Ald and pensioners

[babcock]

MOH has just received info that he has been accepted (if that's the correct expression) for care under an ALD. I have read through the booklet and cannot understand how this benefits him. We are pensionners and our healthcare in under the E121 and we have a mutuelle. Certain things like non conventionee costs, transports sanitaires are not covered and will be covered by the mutuelle. Am I missing something? (very possible)

[Patf]

If you have a mutuelle probably the only time you would notice the benefit of the ALD is if he has some treatment for this condition for which the charge is higher than the mutuelle would pay. eg some specialists charge above the going rate.

I could well have missed something though.

[Sunday Driver]

Your husband's ALD entitles him to 100% reimbursement of his treatment costs for that specific condition.  That gives him the benefit of not having to meet the normal 30% shortfall either from his own pocket or by paying for a mutuelle.  However, in practice, most people who suffer from a medical condition which qualifies as an ALD also tend to have other conditions and therefore have mutuelle cover for those.

So in real terms, it's the mutuelles who actually benefit from him having an ALD as they don't have to pay out the 30%, so it's worth asking them for a discount on his premium.  I did and they knocked 15% off.....[;-)]

 

[babcock]

[quote user="Sunday Driver"]

Your husband's ALD entitles him to 100% reimbursement of his treatment costs for that specific condition.  That gives him the benefit of not having to meet the normal 30% shortfall either from his own pocket or by paying for a mutuelle.  However, in practice, most people who suffer from a medical condition which qualifies as an ALD also tend to have other conditions and therefore have mutuelle cover for those.

So in real terms, it's the mutuelles who actually benefit from him having an ALD as they don't have to pay out the 30%, so it's worth asking them for a discount on his premium.  I did and they knocked 15% off.....[;-)]

 

[/quote]

I'm glad it's not my misunderstanding . One thing he had recently was a cardio. It was reemboursed at 100% so no charge to the mutuelle but because it was over 91€ there was a forfait of 18€ to pay! It all seems a bit pointless