In this article
To understand a supplementary health insurance reimbursement expressed as a percentage, first identify the rate to which it applies and check whether French statutory health insurance is included. A fixed amount in euros under supplementary health insurance is read as an amount stated in the benefit. Before combining these figures, ask the insurer how they apply to the care concerned.
Supplementary health insurance may cover all or part of the amount left after reimbursement by French statutory health insurance, depending on the policy chosen. The level and nature of benefits vary between policies. Reading the benefits table therefore helps you understand the cover offered for each expense, rather than comparing figures in isolation.
The percentage: a reference to the reimbursement base
The reimbursement base is the rate used to calculate reimbursement for a medical procedure by French statutory health insurance. It is also called the reference rate.
In the example presented by Service Public, cover at 150 % of the convention rate, including French statutory health insurance, means that total reimbursement can reach 50 % more than that rate. The wording “including French statutory health insurance” is essential to interpreting this example: it indicates that the possible total includes both the statutory health insurance reimbursement and the supplementary insurer’s reimbursement.
To read your own table, look for the reference associated with the percentage and the clarification about the role of French statutory health insurance. If the wording seems ambiguous, ask the insurer to explain the amount corresponding to the benefit you are interested in.
The fixed amount in euros: an amount to read separately
In the Service Public example, a benefit of up to 200 € means that the supplementary insurer reimburses a maximum of 200 €, in addition to any amount reimbursed by French statutory health insurance.
This wording differs from the percentage example: one refers to a maximum amount from the supplementary insurer, while the other refers to a possible total reimbursement relative to a reference rate. To compare benefits, therefore, note their units and the role of statutory health insurance reimbursement separately.
If your table contains a percentage and a fixed amount in euros for the same benefit, ask how they work together before adding them. Also ask what amount the supplementary insurer could cover for your expense: you can then compare the answer with the wording of the policy.
How can you compare benefits tables?
- Find the care or benefit relevant to you in each table so that you can compare the corresponding cover.
- For a percentage, look for the reference rate and check whether French statutory health insurance is included in the stated amount.
- For an amount in euros, look at what the benefit says about the sum reimbursed by the supplementary insurer and how it works with French statutory health insurance.
- If the wording differs or several figures appear for a benefit, ask each insurer for an explanation before comparing the results.
Some policies may also reimburse all or part of the cost of services not reimbursed by French Social Security, such as osteopathy or certain vaccines. For these services, look for the applicable benefit in the policy you are examining.
A reimbursement example in context
Service Public presents the case of a consultation with a sector 1 general practitioner, billed at 30 €. After deduction of the fixed patient contribution of 2 €, French statutory health insurance reimburses 19 €. In this example, a responsible supplementary policy covers 9 €, or 30 % of 30 €, leaving 2 € to be paid by the patient.
This example applies to a responsible policy and the situation described. For your own expense, review the relevant benefit and ask your insurer for an estimate. The estimate can help you understand the amounts before choosing; this general information is neither personalized advice nor an enrollment.
Prepare an easy-to-review comparison
Keep one line per benefit in your notes: the name of the care, the reference for the percentage, the amount in euros and clarification about statutory health insurance reimbursement. Also copy down the conditions accompanying the benefit, then have any ambiguous points confirmed. This item-by-item review will help you explain your needs when speaking with your adviser.
You can then compare supplementary health insurance policies in France, consulting the official table for each plan. Find the examples used here in the Service Public supplementary health cover guide.