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Trying to trim down my mutuelle


Gardener
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I do find the whole % business re health cover a minefield. But as our mutuelle is up for renewal and its good chuck on my income every month for a family of 4, I am interested in where I may be able to fairly safely cut back on parts of the cover.

Hospitalisation honoraires en éts conv. 400% everything else is at 150% except pharmacie at 100%. We haven't had to pay anything for prescriptions or dr's appointments except the 1€,  dental treatment for the kids still costs an arm and a leg and blood tests seem to vary as to what money if anything we get refunded.

If we were unfortunate to be hospitalised then the 400 % cover would obviously be better than 300 or 200% cover , but I have no idea ( and realise it depends on why one is in hospital etc)   if 400% is more than average / excessive  or if reducing it to 200% or lower could result in a  huge bill if ever one of us was hospitalised or is the difference just that I would have to change my own bandages?

I know that the bottom line is what I can afford to pay and what level of risk I am prepared to accept, but I'd like an idea what level of cover others feel happy with.

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http://www.ch-aix.fr/public/Prix%20journee%20juin%2009.pdf

Here are some prices from the hospital in Aix.

Why don't you use these figures and ask your mutualist exactly what difference it would make to you if you reduced your percentage. At least you have figures to work with.
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My French is ok for day to day events but with the OP I am now faced with renewal with Groupama and unfortunately my French is not up to it. We have cover for hospitals blood test xrays and most of the other needs. However we are paying some 200 euros per month. I am 66 and my wife 63. We both benefit if indeed that is the word from 100% long duree with Rheumatoide Arthritis and I have a long standing problem with my spinal column.

We have never been hospitalised here so have no knowledge of their costs but know we have 150% cover but of what?

I do wish there was a simple and pragmatic way of approaching such matters.
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Groupama recently invited me in to try and tempt me to switch the top up cover to them by offering 2 months free as a new (or should that be previous) customer. She tried to sell me 200% cover, but when pressed she agreed that 100% would be enough for all the hospitals around here, just some clinics charge more.

I definately think it's worth shopping around every year as it seems that all the companies will offer a good deal to new customers.

PS Current cover for both of us (57 & 55) is €370 a year.
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[quote user="Gardener"]Hospitalisation honoraires en éts conv. 400% everything else is at 150% except pharmacie at 100%. We haven't had to pay anything for prescriptions or dr's appointments except the 1€,  dental treatment for the kids still costs an arm and a leg and blood tests seem to vary as to what money if anything we get refunded.[/quote]

You don't say where you live but, IMHO, you would really only need over 100% cover if you lived somewhere very expensive eg Paris, where 200% is considered the norm I am told.

OH and I have extra cover for spectacles as we both have quite complex prescriptions, which, to us, justifies the smallish extra charge we pay as we change our specs regularly.

Sue

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Right, thanks everyone for their input.

I have used one of the online comparison sites but to be honest I have not heard of any of the providers they come up with, they may be great but small but on the other hand...

I have been to see my agent and they came up with a policy 12€ cheaper, I was hoping to trim off a bit more than that. I have looked at the figures that Idun posted and with ref to the largest daily figure, CPAM pay 80% , which leaves 20% to find, so how does the 400% cover work in that circumstance? As I said before it is the % palava that I find confusing.

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I found Assurland only came up with rather expensive quotes - you need to hunt around the smaller companies, try for special offers, new customer discounts etc.

With regards to the % business, this is my understanding of it: if a doctor, specialist, surgeon etc charge the 'conventionée' rate (that's the price that the state approve) then 100% top up is fine and it'll cover everything that CPAM doesn't cover. It appears that most doctors/hospitals outside of big cities fall into this category (although dental and optical are invariably more expensive, but I buy glasses on-line from the UK!). Your only other costs could be the daily charge in hospital as some top ups pay it but some don't, also the €1, €2 'forfaits' on visits to the doctor, prescriptions aren't covered.

I believe that it's generally possible to upgrade cover at any time, so if the worst came to the worst........

Hope I've got it right, and it helps.
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Every medical act has a set fee 'tarif conventione'.

You need to check if this is what your medical professional charges - are they listed as 'conventione' or 'non conventione'.

When the state reimburses you, they reimburse 80% (but not always, it can vary) of the tarif conventione, regardless of the cost of the visit.

Your mutuelle will then reimburse the difference as follows:-

If you have 100% cover the mutuelle will reimburse up to 100% of the tarif conventione, regardless of what you have paid.

If you always visit conventione institutions/professionals 100% cover is sufficient. Your insurance company should be able to tell you about the hopitals etc in your area.

However, non conventione hospitals, specialists etc, are able to charge whatever they want so this is where you need 200% or 300% cover etc.

If the TC is 25€ but you doctor charges 75€, the state will reimburse 20€ (80% of 25€) and the mutuelle of 100% cover will reimburse 5€ - ie you receive back 100% of the TC.

If you have 200% cover, the state will reimburse 20€ and the mutuell will reimburse 30€ (TC @ 200% = 50€) so you have received back twice the amount of the TC.

If you have 300%, then you have cover of 3 times the TC and the state will reimburse the same 20€ and the mutuelle, 55€.

Hope this has helped a little - I've tried to space it out but I don't seem to have any editing available when I post?
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That has helped thanks.

It is the hospital cover that I am most concerned about as I don't want to left short if ever I am unfortunate enough to need it, but don't want to be paying over the odds if necessary. Will pay another visit to my agent and ask there.
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[quote user="Gardener"]That has helped thanks. It is the hospital cover that I am most concerned about as I don't want to left short if ever I am unfortunate enough to need it, but don't want to be paying over the odds if necessary. Will pay another visit to my agent and ask there.[/quote]You need to be aware that it's not only hospitals that can charge over the odds, but other services such as physio, nurses etc.  I, for example, have been having physio 5 times a week now for 18 months (plus a 40k each way ambulance journey for most of that time!), and was in rehab' for 6 months before that.  But you can, as somebody has already said, always bump up your level of cover if the worst happens.  Look at the limits for each illness also (these can increase as your % cover increases), plus the other extras which a "better" policy can include before making a final decision to downsize.  It is horribly complicated, for sure, and as ever with insurance, is something of a gamble whatever you do.
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