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votes ) Subscribing to mutual health insurance is not mandatory, but it is always recommended. You can benefit from good healthcare, as social security only covers part of your health costs. If you have already purchased one, but the contract does not satisfy you, it is possible to change it. However, certain legal requirements must be met, which are mainly beneficial to consumers. Learn here what to consider when changing complementary health insurance in 2021
Related reading : How to Manage Well?
What is mutual health insurance?
In France, all workers must have health insurance. If an employee falls ill, social insurance pays 70% of medical expenses, while 30% remains the responsibility of the insured. Most people underestimate this out-of-pocket expense, which can be quite high depending on the care needed.
Further reading : Understanding health insurance: a cornerstone of medical protection in France
To avoid having to pay a high price when you have health issues, it is better to subscribe to mutual health insurance. It is not mandatory, but generally covers the remaining 30% of costs. Thus, in case of illness, it completes the reimbursement of the guarantee. Therefore, your out-of-pocket expenses can be zero or lower, as some expense items may not be covered according to your contract.
Read – Mutual health insurance: how to be well covered?
Why change mutual health insurance?
Just like your health insurance, the health insurance contract includes various guarantees, including basic and optional guarantees.
Read – The care basket in complementary health insurance
This means that your mutual insurance may or may not offer you good coverage, depending on your choices. And, of course, the amount of your contributions depends on the number of guarantees included.
When subscribing to the contract, it is advisable to read all the terms carefully, especially those related to exclusions of coverage. If you believe during the contract that the coverage offered does not meet your expectations, you may consider modifying it. This must always be done correctly, as it is not always possible to terminate the current contract at any time.
Changing, but have you already found a new complementary health insurance?
Before starting the cancellation, you should first find a complementary insurance that meets your expectations. It is preferable to be covered immediately after terminating the current contract.
To find a better contract, use insurance comparison tools. These tools will help you compare offers from different mutuals and their prices. So just turn to those that seem promising for more information. This time, do not skip any details to obtain better coverage than the previous one. Also, remember to revoke any guarantees that do not seem necessary from your contract, as they only add to your bill.
When can we improve mutual health insurance?
There may be two cases:
- A change during the year and thus during the contract
- A change at maturity
Since the enactment of law 2019-733 on annual termination of investment funds in December 2020, consumers can terminate their complementary health insurance contract at any time, but only after one year of the contract. However, certain circumstances require some individuals to start terminating before the end of the first year of the contract.
Mutual change during the year
Certain situations (birth, marriage, relocation, job change…) that cause a change in the insured’s life actually allow them to change without waiting for the contract’s expiration date. Among the most common cases include:
- Relocation: If the change of address results in an increase in the premium to be paid, termination can be requested before the due date. Indeed, if the person leaves France, they would need international complementary health insurance, which is more expensive. And if the person has to live outside France for a few months, but within the European area, they will need to apply for a European health insurance card, but note that only emergencies are covered.
- Change in marital status: birth, marriage, divorce… These events require the insured to modify their mutual health insurance contract to better fit their new profile.
- Retirement: Generally, workers are covered by the company’s mutual insurance. When you retire, you have two options to choose from: either subscribe to an individual fund for retirees or request the transfer of their company mutual. In the latter case, retired employees will keep their company mutual, but ensure that their employer no longer pays their contributions. It will be up to them to pay them. This solution is not necessarily the most advantageous, as the mutual may decide to increase rates for retirees after a certain period. Therefore, it is better to consider an individual contract that will meet your needs and the amount of your pension.
- Membership in a mandatory mutual insurance scheme: This applies to individuals who have just been hired by a company. This allows them to terminate their current mutual agreement to join the company.
- Membership in CSS (Complementary Health Solidarity): If you are eligible for CSS and have successfully joined, you can cancel your current contract.
In all cases, termination must follow a legal procedure during the year. To exercise this right, the insured must inform their current mutual association of their situation within three months of the event. The cancellation will then take place within 30 days of receiving the letter at the complementary insurance.
Read also — Health of seniors: is mutual change recommended from age 55?
