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Complimentary - Top Up Insurance

Monday, 08 October 2007

Complimentary Plans

If you are in the fortunate position of being an expat permanently resident in France and legally integrated into the French Health system, then you should consider the advantages of taking out a competitively priced complimentary ‘top up’ insurance, or, as it is often referred to, a ‘Mutuelle’ or ‘complimentaire santé’.

Our preferred provider offers a wide range of plans that are designed to provide a suitable level of cover whatever your specific requirements. All of these plans are fully compliant with French legislation and offer generous benefits at a competitively priced premium.

In accordance with all French ‘top up’ plans, each of the following plans provides a level of cover relative to the Tarif de Convention.

The following plans cover pre-existing and chronic medical conditions.

The Bronze 100 Plan:

This plan provides for hospitalisation only cover. The level of cover is limited to 100% of the Tarif de Convention. It does not provide any cover for out-patient treatment. It is the basic level of cover that you should consider, realistically, only if you are on an extremely tight budget.

The Bronze 300 Plan:

This is a plan specifically to cater for those who are looking to cover only hospitalisation benefit. It has a generous limit of 300% of the Tarif de Convention. It is therefore best described as a ‘sleep in peace and security’ hospitalisation plan. It does not provide any cover for out-patient treatment.

The Argent 100 Plan:

This plan provides cover for both hospital treatment and outpatient treatment (including routine visits to your doctor or specialist, prescribed medicines, laboratory costs, x-rays and a lot more) up to 100% of the Tarif de Convention (official price list). Dental cover up to €150 per person insured per period of insurance is also included.

The Argent 150 Plan:

A very popular plan, it provides a higher level of cover than the Argent 100 Plan for both hospital treatment and outpatient treatment (including routine visits to your doctor or specialist, prescribed medicines, laboratory costs, x-rays and a lot more) up to 150% of the Tarif de Convention (official price list). Dental cover up to €250 per person insured per period of insurance is also included.

The Argent 300 Plan:

This is a higher level plan which provides almost as much cover as you are generally likely to need for both hospital and outpatient treatment (including routine visits to your doctor or specialist, prescribed medicines, laboratory costs, x-rays and a lot more) up to 300% of the Tarif de Convention (official price list). Dental cover up to €350 per person insured per period of insurance is also included.

The Argent 500 Plan:

This is the ‘top of the range’ plan, offering cover for up to 500% of the Tarif de Convention. Again, it provides high level cover for both hospital and outpatient treatment (including routine visits to your doctor or specialist, prescribed medicines, laboratory costs, x-rays and a lot more). Dental cover up to €500 per person per period of insurance is also included.

All of the Argent plans come with a free (Tiers Payant) Santé Pharma (Mutuelle) Card to facilitate direct payment via the French tele-transmission payment service.

Click Here for a PDF version of the Exclusive Healthcare Claims Process

How to Claim on your Argent Plan

	Carte Vitale	Tiers Payant	No Need to Pay	Pay and get your money back automatically	Pay and Claim
Doctor, Dentist, Specialist		-	-		-
Doctor, Dentist, Specialist (if they have no card reader)	-	-	-	-	1
Doctor, Dentist, specialist (If you do not have a Carte Vitale)	-	-	-	-	1
Doctor (Locum in place of your normal doctor)	-	-	-	-	1
Pharmacy (Prescription drugs)				-	-
Pharmacy (Appliances)		-	-	-	2
Nurse (Home visit) (if the nurse has a card reader)	3	-	-		-
Laboratory and Radiology Centres (if in the full computer system)				-	-
Laboratory and Radiology Centres (if not in the full computer system)		-	-	-	1
Hospital (Day Patient or emergency)		-	5	-	-
Hospital (in-patient)	6			-	-

Notes on CLAIMS PROCEDURE:

1. The doctors, Specialists, treating establishments such as Laboratories, Radio Centres etc., will give you a feuille de soins. Where you have been given a prescription, take it and the feuille de soins to the pharmacy for the medicines, not forgetting to stick the little peel off labels on the boxes, in the appropriate places on the form. Then complete the form and send it together with the duplicate of the prescription to your CPAM branch, which will reimburse you according to the official ‘tarif de convention’. If you are registered into the tele-transmission system ASCORE will receive information from CPAM and will reimburse you according to your Policy Terms and Conditions. If you are not registered into the tele-transmission system, when you receive your statement from CPAM post the original to ASCORE for reimbursement.

2. Wait for the CPAM statement and then send it (the original) and the bill to ASCORE so they can decide if the appliance qualifies for payment.

3. The French government requires all nurses to have a card reader in 2007. This will probably be progressive through 2007. If your nurse has a card reader and your Carte Vitale is used, reimbursement by CPAM and ASCORE will be automatic.

4. If the nurse gives you a feuille de soins, complete the form and send it, together with the duplicate of the doctor’s prescription, to your CPAM branch, which will reimburse you. ASCORE will receive information from CPAM and will reimburse you also. If you are not registered into the tele-transmission system ask for a receipted bill and send it to ASCORE for reimbursement. It is no longer necessary to wait for and send CPAM’s statement.

5. If you are asked to pay a part of the bill make sure you obtain an official invoice (avis
de sommes à payer) and a receipt (attestation de paiement) for the payment you have made. Sometimes you are given the invoice at the time of payment and the receipt follows by post. Both bills and receipts should be sent to ASCORE for reimbursement.

6. You may need the Attestation de droits à l’Assurance Maladie from CPAM as well.
The Hospital will usually contact ASCORE for a Bon de Prise en charge (guarantee to pay your share of the bill directly). A few Hospitals are not familiar with the Tiers Payant system and you may have to send ASCORE information yourselves or through us. In such a case you should follow the items on “Hospital Admissions”. The Fax number of the Hospital is particularly important. You may be asked to pay some extras, called dépassements yourselves. These are amounts above the official price for treatment that may be charged by surgeons and anaesthetists. EXCLUSIVE HEALTHCARE covers these up to the level defined in your Policy Terms and Conditions. You should pay yourself and must obtain a receipted bill (AMC) to send to ASCORE for reimbursement. Make sure that the dépassements are shown on the hospital bill (AMC or S3404).

Normally, there is no need to pay except for personal items such as telephone calls,
television, and news papers.

IMPORTANT

If you go to a pharmacy, laboratory or Radio Centre and you are required to pay your part of the cost (ticket moderateur) you should ask for a receipted bill and send it to ASCORE for reimbursement. This shows that your SP Santé card has not been used on this occasion and the refund should be made directly to you.

Click Here for a PDF version of the Exclusive Healthcare Claims Process

Last Updated ( Tuesday, 08 June 2010 )