'll opt for 300% cover for both inpatient and outpatient stuff, then I can relax for now and gather more info to inform next years buying decision.  The insurer which Coops suggested doesn't seem too bad as a starter and the info is crystal clear and (given my still rather dodgy French) in English.  I can sort everything out online which is always my preferred way of dealing with this type of thing.   

[suein56]

[quote user="idun"]

100% cover will do the trick for hospitalisation?  I would never say that ... [/quote]

And I did not say it either ... I said 'should' not will !

Where you live can, seemingly, make quite a difference on the level of charges by Doctors and Surgeons etc; this is Norman's infamous 'dépassement honoraire' debate.

We made a huge mistake when we arrived and opted for 200%, against advice by our mutuellist, as we wanted to be confident our level would cover all eventualities. It was a total waste of money for our area as when OH needed lots of tests at both Hospital and Clinique and by specialists on their own premises we had the resultant costs and reimbursements explained to us by French friends, and our mutuellist, and we saw, quite clearly, that 100% would have covered everything adequately. We have been on 100% ever since.

Sue

[idun]

Will or should, I would say in the Haute Savoie, I would not have just a 100%. I lived in that region of France and I know what is charged. The Morbihan is a long way away and obviously the prices are different as shown by Le Monde, you appear to live in a region of France that isn't plagued by these demands.

http://goo.gl/vWuPh

[suein56]

[quote user="idun"] http://goo.gl/vWuPh [/quote]

Now that is most revealing ... I had no real idea only what we had been told.

Sue

[cooperlola]

I must say that we have never regretted going for 300% even though a lot of things cost far less.  I have got far better private room and dental cover as a result - they even paid me 300% of the wig allowance which meant I could get really decent one for the chemo hair! I reckon much depends upon your income and your general state of health also but as has been said, you can easily alter the level of cover if you feel you've made the wronng choice initially.

I find it quite telling that the company I mentioned used to have 300 as its top level but this has increased to 500% now (sic) [:-))] so clearly it's a real issue in some parts, as the article confirms.

[NormanH]

A fascinating article idun. Thank you

[idun]

[quote user="suein56"][quote user="idun"] http://goo.gl/vWuPh [/quote]

Now that is most revealing ... I had no real idea only what we had been told.

Sue
[/quote]

Suein56, just beware if you move to another area. Some things can be far more expensive. You even have 'free' motorways en Bretagne nez pah![Www] I suppose all these things have to be considered when assessing the cost of living.

[Patf]

I would advise enquiring carefully into the cover for ambulance costs in your area. They can be very high (eg 900€ per half hour as we found) .

Cost sometimes depends on who calls the ambulance, how far from hospital, whether for an ALD, and other factors.

We have had 2 big bills in the past because of insufficient cover.

[NormanH]

You are quite right that Transport is a section in Mutuelle cover that I forgot in my list.

That price seems outrageous however [:@]

[Patf]

That's what I thought Norman, and I spent a lot of time trying to query it but they all said "that's it!"

It could have been expensive because they came from the next Dept.

So it was for an hour, cpam paid 66% and we had to pay 600€ as we had no mutuelle at the time.

[idun]

Patf, I'm sure that this has been gone over before, but how did you end up with an ambulance, and not the Sapeur Pompiers?

We didn't live that far from a city, and I know where the private ambulance places were. A medical emergency in our village and everyone called the Sapeur Pompiers. Theirs was the number to call and never an ambulance. They were there within minutes and would have people whisked off to hospital immediately.

An ambulance would have taken at least 30 minutes to get to us, with lights flashing.

[Patf]

We were at our doctor's surgery, he thought Eddie was having a heart attack and sent for an ambulance.

[idun]

OK, was that because they close by?

I don't think our Toubib would have done that as we didn't have any ambulance stations nearby, I'll have to ask friends. Also we lived on a border, and we would always be taken to the next county hospital as it was the closest major A&E.

[shimself]

Despite the ambulance bill of 600€, I still wonder if its worth it

We're

a family, I'm in my 60s, and I have an ALD illness.  So last year if I

read the RSI statements correctly, without a mutuelle we'd have payed 20

visits to the GP at 7€, about 300€ for a (needless) endoscopy, about

£130 for the specialists, and about 40€ for the drugs.  Total 600€. 

Mutuelle bill was 1500€.  That leaves 900-1200€ worth of additional

unexpected costs to break even.  (As it happens I could probably hop to the hospital, it's under 1km away). 

I'm the same with all insurance, I'll take the biggest excess (franchise) they'll allow me, I know damn well if I make a small claim they'll jack up the renewal cost; so it's never economic to claim except for write-offs and such disasters.

I get specs online, which is much cheaper than buying here even after the mutuelle coughs up its bit.

Does anybody know how one might

easily start to run up bills of over 1000€ without a mutuelle?  It

sounds silly, and I'd much rather no-one in the family had a dread

disease or car crash or nasty turn, but I think my question is what

would such events cost?

Steve

PS I'm a bit uneasy about this, because I really do like the mutuelle/no medical questions aspect, and it feels a bit like cheating, but I think if we were unlucky enough to have someone parked in hospital for many months then don't the RSI start to pick up more of the bills anyway, and couldn't you just sign up for a upmarket mutuelle from now on?

[NormanH]

To answer the last question first there are age limits in practice to joining Mutuelles. I changed last year at 65 and was told I just got in. It would be difficult after 70 I believe, or much more expensive since you haven't built up any history with the firm. You will see advertisements for them without age limits, but the cover may be limited.

If you think about it, the idea is that you pay for a while without taking anything, until the day you do need help.

Don't forget that the ALD only covers that specific disease, so if you have other things which aren't related you remain responsible for the 35%

The state also only covers 100% of its tariff, not necessarily the actual costs which can include extra fees for surgeons and anaesthetists over and above that base.

The Mutuelle also covers (depending on what you have chosen) such things as the daily 18€ charge, and the cost of a single room (about 50€ a day)

Some idea of daily costs

http://www.chu-lyon.fr/web/2489

To give you an idea of possible costs:

My total costs for care last year were about 25,000€, plus 3500€ that the Mutuelle didn't cover  for a single room in the convalescent home.

[idun]

Like all insurance policies they are a sort of waste of money if you don't need them. But if you do, well, I suppose that we are all thankful. Still there are many types of mutualist policy that give varying methods of cover as well as varying prices.

In our last three years in France, we had two hand operations, a cruciate (sp) ligament operation and me 10 days in hospital for nothing. All that little lot cost our mutualist thousands, mine especially. We were pleased to have the mutualist.

These bills can soon mount up.

Mazan, a poster on here in the early days did not have a mutualist and suggested that for those that prefered, just saving the money that the mutualist would normally get should cover most eventualities. I wouldn't have, but he seemed happy to do just that.

[mint]

This is my policy er...on a health policy:  As long as I can afford it, I will pay and hope that I don't get ill and don't have to "get back"  too much. No different from paying into the NHS, IMHO.  I paid all my working life and, until the final couple of years when I developed asthma, I didn't have to use it much and didn't know my GP's name for absolutely years.  That also suited me just fine....[:)]