Mutual change at maturity
Aside from the exceptional cases mentioned above, the insured must wait for the expiration of their contract to terminate their mutual agreement and choose another. Without this approach, their contract will be tacitly renewed for another year. And aside from the above circumstances, they will have to wait again for the deadline to do so.
To protect consumers, the Chatel law of 2005 requires health mutual companies to inform their clients of the expiration date 15 days before the end of the contract. They must send them a letter specifying this period indicating that they have the option to terminate their contract. Strict rules govern the sending of this correspondence. It is stated that if:
- The Mutuality Party sends the letter within 15 days before its expiration, the insured has 15 days to terminate their contract on time.
- The insured receives the termination letter only within less than 15 days, they will have 20 days from the date of receipt of the notification to send their termination letter.
- The mutual association did not inform you of this possibility of termination, if the expiration date has already passed, the insured can terminate their contract at any time without notice.
And if you do not want to change, then you will not have to take any action, as the contract will be tacitly renewed under the same conditions as before.
For information:
Mutuals impose different deadlines. Some have set it for January 1, while others practice a quarterly calendar system. It is necessary to clarify this point with the organization to avoid mistakes regarding the dates.
Mutual change at any time
Since the enactment of the law of July 14, 2019, on the right to terminate mutual insurance, insured individuals can cancel their supplements at any time, free of charge and without conditions, once their current contract reaches its first year of subscription. The insured is not required to provide evidence, and the mutual party cannot penalize them. This period must also be included in their contract.
The mutual party must terminate within 30 days of receiving the termination letter.
For information:
The Hamon law is the law that allows insured individuals to change their health insurance at any time. It does not apply to mutual health insurance, but is in line with the new law on semi-annual termination.
Can we change mutual funds due to a rate increase?
If your contract provides for the possibility of increasing the rate from the start, you will not be able to terminate your contract due to rate increases. The same applies in the case of tax increases by the state or in the case of additional guaranteed tax increases for your contract.
On the other hand, if the increase is both abusive and unjustified, it is possible to request termination. The letter must be sent by registered mail with acknowledgment of receipt within 15 to 30 days following the aforementioned price increase.
In general, termination takes effect after one to two months. Use this time to find another, cheaper addition.
Read also – Supplemental insurance: how to reduce costs?
How do you approach changing complementary health insurance?
Here are the steps to follow to change mutual health insurance:
- Termination of the current contract
To terminate your current contract, simply send the termination letter either by post or by email with the letter attached. According to the 2020 law, sending the letter by mail with acknowledgment of receipt is no longer mandatory. Nevertheless, it is advisable to keep an eye on your claim in case of dispute. Keep the mail or email you wish to retain in your inbox.
- Request for cancellation certificate
You should always consider requesting this certificate from your insurance organization. This document serves as proof of the new mutual connection you wish to join. In fact, it is important to prove that you want this change because you want it, and not because your previous mutual has stopped covering you. With it, you will not have a waiting period.
- Subscribing to a new investment fund:
Since you started your search early enough, you just need to finalize your new contract by signing with the chosen mutual. Note that the new insurance organization is aware of your termination of employment with the previous insurer.
What about the company mutual?
Private companies must adhere to a mutual collective agreement for all their employees. If you work in one of these companies, you cannot refuse subscriptions to this contract. Contributions are shared between the employer and the employees. Employers generally agree to pay more. You can then cancel your individual investment fund.
Read also – How can you stay with mutual insurance after leaving the company?
As an employee, can you cancel or modify this agreement? The answer is “no”. Not only are they required to pay the contribution, but they must also comply with the terms of the contract.
If you believe that the contract does not adequately cover your needs and those of your colleagues, you can ask your employer to be more efficient. Only they can terminate the current contract and change it mutually. They also have the right to terminate the contract for certain employees in case of dismissal, resignation, or retirement.
On the other hand, the employee can opt out of the mandatory mutual agreement of the company that employs them. This is often the case when they are already covered by their spouse’s mutual health insurance. They can then request the termination of their company mutual.
Tag : What is the purpose of health insurance?