Understanding the French healthcare system is crucial for employers, as there are certain legal obligations that they must fulfil. One such obligation is the provision of mandatory health insurance for their employees.
The French health system: an overview
Three years before the NHS was established in Britain, the Sécurité Sociale Française – a national health insurance system known colloquially as the “Sécu” – was created in 1945.
Adhering to principles of solidarity, universality, and fairness, the primary goal of the Sécu is to protect individuals from the consequences of situations referred to as “social risks”. These include the effects of disabilities, accidents, and work-related illnesses.
The Sécu is funded through social contributions and taxes, and membership is compulsory for everybody. The Unions de Recouvrement des cotisations de Sécurité Sociale et d’Allocations Familiales (URSSAF) collects social contributions and distributes around 500 billion euros every year.
So under the Sécu, health expenses are partially reimbursed and there is no discrimination by age or health status. While the patient is liable for the remainder of health costs not paid by the state, the principle of solidarity means that the sickest people usually pay less, thus protecting them from becoming financially disadvantaged.
French citizens enjoy universal access to healthcare.
The Caisse Primaire d’Assurance Maladie (CPAM) is an efficient locally-based funding system that acts as an intermediary between the patient and the Sécu.
There are around one hundred CPAM offices in France (a person’s place of residence determines which they are registered with), which process treatment forms and reimburse appropriate costs for over 60 million people, including employees, self-employed people, jobseekers, students, and retirees.
A mutuelle health insurance will then provide ‘top up’ cover for health costs not automatically reimbursed by the state.
Mutuelle health insurance is mandatory for salaried employees in France. Usually, the company’s Convention Collective will set out a minimum level of health cover that must be provided to all employees.
Since 2016, companies with at least one employee must contribute at least 50% of the cost of complementary health insurance offered under the company’s chosen mutuelle. There is a large number of mutuelles available, with differing levels of cover. In some cases, mutuelle cover may also extend to employees’ families and/or dependants.
What about prévoyance?
In addition to mutuelle cover, employers must offer prévoyance insurance to their executive employees, known as cadres (non-cadre employees may also be entitled to prévoyance, if a relevant collective agreement exists).
Prévoyance covers personal risk and must offer a death in service benefit at the very least. It may also cover temporary or permanent incapacity to work, and total or partial disability.
It should be noted that offering prévoyance insurance to all employees may be preferable for some employers, due to the legal compulsory payments that must be made in the event of an employee falling ill.
Health insurance obligations and legal minimum cover
The employer is responsible for negotiating and monitoring the mutuelle contract. Since mutuelle provision is mandatory, employees may not opt out unless they are already covered elsewhere (relevant proof must be provided every year), or are working on a fixed-term contract of under three months.
Minimum cover requires full payment of the ticket modérateur, which are the remaining expenses to be paid following CPAM reimbursement. Full daily hospital charges must also be covered, along with specific dental expenses (up to 125% of the conventional rate) and optical expenses based on a fixed amount per two-year period.
Do you have questions about mandatory health insurance in France?
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