Teamedup Posted November 21, 2004 Share Posted November 21, 2004 I have mentioned that our mutualist cover has changed. I've noted what is mentioned on our contract for the last two years, concerning lenses. Verre (par verre et par an) 900%tc+2Verres (limite a 14% pmss/an) 90%fr The amount given will depend on what is wrong with one's eyes. We often see that people say that their mutuelle will give 100% reimbursement. Unfortunately 100% means very little in many circumstances. The social security figures have minimum and maximum amounts for some things too. The other thing is that it is nigh on impossible for someone like me to get hold of all the ss tariffs. And those figures I mentioned, well, I had no idea of the implications of the changes. 90% or 900% with a 14% thrown in. And the implications worked out to be rather a lot of money.Do you really know what cover you have and what all these strange percentages mean. Link to comment Share on other sites More sharing options...
Owen Posted November 22, 2004 Share Posted November 22, 2004 Hello TU, I will answer your last question by saying; yes, if you have a reasoanble grasp of the system. It is always difficult to give a precise answer to a query such as this because one has no sight of the original document but I will have a go....Verre (par verre et par an) 900%tc+This benefit is 900% of the "tarif de convention" per lens per year plus what the "sécu" contributes (very little in respect of routine optical).The tarif will depend on the lens but it is always very, very low. A common tarif for a lens is only 10.37 Euros and only 65% of this figure is reimbursed by the "sécu'. So even at 900% of the tarif you are not going to obtain a great deal.2Verres (limite a 14% pmss/an) 90%frWhat this means is 2 lenses but the benefit is limited to 14% of the "plafond mensuel de la sécurité sociale" (pmss). The "pmss" is currently 2476 Euros so 14% of that is around 177 Euros. Not sure what the 90% fr means in this context but if I actually saw the original document I would be able to work it out.I trust that you are not totally confused!RegardsPeter Owenpjowen@expathealthdirect.co.uk Link to comment Share on other sites More sharing options...
Teamedup Posted November 23, 2004 Author Share Posted November 23, 2004 Yes, I do understand what it means. Shows that last year we got a good reimbursement when it was limited at 14% then 90% where as the 900% is an awfully lot less. Always seems to me to be smoke and mirrors and very difficult for folks to work out how much they will really get reimbursed until they are perhaps sat there in the opticians and are told. Owen, you are lucky as you know how it all works. The company we use is reputable and I did quote exactly what was quoted on the Carte de Tiers Payant. Link to comment Share on other sites More sharing options...
CJJL<HR>Si jeunesse savait! Si vieillesse pouvait... Posted November 23, 2004 Share Posted November 23, 2004 "The other thing is that it is nigh on impossible for someone like me to get hold of all the ss tariffs. And those figures I mentioned, well, I had no idea of the implications of the changes. 90% or 900% with a 14% thrown in. And the implications worked out to be rather a lot of money.Do you really know what cover you have and what all these strange percentages mean."The following link is a good starting point:http://www.ameli.fr/229/RUB/229/omb_vitale.htmlJules Link to comment Share on other sites More sharing options...
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