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Mutual Insurance – Benefits, Coverage, and How to Apply

Without a health insurance plan, managing the cost of healthcare services can be challenging for individuals. Fortunately, the national health insurance system helps citizens cover a significant portion of these expenses. But there will still be certain out-of-the-pocket costs that individuals must bear, which, while seemingly small, can add up over time.

Mutual Insurance – Benefits, Coverage, and How to Apply
To address this concern and cover such unplanned expenses, applying for mutual health insurance, or “mutuelle,” can be advantageous.

Understanding mutual insurance
The state health insurance system, which is called “sécurité sociale” or “Protection universelle maladie (PUMA),” provides coverage to all citizens who have applied for it. It works on a reimbursement basis. This means that individuals are initially required to pay their complete healthcare bills and can later claim the covered costs from the state. This amount is reimbursed directly into their bank accounts. But, the state health insurance system does not cover 100% of the treatment costs. The amount of reimbursement an individual is eligible for depends on the type of treatment they receive. For instance, state health insurance only covers 60% of the cost of consulting a physiotherapist. So, individuals need to pay the remaining 40% of the costs from their savings. To avoid this, individuals can purchase a private health insurance policy called mutual insurance.

Mutual insurance is specially designed to cover the out-of-pocket healthcare expenses that the citizens bear. Individuals can either purchase a mutual insurance policy that solely covers their own expenses or a combined policy, which covers their family’s expenses as well. Mutual insurance policies also require individuals to pay a monthly premium, which can vary based on the type of coverage they choose. Besides private companies, individuals can also purchase state-funded mutual insurance, which is called complementary state health insurance (complémentaire santé solidaire).

Benefits of mutual insurance

  • Exemption from extra charges
    Firstly, if an individual has mutual insurance, they will not have to bear any additional expenses, including consultation charges and healthcare examinations.
  • Benefits of purchasing assistive devices
    Mutual insurance policies can also cover the costs of assistive healthcare devices, such as hearing aids, wheelchairs, glasses, dental implants, etc.
  • Flexible plans
    Mutual insurance policies also have flexible plans, meaning individuals can select a plan based on their requirements. Several companies also offer the flexibility of adding and removing coverage according to preferences. This ensures that individuals can manage their insurance costs more effectively by paying only for the necessary coverage.

How to apply for mutual insurance
Individuals must apply for the state health insurance policy before applying for mutual insurance.

Consider individual needs
Before applying for a mutual insurance policy, individuals first need to evaluate their exact needs. They need to check the healthcare expenses they frequently have to bear and where they can benefit from having a cover. One must also consider if they have any additional requirements besides basic healthcare needs. This can include frequent visits to the dentist, eye specialists, physiotherapists, etc., and the need for healthcare assistance devices. Based on these factors, one can select the right plan offering the required coverage.

Look into the specific policies
Most insurance companies offer mutual insurance policies tailored to specific groups of individuals. For instance, many companies offer policies designed especially for seniors. Several organizations also offer policies for high-risk professionals, such as construction workers.

Compare different providers
When looking for immediate online mutual insurance policies, it is also advisable to compare the plans from different providers. This will allow one to choose a plan with good coverage but low monthly premiums. Besides that, one must also read customer reviews about the providers they are considering. Feedback from customers provides honest and key insights about the organization. Through reviews, one can determine whether the provider offers easy reimbursements. When going through reviews, one must also look for testimonials that discuss the provider’s customer service and complaint resolutions. If unsure, one must consider the top insurance companies.

  • Harmonie Mutuelle
  • Allianz
  • AXA
  • APRIL

Choose the percentage of cover
One of the most important things to understand about cheap online mutual insurance policies is that they offer different plans based on the percentage of coverage one needs. Usually, most mutual insurance companies offer policies with either 100%, 150%, or 200% coverage. Some may offer even more varied coverage options. The reason these amounts start from 100% and go higher is because of the way that healthcare practitioners charge in the country. The state sets a base rate that all healthcare practitioners must charge, but not all professionals often agree to this rate.

For instance, suppose the state has set the base rate at €100 for a certain consultation. But the doctor may be charging €130. And, suppose the state insurance policy covers 70% of this particular healthcare cost. Now, one may think that this 70% actually covers 70% of €130. But that is not the case. The 70% coverage offered by the state insurance policy is only for the state-set rate, which is €100. So the state will reimburse €70 (70% of €100), while the remaining €60 (€130-70) will be paid by the individual. If the individual now purchases a mutual policy with 100% coverage, they will receive reimbursement for €30 from this €60. But with 200% coverage, they will be exempted from paying the entire amount.

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