Reimbursement of mutual, how does it work ?

Include the reimbursement of mhos is not always very simple for a novice in this area. Between the different base rates of social Security, the different options offered by the mutual (100 %, 200 %, 300 %, etc), it is quite easy to get lost. Cocoon offers to see more clearly by delivering an explanation on the reimbursement of the mutual.

remboursement mutuelle santé

How does the repayment mutuals ?

Two main elements come into play for an explanation of the operation of the mutual for my refund : the rates of reference of the social Security (repayment basis) and the percentage of repayment proposed by my mutual. When I hire health-care costs, social Security to me to reimburse a portion of these costs based on its reference tariffs (23 € for example for a consultation with a general practitioner). But the social Security only pays a percentage of this tariff of reference (which varies depending on the acts performed). The difference between taking charge of the social Security and the price reference remains, therefore, my dependent, or my mutual. According to the level of my protection, my mutual then provides a support 100 %, 200 %, or more, of the remaining amount. This percentage is always to report the rate of reference set by the social Security. This is the reason why there are protections in 300 %, to be able to compensate for the differences (such as exceedances of fees) between the price of reference practiced by social Security and the actual amount of costs incurred.

How do I get my refund ?

The reimbursement of expenses incurred in my journey of health can be obtained automatically or manually. In the first case, I am paid my fees by bank transfer without any action on my part. This situation applies to most of the refund requests mutual. In the second case, to respond to a particular situation, I will be asked to fill out a treatment form and send this document to my complementary health to get my refund.

Explanation of the repayment mutuals : illustration by a concrete case

There is nothing like a concrete example for a clear explanation of the operation of the refunds of a mutual. So let’s take the case of Patrick, a senior still in business professional who wishes to consult with a specialist for a health problem common. During the consultation, the specialist he informed them that he practice of fee free, and fixed the amount of his or her consultation to € 55. The social Security, it, fixed the rate of repayment basis at € 23 for this consultation, and is responsible for 70 % of this amount. The social Security will reimburse, therefore, to Patrick in the amount of 15,10 € (70 % of 23 € = 16,10 €, – € 1 share of fixed and non-refundable) on the € 55 for the consultation. It is from there that intervenes the support of the mutual. If Patrick has selected an offer that allows him to get a 100% refund, he will receive from the hand of its mutual in the amount of 7,90 € (23 € – 15,10 €). Will remain so to his charge 32 €. If Patrick wishes that all of its consultation will be supported, he will have to subscribe to an offer of health insurance mutual, which offers a reimbursement to 300 %. In this case, the mutual will reimburse Patrick up to 3 times the basic amount of the social Security (3 x 23 € = 69 €). The level of reimbursement proposed by a mutual (100 %, 200 %, 300 %, etc) is therefore an important criterion to be taken into account at the time of subscribing to a mutual. These payback percentages are most of the time listed on the insurance card, that I can learn to read with Cocoon. Attention : to get my refund mutual, I have to be up to date with my rights.
This clarification is helpful to better understand the functioning of the refunds of a mutual. Arrays of guarantees of mutual insurance, reimbursement of health Insurance… it is difficult to see clearly in the jungle of tariffs and rates applied in respect of rebates.

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