Is top-up health insurance really necessary?

[Logan]

My understanding is that the consultant in charge of a particular case of hospitalisation will certify the condition to be either life threatening or not. This then is related to the percentage the state will fund. It's hard to imagine a heart attack case not being regarded as life threatening. However when it comes down to a particular doctors opinion, differences are inevitable.

[osie]

The pro's and con's of life insurance is something that has gone round and round in my mind for years, much of which has been already discussed in the previous messages.

My summary is that mandatory insurance is generally worth it as if the country has deemed it mandatory that it probably is a good idea.. i.e. house insurance

Other insurances play on the fears of people and sometimes those people benefit financially and most times they are for the comfort factor... all good reasons to take it out.

My opinion is that it is better to put money aside rather than to give it to a profit making company to put on their side.  However, this normally simple task is quite tricky for most.  Therefore insurance companies exist... and the world goes round.

p.s. I have not yet got a top-up although I regularly re-access the variables.

thanks

osie

[Sunday Driver]

Hospital fees are not automatically covered 100%.

From the Assurance Maladie website:

Hospital fees:

You (or your mutuelle) are responsible for the ticket moderator (that's the shortfall from the state cover) except in the following cases:

Vos frais d'hospitalisation seront intégralement remboursés si vous êtes dans l'une des situations suivantes :

• vous êtes hospitalisé(e) plus de trente jours consécutifs (votre prise en charge à 100 % débute alors le trente et unième jour) ;

• vous êtes enceinte et devez être hospitalisée pendant les quatre derniers mois de votre grossesse, pour votre accouchement, ou pendant douze jours après ;

• pour votre nouveau-né, s'il est hospitalisé dans les trente jours suivant sa naissance ;

• vous êtes hospitalisé(e) en raison d'un accident du travail ou d'une maladie professionnelle ;

• vous êtes hospitalisé(e) en raison d'une affection de longue durée ;

• pour votre enfant mineur, s'il est hospitalisé suite à des sévices sexuels ;

• vous percevez une rente pour un accident du travail (avec un taux d'incapacité égal ou supérieur à 66,66 %). Vos ayants droit bénéficient eux aussi de cette prise en charge à 100 % ;

• vous êtes titulaire d'une pension d'invalidité, d'une pension de veuf ou veuve invalide, d'une pension vieillesse qui a remplacé votre pension d'invalidité, ou d'une pension militaire ;

• vous dépendez du régime d'Alsace-Moselle ;

• vous bénéficiez de la Couverture maladie universelle ou de l'aide médicale de l'État.

Note that if you hold an E106 or an E121, then you are not a beneficiary of CMU and therefore the last qualification does not apply. 

 

[Patf]

That's interesting SD. Perhaps I had to pay the 30% because I hadn't at that time been confirmed by my doctor as having an ALD.

[NormanH]

I think so Patf.

I would also point out that if you have one of the list of illnesses counting towards an ALD that isn't  an automatic guarantee of 100% cover, until your  your Géneraliste has sent in a 'formulaire de demande de prise en charge'  to your local Caisse, and you have the specific 'notification d'exoneration du ticket moderateur' and a list or 'protocole de soins' which shows which medicines and tests etc are covered.

I mention this because it might be imagined that this is automatic.  You will be accepted if you apply , but it is much better to go through this rather long-winded process as soon as you are diagniosed  and have the right documents to produce in an emergency arising from your illness.

Of course you are only covered at 100% for the things on that list.

[Logan]

Last year my wife had a major operation and was hospitalised for 3 weeks. Thankfully she made a complete recovery thanks to the skill and expertise of the hospital. I was expecting a big bill and spoke to the consultant about it. He said not to worry, the condition was life threatening and would be met by the state even though at that time I did have a mutuelle.

Eventually a statement came from CPAM indicating the total cost was 15,000 euros and paid 100% by them. Now looking down the list that SD posted, my wife's circumstances did not fit into any of those catagories.

So I guess like Donald Runsfeld we must assume "there are knowns and unknowns, as well as knowns where some are unknown and unknows where there are some known knowns and also unknown knowns!" In other words a complete Kafkaesque.

[Blossom]

All of which makes me wonder how the actuaries arrive at their premiums. But, then, I suppose Kafka did work in insurance!

[Clair]

Worth reading:

http://www.french-property.com/newsletter/2008/6/3/top-up-french-health-insurance/

[seb47]

Yes - I agree, but what if you are critically injured in a road accident?

[Jonzjob]

Insurance is a total waste of money and no-one ever needs any insurance until they need it [8-)]??

