Which type of french top-up health insurance pays out the most?

You have probably heard a lot about _mutuelles_ in France, but these are not the only form of health cover. The costs and benefits of various top-up health insu­rance options have been

highlighted in a new report. Most people have some form of _complémentaire santé_ to ‘top-up’ health expenses that social security does not pay for. GP visits, for example, are only

70%-reimbursed by the state without one. Figures of around 95% are often cited for such coverage among people in France. However, a 2019_ baromètre_ report by the Fnim (a body representing

top-up providers), looking at the situation in the industry, stated that it had dropped to 90%, with low-income households and young people most affected. The latter was partly because

students are no longer required to have a top-up to claim basic healthcare coverage. READ MORE: HOW ARE YOU REIMBURSED FOR YOUR MEDICINES IN FRANCE? READ MORE: WHAT HELP IS THERE TOWARDS

TOP-UP HEALTHCARE INSURANCE IN FRANCE? THREE KINDS OF ‘TOP-UP’ PROVIDERS While such policies are often called mutuelles in everyday language, this is technically only one of three kinds of

provider of these policies. Strictly speaking, a _mutuelle_ is a non-profit organisation that is funded by, and belongs to, members. Then there are ordinary insurance companies, which seek

to earn a profit for shareholders. Finally, _institutions de prévoyance_ are another kind of non-profit, responsible for some workplace health schemes. People on low incomes might benefit

from free or subsidised top-up cover under a scheme called _complémentaire santé solidaire_. However, France has stopped allowing this for people whose main healthcare rights are paid for by

another country under the S1 scheme, including British and EU citizen retirees. READ MORE: LOW INCOME BUT REFUSED FREE FRENCH TOP-UP HEALTH INSURANCE? NEXT STEPS COLLECTIVE CONTRACTS APPEAR

TO GIVE BEST VALUE In 2021, institutions de prévoyance paid the highest percentage of premiums back out in the form of healthcare services (86%), according to a report from public

statistics body Drees. _Mutuelles_ paid out 81% and insurance companies 77%. This difference is partly due to the high number of collective workplace contracts, Drees said. Across all

providers, collective contracts appeared to give the best value, returning 86% of premiums in the form of services, compared to 74% for contracts taken out by individuals. This is probably

because companies, that are obliged to provide a subsidised top-up to employees, have greater ability to negotiate. _Institutions de prévoyance_ also have lower-than-average administrative

costs since collective contracts can be managed more efficiently. CHOOSING BETWEEN A MUTUELLE AND INSURANCE COMPANY Other than employees, individuals deciding which top-up to take will

usually be choosing between _mutuelles_ and insurance companies. Delphine Bardou, marketing director at insurance comparison website Réassurez-moi, said: “Contrary to what we might think,

[commercial] health insurance contracts are not more expensive than _mutuelle_ contracts.” Her advice is to “choose the level of guarantees provided in different areas (medicine, dentistry,

eye care) and compare the prices, without worrying too much about whether the provider is a non-profit or not. In the past, there might have been another advantage to a _mutuelle_:

traditionally, if the cost of claims during the year was lower than expected, a mutuelle would refund the difference to policyholders. Commercial insurance companies, meanwhile, would pay

part of the surplus to shareholders as profits, and part would go towards offsetting any future increases in claims. Recent law changes have led to an increase in reimbursements paid to

patients, meaning this is rarely relevant these days, Ms Bardou said. “_Mutuelles_ no longer reimburse the difference at the end of the year, because the claims are equivalent to the

premiums paid. “In fact, total reimbursements are often higher than premiums, so prices increase year on year.” PREMIUM INCREASES A study by consumer group UFC-Que Choisir found that, on

average, top-up prices rose by 7.1% between 2022 and 2023, equivalent to a median rise of €126 per year. Premiums rose 9% with insurance companies, 8.8% at_ institutions de prévoyance_, and

6.9% among mutuelles. Premiums have shot up 23% since 2019, twice as fast as inflation, the group said, adding that, in its view, most providers did not inform policyholders of price rises

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