# Mutuelle



## DC12345

Hi. We received our social security # (Yay!) and would like to apply for mutuelle insurance. 

Is there one that you recommend? Expat-friendly, easy to file claims, etc. 

Thank you.


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## Peasant

We have Groupama and they've been good.


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## Bevdeforges

Generally speaking, it's not a matter of "filing claims." For most things, your medical appointment or treatment is reported directly to CPAM using your Carte Vitale, and it's CPAM that passes the information on to your mutuelle.

You need to assess what level of coverage you need - based on the situation in the area where you live. (Availability of doctors, hospitals and facilities that stick to the rates list - or if there are private hospitals and other "independent" practitioners in your area.) 

But talk to whoever handles your regular insurance (i.e. for house or apartment) if you're satisfied with them. They can explain the various offers they have. Also consider any "special needs" you might have - for eyeglasses, dental care - or if you want services not covered by CPAM (say, chiropractic, osteopathic or other "medecine douce" (i.e. alternative treatments). Some mutuelles will cover alternative stuff - at least to some extent.


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## rynd2it

DC12345 said:


> Hi. We received our social security # (Yay!) and would like to apply for mutuelle insurance.
> 
> Is there one that you recommend? Expat-friendly, easy to file claims, etc.
> 
> Thank you.


We use the local office of Allianz and are very pleased with the service and the helpful staff. They also put out a monthly newsletter with all sorts of help and guides for English speaking customers, including their annual guide to the tax filing, for which they also provide on-line and in person help for free.


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## DC12345

Thank you for your feedback. So my broker is recommending a company called April..not sure if anybody knows/has experiences with them. I'm reading about how mutuelles works (a bit confusing but I think I get how different payouts work - ie 100% vs 200% vs 300% etc). Question -- what is the % policy you recommend and what do you think is a fair monthly premium for a married couple with a child? I know this is not fair question given everyone's situation will be different depending on your overall health, how much premium you'd like to pay (higher premium, more protection), your risk appetite, etc. But just wondering how to think about it based on your experience...eg do a lot of good doctors in France charge higher than the CPAM guideline..which would mean that I should probably get a high % policy, etc...just want to know how to think about it. Thank you again.


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## Bevdeforges

You can look up on the Ameli website to find doctors and specialists in your area and the listings indicate their status (by category - 1 means they charge strictly by the official list, 2 means they are authorized to charge based on a higher fee schedule). I'm not sure, but they may also have a listing of hospitals and clinics that would indicate whether they are public or private. You need to see what is available in your area - and also what your preferences are. Much of this information is also available on Doctolib and other health care scheduling sites. 

Then you need to consider your ages - mutuelle fees are higher the older you are (at least when you start with a given plan). And there are discounts (10 or 15%) for combining all the family coverage under a single payer. The other consideration is your "need" for certain specialties, treatments or services like eyeglasses and dental. Example - I have a really "difficult" eyeglass prescription, so I want a plan with as much eyeglass cover as I can get (and afford, obviously). If you have fairly standard eyeglass prescriptions (or none at all), you don't need to worry too much about the cover - especially since they do have to fully cover eyeglasses up to certain limits on all mutuelles these days. And they do cover eyeglasses for children as standard (again, with certain limits - but better than for adults).

However, it's not that difficult to change mutuelles if you choose one and then find you need more or different cover. And don't be afraid to ask for multiple quotes ("devis") and then just line them up and see how they compare. (Warning: there is no one standard way of presenting the coverage - but when you're looking at 3 or 4 different quotes, you'll start to see where the biggest differences are.)


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## suein56

April are usually considered to offer reasonable/good cover, notably covering the Anglophone market. Though they can be on the pricey side.






Avis APRIL mutuelle santé : que pensent les internautes ?


Découvrez les 1662 avis déposés sur la mutuelle santé APRIL. Triez les en fonction de la note pour retrouver les meilleurs ou les moins bons avis.




www.opinion-assurances.fr





Disclaimer : I have no relationship with them. In the past a friend of mine (same age as me, same commune) had a policy with them, equivalent to mine, and hers was quite a bit more expensive.


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## DC12345

suein56 said:


> April are usually considered to offer reasonable/good cover, notably covering the Anglophone market. Though they can be on the pricey side.
> 
> 
> 
> 
> 
> 
> Avis APRIL mutuelle santé : que pensent les internautes ?
> 
> 
> Découvrez les 1662 avis déposés sur la mutuelle santé APRIL. Triez les en fonction de la note pour retrouver les meilleurs ou les moins bons avis.
> 
> 
> 
> 
> www.opinion-assurances.fr
> 
> 
> 
> 
> 
> Disclaimer : I have no relationship with them. In the past a friend of mine (same age as me, same commune) had a policy with them, equivalent to mine, and hers was quite a bit more expensive.


