Health InsuranceJanuary 1st is the usual date when renewals for complementary health insurance policies become due (the correct term is “organismes complémentaires”). Premiums have increased. This is likely to be a continuing pattern so the choice of provider will become a more important factor in healthcare planning. Unfortunately for the individual the odds of obtaining a contract most appropriate to their needs are not good. There are various reasons for this.

Firstly, there is a bewildering array of providers – well over a thousand. Some will not be available to the general public as they cover a specific category of workers but nevertheless the choice is huge. Secondly, each provider may have a number of plans in their stable and detecting where the real value lies is problematical since you may not have a good handle on health costs in France. When surveys have been conducted by independent outfits such as IRDES they make sober reading.

As a guide a third of the population have below average, a third average and a third above average levels of cover. The criteria used were a touch subjective but it is reasonable indicator. There are two ways of reading this of course eg; therefore two thirds have average or above. However, such a survey includes those who have a provider via their employment and such contracts consistently offer better overall value than an individual contract. Again there are various reasons for this. A couple of years ago the insurance industry itself concluded that over 60% of individual contracts were below average. Why is this?

Aside from the huge range of providers there is the problem of obtaining impartial advice. An independent insurance broker can be of help but even he or she will, for very practical reasons, only deal with a few providers. It is much better to try and arm yourself with as much knowledge as possible and then instruct the broker what you want. Transparency.

Although the health insurance industry is well regulated in France it is not necessarily transparent. Providers use various criteria to assess premiums but not all providers use the same ones. Examples of criteria applied are:

  • Age
  • State of health
  • Sex
  • Place of residence
  • Profession

And these criteria are further sub-divided. For example, state of health may only be a factor in plans offering the top levels of cover of a provider. Evaluating plans – contrasting premiums with level of cover offered. This is the most difficult task of all in both choosing a provider and the correct plan within that stable. Obviously premiums will be higher for a greater level of cover.

But does it therefore mean that the highest level of cover offered presents the best value? Not necessarily at all. Let us take a provider which offers several plans offering a broad range of benefits from hospitalisation to prescribed medicines, visits to doctors/specialists, ambulances through to dental and optical cover. Such a plan will offer the highest level of hospital cover, say 500% of the “Tarif de Convention” (TC) for hospital fees and the highest level within the stable for dental and optical.

The real attrition to the underwriters’ book will be on such things as dental where the insurer may pay out to the plan’s maximum (the percentage covered by the CPAM of the real costs of a crown, for example, is quite low). On the other hand, the insurer may not pay out 500% of the TC for a hospital stay. The reason for this is that the loss adjuster will negotiate the fees of the surgeon and may only pay out 200% of the TC. Of course if the surgeon does insist on a “dépassement” of 500% then the insurer will be obliged to pay.

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