Understanding French healthcare is challenging, especially for expatriates. A common misconception is that the state healthcare coverage, accessed via the “carte vitale,” is all-encompassing, leaving no need for additional insurance. However, that opinion is shared by only 5% of French people! 95% of French nationals opt for a “mutuelle”, a complementary or “top-up” private health insurance. While French Social Security provides substantial coverage, it does not cover medical costs at 100%, often leaving individuals with significant out-of-pocket expenses. That’s where a “mutuelle” or “top-up” plan comes in.
What is the “Carte Vitale”?
The “Carte Vitale” is designed to help French residents easily access healthcare services and minimize paperwork. It’s a smart card that contains the holder’s administrative details. This card is your passport to the French healthcare system, known as “l’Assurance Maladie”. It offers partial coverage for a range of medical services. However, some procedures must be paid either fully or partially “out-of-pocket”. “Mutuelle” insurance is designed to cover these remaining costs.What are “Mutuelles” and “Top-Ups” – and do you really need one?
A “mutuelle” or “top-up” is a supplemental health insurance in France that improves the coverage provided by Social Security. It insures an additional portion of medical expenses, up to 100% of actual costs (depending on the policy terms). This is especially useful for dental, optical, and specialist care – which are often expensive and only partially reimbursed by the state. Mutuelles are also very useful for reducing out-of-pocket costs for hospitalizations. Among French people, it would be unthinkable to go without a mutuelle. For the 5% who do not have one, financial difficulties are the most commonly cited reason for abstaining – in brief, it’s not really their choice.What’s the difference between a “Mutuelle” and a “Top-up”?
A top-up insurance in France is theoretically very similar to a mutuelle. The difference is in the implementation. A French “mutuelle” is linked with your Carte Vitale. You do not need to submit your claims by hand – it’s done automatically in most cases. Reimbursement rates are linked to a percentage of the “standard cost”. Mutuelles are managed in French. In contrast, a “top-up” plan is not automatically linked to your carte vitale. You would need to request claims online. The plan would be managed in English with Mondassur. Reimbursements are not linked to a percentage of the “standard cost” – rather, they are linked to set limits and sub-limits, in some cases going up to 100% of actual costs. As such, our “top up” plans provide more comprehensive coverage than a mutuelle.How to understand your quote (“Devis”) for a “Mutuelle”
Understanding your “mutuelle” quote can be a little tricky, as they are based on the “standard costs” established by French social security. When you see “100% reimbursement” on the brochure or in the terms and conditions, it means it covers 100% of the “standard cost” set by Social Security, not the entire bill. If it says “200% reimbursement,” it pays double the Social Security rate, covering more of your expenses, especially when Social Security reimburses very little. Dental expenses are a good example to illustrate how this works, as they are expensive and poorly reimbursed by French social security. In the table below, we’ll show how the different reimbursement percentages translate into real life, taking the example of a dental crown.| Reimbursement | 100% | 200% | 400% |
|---|---|---|---|
| Crown price | 500 € | ||
| « Base rate » / « standard cost » determined by French Social security | 120 € | ||
| Social security reimbursement (70%) | 84 € | ||
| Social security reimbursement + Mutual insurance reimbursement | 120 € | 240 € | 480 € |
| Out-of-pocket expenses | 380 € | 260 € | 20 € |
