We work with you to design appropriate health insurance plans and help you manage these policies over the long term. We do so with complete transparency and with the objective of helping you gain greater insight. The term complementary health insurance refers to a number of concepts that are specific to the French system. The sections below provide an overview of these concepts to help you understand them better.
Social Security: the main principles
The social security system is a mandatory system for all and covers a proportion of the health expenses of all French citizens.
Established by the French ordinances of October 1945, the system is based on a principle of national solidarity: everyone has the right to social protection. To this end, we must all contribute according to our resources and not according to our risk.
The majority of treatments reimbursed by the French social security system are determined by, among other things, a scale that you will often see on your benefit statements: the BRSS or Base de Remboursement de Sécurité Sociale (French Social Security Reimbursement Rate).
Your social security will generally reimburse a percentage of this BRSS. For an idea of the amount this corresponds to, you can consult the rates on Ameli.fr based on the treatment you will be receiving.
The remaining amount of the BRSS is called the TM or "Ticket Modérateur" (the patient’s contribution).
You can also contact us to help you understand your benefit package and to look at how it might be optimised.
However, all kinds of medical care will either not be reimbursed or will only be partially reimbursed, so there is a "remaining cost" for the employee which can be more or less significant. This is where complementary health insurance comes in !
Complementary health insurance
The aim of complementary health insurance is to reimburse health care expenses over and above those covered by social security and to minimise the "remaining costs" according to the level of cover. It can also cover expenses which are not covered by social security, such as osteopathy or non-reimbursed medication. This contract can be individual or group-based.
It is "collective" because its terms and conditions, agreed by the employer, apply to all or some of the company's employees and this is subject to certain rules.
The three complementary health insurance organisations in France
Depending on your circumstances, your social security policy within the company and your employee representatives/unions, we can help you choose an organisation that will meet your needs both from the point of view of the technical aspects of the complementary health insurance system and the social aspects of its risk carrier.
Work based on the principle of solidarity between their members. They also carry out welfare, solidarity and mutual aid activities for members.
These companies operate by covering risks in exchange for contributions. In order to make a profit, the sum of reimbursements to its policyholders cannot exceed the sum of contributions.
In France, provident institutions are governed by the Social Security Code and are partnerships under private law. The unique feature of these organisations is that they are managed by the employee representatives/unions of a particular sector or business.
Choosing the right insurer and manager involves identifying one who will be able to accommodate your priorities and the culture of your company and your employees.
Calling for tenders from insurance companies
We search for the insurer best suited to your needs among the three categories of complementary social protection insurers (companies - provident institutions - mutuals).
Our expertise in employment law and actuarial science and our ongoing monitoring of developments in insurance markets ensure that our tendering process is effective.
The role of a health manager is to manage the health benefits of the insured, with their main tasks being to provide information to your insured employees, manage reimbursement claims, process quotes, manage registrations and withdrawals of the insured and their families, etc.
As with insurance companies, we invite tenders from several managers in order to identify which one is the best match for your business and your employees as regards how it operates on a daily basis.
Our main partner managers