Why choose a health insurance top-up plan? | MIA Assurances

When it comes to choosing a company healthcare plan for your employees, you’ll hear talk of state-approved, “responsible” plans, healthcare baskets, and care pathways. To fully understand what these terms mean and to find out if you need to take out a supplementary insurance plan for your employees, here is an overview of how healthcare works in France.

Compulsory group supplementary health insurance

Since 2016, employers in the private sector had been obliged to provide basic supplementary health insurance to their employees with the entry into force of the National Interprofessional Agreement, commonly known as the “ANI”.

This supplementary insurance must be provided to all your employees, and will be funded at at least 50% by the employer. The basic supplementary insurance plan will provide a first level of reimbursement in addition to French Social Security benefits.

To benefit from existing tax advantages, your basic plan will have to be state-approved or “responsible”, meaning it will have to cover a minimum basket of benefits, and set caps on its reimbursement of excess fees to avoid medical inflation.

The top-up health insurance plan to avoid out-of-pocket expenses

Depending on the package you choose for your basic health insurance plan, it may be necessary to offer your employees an additional top-up plan. This is because the basic supplementary plan doesn’t always provide your employees with a good level of reimbursement, especially if they live in towns or cities where the cost of living is fairly high.

The top-up plan is different from your basic plan. It can be state-approved or not, and can be offered:

  • On an optional basis: only your employees who so wish take out the second plan and pay the premium themselves,
  • On a compulsory basis: the second plan is taken out collectively by the company and funded jointly by the employee and the employer.

In what cases should you take out top-up health insurance?

Some medical services are particularly expensive in France. If your employees consult practitioners who charge excess fees, it is possible that, depending on the level of coverage chosen, your basic health insurance plan will not be sufficient. In this case, offering a top-up plan to your teams will guarantee them a good level of reimbursement.

The items to monitor closely include:

    • Dental costs: dentures, crowns, inlays, implants, and orthodontics.
    • Vision costs: frames, lenses, and contact lenses.
    • Consultations with general practitioners and specialists.
    • Imaging procedures: radiology and ultrasound.
    • Private room in case of hospitalization.
    • Alternative medicine: chiropodists, pedicurists, psychomotor therapists, homeopaths, naturopaths, smoking cessation specialists, psychologists, psychotherapists, shiatsu, reflexologists, phytotherapists, sexologists, sophrologists, hypnotherapists, occupational therapists, etc.