Very expensive mutual (especially in retirement): what to check before changing the contract

Like all insurance contracts, a mutual is automatically renewed each year “by tacit agreement”. In other words, as long as you don’t renegotiate it, it continues. But is it still right for you? Especially when you change your situation, for example retirement.

It is one of the contracts that has the most consequences in the event of an accident in life and yet it is the one that we know the least about in detail, while it weighs heavily on our finances.

Changing contracts every three years saves an average of 20% on your premium”, estimated in December 2020 Julien Fillaud, general manager of the comparator Hyperassur, in the newspaper The world. A mutual health insurance contains several clauses whose role is to detail the different coverage, provided in addition to reimbursements from Social Security. Here is what you can renegotiate if the conditions no longer satisfy you.

– The waiting periods before a treatment works or works again during the year. Example: the reimbursement of glasses or cures. Once a year may be enough if that reduces your annual membership fee.

– Reimbursement levels: 100% or 150% of the TM (moderator ticket) that is to say the rest to be paid for by you; or 200% of the TC (conventional rate), also called BR or BRSS, basis for reimbursement by Social Security. The lower the support, the cheaper the contribution must be.

– Exclusions of guarantees: certain treatments are excluded from health insurance such as thalassotherapy, cosmetic surgery, detoxification cures, certain alternative medicines. If your mutual insurance company offers to reimburse them, such as homeopathy, osteopathy or help with quitting smoking, the contribution is necessarily higher. But is it useful for you?

Beware of trade-offs! Because if you plan to no longer provide certain treatments, you will have to pay for them out of your own pocket. However, medicine is expensive and Social Security does not reimburse everything, far from it.

The minimum coverage of mutuals

Today, nearly 95% of mutuals are said to be “responsible”, that is to say that they do not set the amount of their contributions according to the state of health of the insured and that they provide minimum coverage.

Support for the entire co-payment on consultations with the general practitioner and specialist doctors, medicines reimbursed up to 65% by National Health Insurance and laboratory analyses.

Coverage of the entire daily hospital charge, without time limit in all health establishments (hospital, clinic, psychiatric establishment), except medico-social establishments such as nursing homes.

Reimbursement of dental expenses (prostheses and orthodontics) up to 125% of the conventional rate set by Health Insurance.

100% reimbursement of a selection of glasses respecting a limited sale price, per period of two years or each year in the event of a change in sight, with a minimum charge set at €100 for a simple correction.

List your needs, adapt your contract

If you want to renegotiate your mutual to lower its price a little, first try to clarify your health insurance needs for the next few months or the next year.

For example: you tend to have good eyesight and/or good teeth, no need for reinforced care, the minimum should be enough for you. You don’t like alternative medicine and your health insurance reimburses it. You can negotiate to remove this support in favor of another that you may need, such as cures.

You decide to change health insurance

If you have attempted a renegotiation without much result, you may need to consider changing mutual insurance.

To do this, use an online comparator and ask for quotes. The procedure is recalled on your notice of expiry: it specifies the date on which you must request termination, generally this is the anniversary date of your subscription or the first of another month.

– If the expiry notice arrives less than fifteen days before this date or after, you have twenty days to cancel your mutual insurance by registered letter with acknowledgment of receipt.

– If you do not receive a notice of expiry, you can cancel at any time and the cancellation will take effect the next day.

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