[Blossom]

As the originator of this thread, I would like to add an update by saying that, after careful thought (and further research), we have decided that, for us, top-up insurance represents bad value for money.  We have therefore decided (at least in the short-term) to insure ourselves by saving each year the amount that we would have spent on top-up insurance.

[Newcomer]

Blossom,

 

I am inclined to agree with you.   We have spent weeks looking at top up insurance.  When we ask for Hospitalization Quotations only we are made to feel this is inadequate.   It is amazing.  I do not think the french people pay these high charges for insurance.

 We have been given a quote for less than 400 euros for 2 people for hospital cover only.  It seems too good to be true.  But reading the threads if you are in hospital and have serious illness you will not need this anyway so it is money for the insurance company.

 

[Nearly Retired (I am now)]

I haven't really paid much attention to the top up insurance issue as up to now we have spent most of our time in England.

As part of the calculations regarding possible long term living in France in the future I'd like to know if the top-up cost figures are standard for each level of top-up or do they vary (upwards) depending on pre-existing conditions like holiday travel insurance and UK health insurance.

PS A note on the Insurance vs Save It issue.

We got fed up with paying UK private health insurance after being hit by an exclusion clause. We stopped it and just payed the monthly premium into a ring fenced savings account. I reckon the lump saved represents about 25% of the cost of our maison secondaire.

 

[Owen]

Hello Blossom,

The answer to your question; Is top up insurance really necessary: the simple answer is "No".

Is the purchase of some level of top up insurance (perhaps hospitalisation only) advisable/recommended? For most people I would say "Yes". 

It is particularly the potential costs of a hospital stay (assuming one enjoys general good health) which makes the choice to insure or not a vexing topic. The post by Keith Channing alludes to this.

It is not the treatment of life threatening conditions, expensive as they may be, because such treatment may well be covered 100%. Major surgery may also be covered 100% depending where it is performed. But a hospital stay does not, by a long way, necessarily mean treatment of life threatening conditions or major surgery. It can be a matter of minor surgery, observation, tests, scans etc which will be unlikely to be covered 100% - 70% - 80% is more likely. Add the hotel costs and a private room (if desired) the costs mount up. Apart from privacy I see other advantages of a private room. But even if you are admitted to hospital for something life threatening such as a heart attack and covered 100% this will not be the case when it comes to convalescence if so recommended. Only 80% of the costs will be covered plus hotel costs and again a private room. 30 days in a convalescence/rehabilitation establishment can begin to be quite expensive.

You can of course put money by in a deposit account but how much? Impossible to calculate or forecast.

For people like Logan I can only agree that a mutuelle offers less than decent value because it will undoubtedly offer benefits which are surplus to requirements for someone in general good health. But shop around amongst the commercial insurers for hospital only cover and there are some pretty good deals about. Depending on age you may obtain such cover for around 30 - 50 Euros per month. Of course many providers will look askance at you when you require hospital cover only. We are, after all, living in a country where hypochondria is one of the top national pastimes. Why people have hang ups about providers making profits/surpluses defeats me. I am sure this factor does not stop them from shopping in Carrefour. Worthwhile for most people therefore to have at least a degree of cover afforded by a top up. A pot of gold in a Livret A account can be available for other emergencies.

Regards

Owen

[email protected]

[Mr Coeur de Lion]

If the French government take about 40% of my wages just in social charge taxes (before any other taxes), why the hell can't they afford to pay 100% of any health requirements I (or anyone else) might have?

Somebody somewhere is taking the micheal I think.

[KathyF]

I think the answer to that is that the French health system is prohibitively expensive to run in its present form. There are lots of posts comparing the NHS unfavourably to the French health system, but the lavish supply of hospitals, medical staff and equipment which enables the lack of waiting lists in France also costs an unsustainable amount to finance. The French social security system is a financial black hole.

[Doodle]

Hi there,

I have only just read this thread and thought you might like my views.

I have just arrived home from hospital where I've been held prisioner for two weeks in Angers 80 miles from where I live. This is the first time in my life (I'm in my mid 50s) that I've ever been admitted to hospital and I've been in perfect health since I was 10 years old. It all started with violent vomiting for 4 days until I reached the point where I knew I had to visit the doctor. I apparently had no blood pressure and was sent straight away to the local hospital 15 miles away. After two days and nights of blood tests, ecg tests, radiography, 3 different laser scans abd two endoscopies I was then transported by ambulance to the hospital in Angers. A private room, more blood tests, wee tests a colonoscopie and another endoscopie not to mention the drips I've been on continuously. The outcome is that they don't know what caused the problem but they said it may be a twisted intestine, a tumour but cannot find anything on any of the scans of from the tests that have been done.

