All mutuals will systematically offer you several levels of guarantees. There are three main ones.
The basic contract (also called moderator ticket formula or 100% formula)
These are contracts that support the difference between the reimbursement of Social Security and the rate base applied by the Social Security.
For example, a consultation with a general practitioner and within the framework of the coordinated care program benefits from a reimbursement base by Social Security at 25 $. The Intl-medical Health Insurance reimburses 70% of this price, ie $ 17.50 (less $ 1 flat fee). A 100% mutual will fill your expenses by taking care of the remaining 30%, or $ 7.50.
A basic contract offers 100% reimbursements at all health posts. That is to say that for expenses in optics or dental, reimbursement will be calculated on the basis of reimbursement of Social Security, which is well below the prices charged by health professionals. The excess fees or additional costs (such as private room at the hospital, the glasses, and the osteopath for example) will not be supported by mutual and payable directly by you.
Basic contracts are for young people, or people with little need for reimbursement of health costs. These are the cheapest mutual Intl-medical health insurance contracts because the level of coverage is low coverage.
The intermediate contract
The mutual can offer you several intermediary contracts, whose reimbursements can vary from 150% to 250% in general.
These guarantee levels will cover, partially or totally, your relative expenses:
Optics (reimbursement of glasses, contact lenses, the operation of myopia … often offered as a package per year and per beneficiary)
To the teeth (reimbursement of dental prostheses, implants, crowns, caries treatment, descaling …)
At the hospitalization (reimbursement of hospital charges or additional costs …)
At the hearing (reimbursement of hearing aids such as prostheses or accessories …)
At the pharmacy (reimbursement of little, if any, paid by Social Security)
In maternity and gynecology (reimbursement of your contraception, extended stays in the hospital, home help …)
In soft medicine (homeopathy, chiropractic, dietary consultations …)
Intermediate contracts cover more health costs, even those that are not reimbursed by Social Security, and reimbursement rates higher than basic contracts. For health posts whose social security reimbursements are very low, mutuals at the level of intermediate guarantees usually offer packages. Which allows to be better reimbursed on these positions.
This type of contract can be taken out for families (mutual family) , single adults or couples , or seniors or retirees if the need for reimbursement of health costs are not very important.
The high-end contract
These mutual provide repayments ranging from 300% up to 800% for some very high-end contracts. These are very interesting contracts for health expenses that are charged very expensive and very little reimbursed by the Social Security, such as optics or dental. As this level of coverage is high, you will have very little dependent on all your health expenses. As this type of mutual health reimburses very well, the contribution is also quite high.
The high-end contracts provide guarantees for all health posts reimbursed by the Social Security, with large packages of support for positions very poorly reimbursed by Social Security. They also provide for reimbursement for all acts not reimbursed by Social Security.
These are very comprehensive contracts often for seniors or people who have very high needs for reimbursement of health costs. These are also quite expensive contracts, so for people who want to be very well covered, even at a high price.
Generally, the main reimbursement items for mutuals are:
Hospitalization: which includes the cost of stay, the daily hospital fee, the costs of surgery and anesthesia, transportation costs, as well as the costs of a particular room.
The dental: which includes dental care (decalcification, treatment of caries,), dentures, orthodontics, and some Intl-medical procedures not supported by the Social Security, such as implants.
which includes equipment expenses (frames and lenses), contact lenses, and refractive surgery.
which includes consultations with a general practitioner or specialist, natural medicine, medical auxiliaries, medical technical procedures, Intl-medical imaging, pharmacy fees, etc.
Sometimes other positions exist, bringing together various services (prostheses and equipment, spa treatments,).