Towards easier to compare complementary health insurance

Tables of nearly 100 lines filled with figures, formulas such as “member of a DPTAM” … Even the most informed consumers have something to be put off by the documents provided by their health insurer to explain what it will cover , after Social Security, in the event of the purchase of glasses, dental care or hospital stay.

To help individuals better understand these documents and ultimately not be disappointed with the level of coverage of their health expenses, consumer defense associations have found a compromise with the complementary ones.

By virtue of this agreement drawn up within the Consultative Committee of the Financial Sector (CCSF) and made public on Thursday, health insurers have agreed to review, “before May 2022”, the way in which they give examples of reimbursement of care in the form standardized table.

Easy to understand examples

“This new table allows the consumer to better understand what is actually covered by compulsory health insurance and by complementary health insurance”, assures the CCSF. The document will contain examples that are easy for everyone to understand. “For example, we used to talk about class A and class B lenses, now we’re talking about simple lenses and progressive lenses,” explains a connoisseur.

Insurers have also undertaken to make a “concerted assessment” of the adoption of these new standards. They also promised to facilitate access to documentation on the Internet. So many measures which are supposed to facilitate the comparison of contracts. Knowing that since the end of last year, it is possible to change complementary health almost at any time.

Step by step

“This table will allow consumers to better understand what they have to pay out of their own pockets,” says Marianick Lambert, of the Familles Rurales association. We are moving step by step ”. The subject of the readability of complementary health contracts has been on the table for years and in the sights of the executive. In 2019, a step was taken with the signing of an agreement between the major families of complementary.

Thursday’s CCSF agreement “goes in the right direction”, believes the consumer association UFC-Que Choisir, even if the effort must be “amplified”. “What is really most important for consumers is the table of guarantees. It is absolutely important that there is a harmonization of these tables ”, insists Matthieu Robin, project manager within the organization.

However, health insurers have “asked for stability”, notes the CCSF. And this, knowing that they had to completely review the presentation of their contracts with the entry into force in 2019 of the 100% health reform. This provides for full coverage by compulsory health insurance and additional costs for certain treatments and equipment.

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