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To review a treatment quote before committing, gather the quote and the benefits under the relevant policy, then ask the supplementary insurer for an estimate for the proposed services. Specify what you want to understand: the share covered by Assurance maladie, the share covered by supplementary insurance and the amount you might have to pay yourself. An estimate helps you prepare your decision; it does not, on its own, constitute the final reimbursement.
Supplementary health insurance can cover all or part of the amount not reimbursed by Assurance maladie. The level and nature of supplementary health insurance benefits vary between policies. It is therefore useful to have the quote reviewed against your own policy rather than relying on a benefit presented in isolation.
What documents and information should you prepare?
Start with the treatment quote you want reviewed. Send it along with the information your insurer needs to locate the relevant policy and understand your request. If you are comparing several policies, clearly indicate the one for which you are requesting an estimate; keep a copy of each request and response so you can compare them later.
Attach or keep the health benefits table and policy terms at hand, if you have them. Find the section that appears to correspond to the proposed treatment and point it out to the insurer. If you are unsure which section applies, ask the insurer to specify it in its response rather than choosing a line yourself based solely on its heading.
Here is a simple outline for preparing your message:
- the relevant quote and the treatment for which you want an estimate;
- the policy or plan you want reviewed;
- the section of the benefits table you have found, if you have identified one;
- a request for a breakdown of the share covered by Assurance maladie, the share covered by supplementary insurance and the estimated out-of-pocket cost;
- a question about whether additional information or documents are needed to respond.
To make your request, you could write: “Could you review this quote against the indicated policy and specify the applicable benefit, the estimated reimbursements and the amount I might have to pay myself? Please also tell me what information is missing to assess my request.” Adapt this text to your situation and keep the response with the quote to which it relates.
How should you interpret the benefit associated with the quote?
The amount reimbursed by your supplementary health insurer may be expressed as a percentage of the reimbursement base or in euros. Before comparing figures, check what the stated benefit refers to. A percentage and an amount in euros are not necessarily interpreted in the same way.
Service Public gives an example of a benefit expressed as a percentage of the agreed tariff, including Assurance maladie: the amount then describes the total reimbursement that can be reached by Assurance maladie and the supplementary insurer. In its example of a benefit expressed in euros, the amount shown corresponds to the maximum paid by the supplementary insurer in addition to any amount reimbursed by Assurance maladie.
Ask your insurer how the line used for your quote should be interpreted. Ask it to specify the amounts used and how they fit together, rather than directly subtracting the figure shown in the table from the quoted amount. If the response groups several services together, ask for a breakdown that identifies the items reviewed.
What points should you ask the insurer to clarify in its response?
A useful response should allow you to link the estimate to the quote and policy you submitted. In particular, you can ask:
- which policy benefit was applied to the proposed treatment;
- what share of the estimate corresponds to Assurance maladie and what share corresponds to supplementary insurance;
- what amount you might have to pay yourself and how it was calculated;
- which items in the quote were taken into account and whether further details are needed;
- to what extent the estimate depends on the information provided.
This distinction is important: the supplementary insurer reimburses costs remaining at your expense according to the policy chosen. Some policies also provide full or partial reimbursement for services not reimbursed by Sécurité sociale. For a service of this kind, expressly ask whether the benefit reviewed covers it and how the estimate was calculated.
Compare without confusing an estimate with enrollment
If you are considering several offers, use the same quote to request a comparable assessment of each plan. Organize the responses by policy and note the benefit used, the stated shares and the estimated out-of-pocket cost for each one. When a response lacks detail, ask for clarification before comparing it with the others.
An estimate helps inform your choice; taking out a policy is a separate process. Before making any decision, reread the documents for the relevant offer and ask the insurer to clarify any points that remain uncertain. This guide provides general information: it does not replace a review of your quote and policy by the appropriate insurer.