I now have to return on monday when they are going to take a biopsy and I have to stay in overnight.

Now I've not relayed all of this to get sympathy as it's not needed but thank goodness we have top up insurance as I cannot begin to think how much this would of cost (maybe someone else knows).

I looked at the notice board in the hospital and some of the operations were 1,000 euros plus.

We've been paying the top up insurance for 3 1/2 years at 65 euros a month for the two of us and I'm sure I've had more than my monies worth.

Is it worth the risk? Only you can decide.

Chris

[cooperlola]

Another of these Lazarus threads, how does this happen?

Oddly, Chris, I think it does tend to be the scans, tests, x-rays etc which eat up the cash, as opposed to the ops which are often, as Owen explained a couple of years ago, re-imbursed in total.  I cannot tell you how many X-Rays I've had but suffice it to say that each of the envelopes (about 5 now) which contains them is getting on for a centimeter thick!  Not to mention 5 half days of physio for the past 2 years and the 40k vsl ride in each direction (in my case not being paid for by my own insurance but it was just a matter of luck that it wasn't my fault but somebody else's).  Like you, I would not be without top-up - great for peace of mind if nothing else; it's not until this sort of thing happens to you that you find that out, is it?

Fingers crossed that the biopsy turns up something benign that they can deal with.[:)]

[idun]

My 10 days cost 7000 in total (no ops and not that much testing either) and a lot of this was paid by my mutualist.

Also, I don't think that people realise that a lot of french people, well the ones I know at least, have their top up health insurance via their employer, who does a deal with the mutualists, in our case it would seem to be done via the comite d'entreprise to have all employees covered and the mutualist payments are made directly from wages.

I am sure that this is 'cheaper' for many than doing it themselves, as I can only imagine that many would opt out and have DIY top up plans.

[Rose]

I thought I would add my 2p worth whilst this thread has popped

up.

When we arrived in France some other English folks we met told us not

to bother with top-up... they said they saved the money they would have paid and keep it for a rainy day.  We followed this policy for a little while but

it bothered me, as we have a young son at school, and I just thought it's just better

to be safe.

Anyway... we did take out a mutual top-up and since then I've

had my troubles and I know the cost of the treatment and scans and tests is

running into 1000's...  I will now come under the 100% exemption rule but this

isn't the case for all emergencies. 

We've also had for a few scans and x-rays

and hospital visits for my son... fortunately just the usual bumps and falls and

bangs of childhood and rugby... but I can say without a shadow of doubt that I

am very pleased we have the top-up.

I know it's down to choice but my

advise would be to get it.

[Pickles]

[quote user="cooperlola"]Another of these Lazarus threads, how does this happen?[/quote]

The thread was resurrected by a spammer, whose post was then deleted.

Regards

Pickles

[cooperlola]

[quote user="Pickles"][quote user="cooperlola"]Another of these Lazarus threads, how does this happen?[/quote]
The thread was resurrected by a spammer, whose post was then deleted.
Regards
Pickles
[/quote]Aha! Mystery solved, thanks.[:)]

[skc]

  Chris

   I hope you are well now ? Very interesting comments ,many thanks. You've helped  me to decide.

   I am in my early 50's and my good lady in her late 40's--common law rather than married. Very

   much interested in your level of cover you both have for monthly premiums of 65 Euros.We would

   like to have a joint policy for a similar amount of money. Could you please give some contact 

   information and are they English speaking ? We are moving to France to live very soon--2 years

   on a S1(e106)-so need top up-while setting up a small B & B on the Auto Enpren' system.

   Look forward to hearing from you and thanks in advance.

 

   Kind Regards ---Steve

[Laotze]

A small point that doesnt seem to have been mentioned in any of the posts on this thread - your premium for a mutuelle is set AT THE AGE OF ENTRY. Perhaps this is why for French people who start paying in at the age they start work, it does not seem too expensive. Those British  who start at retirement age will find their premiums very much higher. My premiums are a fraction of those of my husband who is a decade older than me. Those who have decided to put off joining a mutualle until later will find their premiums have gone up in the interim.

[Lou]

This is an interesting post - does this also suggest that your premiums shouldn't / don't go up each year as you get older?

Ours always have (somewhere between a few to 20 euros per year) and I've assumed that this was because as we get older the risk of us costing more increases.

Lou