Thank you for the link...very helpful. Most of the reviews seem like people are pretty happy with the price.


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## papaia

For what's worth - I followed the comments of a "local", and decided to postpone the acquisition of a mutuelle, at least for the first year, until we get a better understanding of the mechanisms. So far we had a few non-std doctor & specialists visits, including specialized tests, and the cost levels (not only compared to the US rip-offs, by being at least an order of magnitude lower) and the totals/absolute values supported this approach, vs the sum of monthly payments (I basically "budgeted" a min mutuelle cost). _*YMMV!*_


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## jweihl

DC12345 said:


> Thank you for your feedback. So my broker is recommending a company called April..not sure if anybody knows/has experiences with them. I'm reading about how mutuelles works (a bit confusing but I think I get how different payouts work - ie 100% vs 200% vs 300% etc). Question -- what is the % policy you recommend and what do you think is a fair monthly premium for a married couple with a child? I know this is not fair question given everyone's situation will be different depending on your overall health, how much premium you'd like to pay (higher premium, more protection), your risk appetite, etc. But just wondering how to think about it based on your experience...eg do a lot of good doctors in France charge higher than the CPAM guideline..which would mean that I should probably get a high % policy, etc...just want to know how to think about it. Thank you again.


Hello! We are using a plan called "MyHEALTH FRANCE" from April International as our Mutuelle. We had been using an insurance plan from April to get our visa, and were able to convert from full cover to a mutuelle as soon as we got our social security numbers. We've been using it for several months now, and we've just had our first several reimbursements from them. My wife's got her carte vitale already (I'm still waiting for my letter asking me to send in my photo). For the most part it works seamlessly. We get reimbursements from CPAM and April directly into our account without filing a claim. The only fail I've had with it was trying to use it one time at a pharmacy without an active AMELI account (it works flawlessly once that's set up). Honestly, for an €11 pharmacy charge, I didn't bother trying to figure it out. The plan has 6 levels from minimal through deluxe coverages. Prices are easy to understand as you just cross reference your age with benefit level on the chart provided in the plan information document. We purchased through a broker at Exclusive Healthcare and it was pretty easy. My wife just ordered new hearing aids today and the mutuelle will cover a few hundred euro of the bill.

Good luck!


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## DC12345

More questions on Mutuelle. I was going over my mutuelle documents from April and I realized that there's no mention of the word "mutuelle" in any of the pages...only the words "Complémentaire santé" . So I looked up if there's any difference between Complémentaire santé and mutuelle and I found this article (which confused me even more): 
Quelle différence entre mutuelle et complémentaire santé ? 
The beginning of the reading seemed like there's a clear difference between the two and one needs to be careful... but the end implied the two are interchangeable and not a big worry. Thoughts?


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## jweihl

DC12345 said:


> More questions on Mutuelle. I was going over my mutuelle documents from April and I realized that there's no mention of the word "mutuelle" in any of the pages...only the words "Complémentaire santé" . So I looked up if there's any difference between Complémentaire santé and mutuelle and I found this article (which confused me even more):
> Quelle différence entre mutuelle et complémentaire santé ?
> The beginning of the reading seemed like there's a clear difference between the two and one needs to be careful... but the end implied the two are interchangeable and not a big worry. Thoughts?


This is interesting, I've never heard of the term complémentaire santé. And I guess that's one of the points of the article. My reading of it is that there are two types of supplementary insurance, mutuelle and complémentaire, and that the two differ mainly in who offers them and how they're set up, but that both do essentially the same thing in paying costs that assurance maladie does not. If I read the article correctly, both products exist and are used, but people generally refer to both products as mutuelles, even if they're not. Maybe this is just habit, like people continuing to refer to cartes bancaires as "carte bleue"?

I'd be interested in an interpretation by someone who's been here longer and whose french is much better than mine.


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## Bevdeforges

I'm sure you've seen multiple comments here on the board about the French not parsing documents down to the word like so many English speaking countries seem to do. Basically, that's what you have here. A true "mutuelle" is organized like what you may know as an insurance mutual or a mutual bank back in the US. When you sign up for their services, you become a "member" rather than a customer, and there is an annual meeting where members can vote on various policies, etc. 

