What is the “100% Healthcare” reform about ?
November 29, 2019
“Zero out-of-pocket” is on its way
On December 3, 2018, France passed its social security financing bill for 2019, paving the way for a program to provide “zero out-of-pocket” healthcare. This was one of Emmanuel Macron’s key promises during his presidential campaign.
The initiative, now called “100% Healthcare”, aims to eliminate out-of-pocket expenses – the cost that remains for insureds to pay after receiving reimbursements from mandatory and supplemental health insurance for dental care, eyewear and hearing aids. The goal is to ensure that cost does not drive French people to avoid medical care.
In 2018, in France (1), the average out-of-pocket expense was €65 for a pair of eyeglasses, €195 for a porcelain crown and as much as €850 for a hearing aid.
Guaranteed by responsible health insurance policies
To eliminate their out-of-pocket expenses, insureds must meet two requirements :
- Be covered by a policy that is socially responsible (no medical checks) and economically responsible (applies the minimum and maximum coverage amounts set by the government). 95% of the health insurance policies taken out by companies for their employees meet these criteria. The employer’s contributions to these policies are tax-deductible and can be exempted, up to a certain limit, from social security charges.
- Choose eligible “100% Healthcare” products, meaning products that meet a strict set of specifications defined in a ministerial order. The range of eligible products will also be regulated. For example, opticians will be required to offer at least 17 different eyeglass frames for adults and at least 10 different eyeglass frames for children, clearly labelled as “100% Healthcare” in their store and/or on their website.
If these criteria are met, then the cost of the healthcare will be fully covered by the combined mandatory and supplemental insurance plans. The out-of-pocket cost for the insured will be zero.
Note : insureds will be able to combine “100% Healthcare” eyeglass frames with corrective lenses that are not “100% Healthcare” (and vice versa). In this case, the insure may still have an out-of-pocket expense, depending on their level of coverage for the non-100% Healthcare product.
Available in two phases
The “100% Healthcare” reform will be rolled out in two stages. The program will go into effect as of 2020 for eyeglasses and dental prosthetics, and then in 2021 for hearing aids. All opticians, dentists and hearing specialists will be required to offer “100% Healthcare” options to comply with the new regulations.
If companies want to maintain their social security and tax benefits, their group healthcare policy must be made compliant with the new reform as of January 1, 2020.
(1) Source : “100% Healthcare” press kit dated June 13, 2018, from the French Ministry for Solidarity and Health.
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