When scheduling an appointment with a doctor, you may wonder about the difference between non-contracted physicians and those contracted under sector 1 or sector 2. Let’s focus on the concept of a sector 2 contracted physician to better understand how it works in France.
The medical industry, with its complex set of constantly evolving regulations, can sometimes seem bewildering. One of the recurring topics in the health sector, which has a direct impact on the cost of consultations for patients, concerns the choice of the health professional’s contracting sector. There are three contracting sectors, ranging from sector 1 to 3.
This article will help you understand the concept of “contracted sector 2” and the implications it carries.
What is sector 2 in the medical industry?
When we speak of “sector 2,” it refers to a formal agreement between Social Security and certain physicians. This agreement grants them the freedom to set their fees, and thus to charge a higher consultation price than the standard price set by Socia Security for sector 1. Moreover, Social Security coverage is based on the sector 1 standard rate, not sector 2. The difference between the higher price charged by the practitioner and the standard price of sector 1 is called an “extra fee” and can vary from a few euros to several hundred euros.
What are the actual prices of sector 2?
To better understand the concept of “contracted sector 2,” let’s consider a numerical example. For instance, if we take a general practitioner from sector 2 who sets a consultation fee of 80€, while the standard sector 1 price, set by Social Security, is 25€ for such a service, the practitioner’s extra fee is 55 euros. The patient will receive a reimbursement based on the Social Security’s share based on the standard sector 1 price of 25€, which is 70% of 25€, minus a 1 euro deductible, therefore 20€. The remaining difference (60 euros) is the patient’s out of pocket, unless they have appropriate supplementary medical coverage also called “mutuelle”. This is why it is strongly advised, and even mandatory for employees, to take out additional medical insurance.
How can I tell if my doctor is of sector 2?
Sector 2 is not accessible to all doctors. It requires obtaining a right to opt by the CNAM and meeting specific criteria established by Social Security, which are as follows:
- Declaration to the Medical Association: physicians must inform the Medical Association of their choice to practice in sector 2.
- Respect for standard rates: although sector 2 allows physicians to set higher fees than those of sector 1, they must adhere to a certain ceiling, called the authority rate, negotiated between the physicians’ representatives and Social Security.
- Information on fees: sector 2 physicians must be transparent; on their website, on the “Doctolib” appointment booking website, within the clinic, etc; about the rates they charge and any potential extra fees
To avoid any surprises, we recommend consulting the Social Security directory where you can search for your healthcare professional and check their profile: http://annuairesante.ameli.fr/. This website allows you to know the doctor’s status (contracted or not) and their fees.
If you are an employer and wish to offer your employees the best medical coverage, thus avoiding a significant out-of-pocket expense, or if you are self-employed and want to benefit from adequate insurance, contact us! Our team will be happy to answer your questions, and all quote requests are free and non-binding. You can contact us at the following email address: contact@mia-assurances.com or by phone at +33 1 70 91 25 65.