One of the many criteria for choosing a mutual is likely to be the master of its budget. Particularly among seniors. Retirees have to heart – to not only take care of their health, but also to control their accounts. It is essential to know the guarantees in his contract for several fundamental reasons : choose the formula most suited to its situation and to its budget, and an estimate of her payments.
What is the reimbursement for a medical consultation by health Insurance ?
The consultation of my doctor is in part reimbursed by the sickness Insurance, 70 % of the price of conventional. Some specific situations require a support consultations at 100 %. This is the case for pregnant women over 6 months of age and the beneficiaries of the CMU in particular.
My doctor is charging me 23€ consultation. The Insurance repays me 15,10 € (or 70% of the amount paid). The amount reimbursed takes into account a lump-sum contribution of € 1, restraint on each consultation (with the exception of under 18 years of age, pregnant women from the 6th month of pregnancy and up to 12 days after delivery, of the beneficiaries of the CMU are complementary…). Without mutual, the remaining burden amounts to 7,90 €.
Another possible case : my doctor directs me to another doctor for routine care or for an opinion. The rebate will also be 70% of the amount paid.
What is the reimbursement for a medical consultation by my mutual Cocoon ?
Cocoon offers 6 different formulas : Eco, Essential, Essential+, Comfort, Comfort+ or Privilege.
Each of them adapts to my situation, I was protecting the best. Whatever the chosen formula, for a consultation with a general practitioner is not practicing any overrun fee, the refund will be full. In fact, the refund rate for my mutual Cocoon varies between 100 % and 300 % of the formula is the most widespread.
For a consultation costing 23 €, the health Insurance I get paid for 15,10 €. Reimbursement physician mutual Cocoon will be 6.90 €. The total of the reimbursement is € 22. Therefore the cost is 1 €, corresponding to the charge retained on each consultation.
The operation of the third-party payer : how and for whom ?
The third-party payment allows the insured not to advance the money for her health costs (medical expenses, consultations, medication…). In general, the services concerned by the principle of third-party payment is based on the agreements established with the social Security. Only health professionals who have agreed to partner with Cocoon allow me to take advantage of this service. This is a real advantage for the insured. Seniors are aware of this practice, including retirees with modest pensions. The regulation of their budget is thus assured.
Cocoon, my mutual health
Cocoon works without commitment, without any formality, without medical questionnaires. The flexibility is its major asset.
My complementary health Cocoon offers several formulas to guarantee my health. Of thehospitalization to the field of dental, through theoptical or even the drug, according to the selected formula I can receive reimbursement suited to my budget. I will soon ’mleaving ? This is not a problem, since I will also be covered abroad.
Once the principles of the reimbursement of the social Security and return of the mutual controlled, it is easy for the insured to estimate its cost according to the medical acts performed. The choice of a mutual will be more clear, and more easy.