The Insurance takes charge of all or part of the medical expenses incurred by my health problems. That repays me my mutual Cocoon ? That means a refund of 100 %, 150 %, 200 % of the SSRB ? What are the the best reimbursed ? The less well reimbursed ?
Understand the returns of my mutual, not so simple. Here are the essential points to be taken into account to fully understand your contract.
The role of my coverage supplementary health Cocoon
The mutual health Cocoon allows you to be reimbursed for part or all of my health expenses that are not covered by social Security. But at what height ?
Between the fare actually paid by the insured and the reimbursement of the Insurance, there is a difference called ticket modérateur. The mutual health Cocoon takes charge of all or part of the copayment, depending on the types of health care expenditures. It also supports other costs that are not reimbursed by social Security. This is the case of the daily hospital charge, of drugs such as certain vaccines, or contraceptives. Reimbursements are expressed in rates, depending on the type of act and on the basis of the price conventional. The mutual shall not refund the participation fee of € 1 applies to the consultations.
The repayments of my coverage supplementary health Cocoon : the 100% refund
A refund of 100 % means that the entire co-payment is refunded. How to calculate the reimbursement mutual ?
For example, for a consultation with a general practitioner respecting the tariff of convention – that is to say, they do not practice excessive fee – the insured will be reimbursed up to 22 € (23€ less 1€ flat fee). 15,10€ are reimbursed by the social Security and 6,90 € for my mutual Cocoon. The euro remaining corresponding to the participation rate. In the case of an excessive fee, the additional amount remains to be the responsibility of the insured.
The repayments of my coverage supplementary health Cocoon : the reimbursement to 200 %
A refund of 200 % means that my complementary health Cocoon supports the copayment plus the equivalent of a second rate convention. What will be the amount reimbursed by my mutuelle ?
For example, the tariff rate conventional a consultation with a neurologist is 37 €. The social Security pays for 24,90 €. If the consultation is charged at 80 €, the reimbursement to 200 % ensures a refund of 2×37€, 74€, less than 1€. It then remains the responsibility of the patient 7€ to pay. 100 %, the reimbursement is only 36 €.
The repayments of my coverage supplementary health Cocoon : the reimbursement to 300 %
A refund of 300 % means that my complementary health Cocoon will reimburse up to three times the basic rate of social Security. What refund my mutual offers me ?
For example, for a consultation of a general practitioner up to 69 € (3 X 23 €), Cocoon will support up to 53,90 € (69 € – 15,10 € supported by the health Insurance). Therefore, I will be fully refunded and not have to pay that £ 1 share fee.
Cocoon, a mutual health that looks like me
Seniors, active youth, students, retirees, managers, employees, etc. What are the warranties of the various forms of complementary health ? Cocoon is a mutual flexible, as evidenced by the conditions of termination. Practice, especially if I’m part of the employees to subscribe to the mutual binding of the company. Clarity and consistency are two key principles of the state of mind of the Cocoon : no waiting periods, no health questionnaire required.