Health supplements: who wins, who loses?

Survey – Presented as social progress, the reform of complementary health insurance could eventually lead to the establishment of multi-speed coverage.

A great social advance. It is in these terms that the government presents its reform of complementary health, which entered into force at the beginning of the year.

Two years later the National Interprofessional Agreement (ANI) which laid the foundations, the reform constitutes one of the main components of government policy, to improve the financial access of the French to healthcare.

Up to now, 4 million employees, mainly in very small businesses and SMEs (1), have not benefited from any company health coverage. The idea of ​​the reform was to reverse this trend, for the sake of equality between all assets in the private sector.

New complementary health contracts were therefore negotiated, branch by branch, and all the companies that did not have one were able to offer them to their employees.

However, if it started from a good feeling, the reform does not only have followers. Some fear in particular that it confers too much power on complementary, and that it leads to a form of two-tier medicine.

Who is the winner of the reform?

Among the four million employees who did not have complementary collective health, 400,000 employees did not have individual mutual insurance either. For the first time, they have access to additional protection. They therefore emerge as winners from this reform, especially since they share the cost of the mutual insurance scheme with their employer.

The complementary health organizations are also strengthened by the reform, since they gain new insureds.

Who is the loser?

Of the four million employees not previously protected by a company supplement, 3.6 million had already taken out an individual contract on a private basis. This will therefore now be transformed into a collective contract.

The contributions will be paid by the employer, up to a minimum of 50%, but in return a certain number of employees will see the quality of their contract deteriorate, especially if their company offers them a contract based on the basket. minimum care, defined by the ANI. This includes the basic guarantees that the company must, at a minimum, offer to its employees. Problem: it is considered not very protective by experts.

But as this contract is offered at a discounted price by complementary health organizations, it risks being offered to a large majority of employees. It is indeed a step backwards for those who benefited from quality individual contracts, much more protective. In particular, the ANI basket reimburses poorly for optical and specialist care, with a reimbursement rate of 100% of the reference rate for Health Insurance.

In addition, a price catch-up should take place on these basic contracts in the coming years, with a sharp increase in prices since they are currently not sustainable.

The reform is also addressed only to employees in the private sector. This means that the unemployed, civil servants and the self-employed are excluded. We are therefore far from generalization to all French people. Worse, they should even lose in the exchange. A majority of civil servants, for example, benefit from individual contracts. However, the price of the latter risks increasing to compensate for the broken prices of the contracts offered in companies.

At the same time, from January 2018, all mutual insurance contracts offered to employees must be “responsible” if the company wants to continue to benefit from attractive tax breaks. This involves introducing ceilings for the reimbursement of certain services, particularly in optics, and for excess fees. All employees will therefore see the amount of their reimbursements limited, for a certain number of treatments.

Special cases

Derogations are in theory possible for employees who do not wish to benefit from the reform.

This is the case for employees on “precarious” contracts, fixed-term contracts, part-time, or apprenticeship. For example, people on fixed-term contracts may not subscribe, if they can justify an individual contract offering the same type of guarantees.

Generally speaking, people who have recently signed an individual contract can keep it until it expires. They will eventually have to refer to that of their company.

Finally, people who are covered by their spouse’s mutual insurance company can also request an exemption.

In some cases, employers have not yet implemented the reform, often for lack of information. No sanction is foreseen against them, the only risk they run is that a disgruntled employee decides to attack them at the Prud’Hommes.

System flaws

To achieve a high level of protection, while they are only offered a basic contract, some employees will be encouraged to take additional supplements. However, these risk costing them dearly, even if here too, the company will have to participate in the costs up to 50%.

Fundamental problem, the system wanted to harmonize the situations between the employees, but ultimately risks to dig them a little more. Large companies will continue to offer quality contracts to their employees, while smaller structures, which often subscribe for the first time to a supplement, will have to offer a basic contract. Inequalities could appear between employees who can financially afford to afford an additional supplement, and others.

Beyond its basic dysfunctions, there is also the question of the relevance of the reform. Indeed, on average, the remainder payable by a French person is 200 euros per year. Taking a mutual for such a low financial risk is not necessarily interesting, in any case, not when you consume so little care.

Read the rest of our survey

Health supplements: a two-tier reform

Complementary #health : Who wins, who loses? Investigation of a 2-speed reform https://t.co/8ZZfGifvmU pic.twitter.com/prkOZHbIDd

– Pourquoidocteur (@Pourquoidocteur) January 17, 2016