Before taking out family supplementary health insurance, check whether your employer’s group policy already covers your spouse or children. Coverage for dependants is not mandatory, but the employer or the social partners may decide to cover them.
To prepare your comparison, identify the people covered, then ask about the benefits and contributions that apply to them. You can then assess possible family coverage based on your actual situation, rather than assuming that all your family members are already protected.
What employer-provided supplementary health insurance covers
In the private sector, employers must offer group supplementary health insurance to their employees, with some exceptions. An individual who employs someone to work at home is not subject to this requirement. Supplementary insurance adds to the reimbursement of an employee’s healthcare costs beyond the portion reimbursed by Social Security.
For family members, you need to examine the policy applicable at the company: it may provide coverage for them, but this is not generally required. Service Public gives the example of a mandatory family plan in which the spouse, civil partner and children must enrol on the same basis as the employee.
Start by distinguishing the employee’s coverage from that of each family member. Ask whether your spouse and each of your children are eligible under your employer’s plan, and then whether their enrolment is mandatory or optional. Have their actual status clarified before comparing another offer.
Questions to ask before comparing
Ask your employer or the administering organisation for the documents and details needed to answer these questions:
- Which members of my family are actually covered by the policy?
- Is their enrolment mandatory or optional?
- What benefits and contribution apply to each person covered?
- What steps must be taken and when does coverage take effect?
To make the answers useful, record the people covered, benefits and contributions separately. If an answer remains uncertain, ask for clarification before making an assumption in your comparison. Also remember to have the date on which each family member’s coverage takes effect confirmed.
Comparing benefits and cost
Mandatory group coverage must meet a minimum set of benefits. These include coverage of the daily hospital charge and of dental and optical costs under the conditions set out by Service Public.
Supplementary health insurance may also offer additional benefits, such as direct payment to providers, assistance services, or prevention and support initiatives.
For each person to be covered, compare the benefits of the employer’s policy with those of any potential family offer. Look at the areas that matter to your household, such as hospital care, dental and optical care, as well as the conditions and contributions stated in the documents. Ask for clarification when benefits are presented differently.
Use these answers to compare the benefits and cost of potential family coverage with your current situation. Requesting a simulation helps you prepare this comparison; check the conditions before taking out any policy. A simulation is used to examine a proposal: ask for confirmation of the terms if you subsequently decide to take out a policy.
If your spouse also has a group policy
An employee covered as a dependant under another mandatory group policy may request an exemption from enrolling in their own group policy, whether their coverage as a dependant is optional or mandatory. Ask the relevant employer about the steps to take before choosing this option.
Before making this choice, ask for the documents relating to the policies concerned and check each household member’s coverage. Compare the benefits and contributions applicable to your situation, then have the steps confirmed by the relevant employer.
If your employment situation changes
When an employment contract is suspended and the employee receives compensation from the employer or Social Security, coverage must be maintained. If the employee is not receiving compensation, they must contact their employer to find out whether the supplementary insurance is maintained.
To assess the consequences for family coverage, also ask for confirmation of the conditions applicable to family members. This general information does not replace an examination of your policy and your situation.