A complementaire santé is a commercial or privately owned and operated operation that offers top-up health insurance complementary to the CPAM coverage. For a complementaire santé to be recognized as a "mutuelle" they have to abide by some of the same rules that govern a statutory mutuelle - key among them is that they cannot base their cover on your current state of health (i.e. no excluding "pre-existing conditions"), among other rules they need to follow. They can offer payment or reimbursement for some things that aren't covered by the Sécu (like, perhaps alternative medicine) - but the big advantage (to you and to them) is that you don't have to "make a claim" for anything covered by the national program. You register your "mutuelle" with CPAM (using your Ameli account) and when you use your Carte Vitale, the "claim" for reimbursement goes first to the CPAM, and then is forwarded automatically to your mutuelle. And in some cases, if CPAM will pay the medical provider directly ("tiers payant"), the "mutuelle" may also pay directly, depending on your policy terms and conditions (though they may need to have an arrangement with the provider). 

In short, the "difference" is mostly whether the top up insurer is a true "mutual" company, or if it is a private insurance contract (subject to specific rules).


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## BackinFrance

In terms of April it just means that you are effectively covered by an insurance company. April offers a variety of products that suit expats, such as the ability to change health insurance cover to what is commonly known as a mutuelle in France, albeit the cover is provided by an insurance company. Nothing to be concerned about unless you prefer cover provided by a true mutuelle, which in any case you are unlikely to be eligible for unless you are working in France.


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## suein56

BackinFrance said:


> In terms of April it just means that you are effectively covered by an insurance company.
> Nothing to be concerned about unless you prefer cover provided by a true mutuelle, *which in any case you are unlikely to be eligible for unless you are working in France.*


Why do you say that ? We came over as inactifs and are now retired : we have been covered by Groupama for our health for years.
Groupama is a Mutuellle.


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## BackinFrance

suein56 said:


> Why do you say that ? We came over as inactifs and are now retired : we have been covered by Groupama for our health for years.
> Groupama is a Mutuellle.


It's not a true mutuelle.


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## DC12345

Pricing question. Does 270Euro per month ( = 3244 annual) for a married couple w/ a kid sound high for the highest coverage (level 6. Ex. Hospitalization 300%, Consultation 300%, Dentaire 350%, etc...I want the maximum coverage for peace of mind) seem reasonable in the Paris area? I searched everywhere and all the prices people are quoting seem lower hence asking... (but I realize maybe they are single, students, or live elsewhere where, etc.). Merci beaucoup.


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## suein56

BackinFrance said:


> It's not a true mutuelle.


How not ? It says it is and is described as such. What do you know that I don't ?


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## BackinFrance

suein56 said:


> How not ? It says it is and is described as such. What do you know that I don't ?


It is run by an insurance company, that makes it officially a complémentaire de santé, but they are all allowed to use the term mutuelle.


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## Peasant

BackinFrance said:


> It's [Groupama] not a true mutuelle.


It is as far as my doctors, hospitals, pharmacy, etc. are concerned...


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## Peasant

BackinFrance said:


> It is run by an insurance company, that makes it officially a complémentaire de santé, but they are all allowed to use the term mutuelle.


If "they are all allowed to use the term mutuelle", they they're a mutuelle.
Don't be too pedantic.


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## BackinFrance

DC12345 said:


> Pricing question. Does 270Euro per month ( = 3244 annual) for a married couple w/ a kid sound high for the highest coverage (level 6. Ex. Hospitalization 300%, Consultation 300%, Dentaire 350%, etc...I want the maximum coverage for peace of mind) seem reasonable in the Paris area? I searched everywhere and all the prices people are quoting seem lower hence asking... (but I realize maybe they are single, students, or live elsewhere where, etc.). Merci beaucoup.


Hi
I would suggest you consider all of the mutuelles mentioned here and get quotes from them and compare as far as possible with the quote you already have, simply because I don't think any of those who have recommended mutuelles actually live in Paris and most are retired. Because you are essentially I think stuck with a mutuelle run by an insurance company, where you live and the composition of your family makes a big difference in terms of cost, because there is no smoothing or common charge. 

There are also comparison sites, but you would still need to get a specific quote in order to make a real comparison. 

Good luck.


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## Bevdeforges

DC12345 said:


> Pricing question. Does 270Euro per month ( = 3244 annual) for a married couple w/ a kid sound high for the highest coverage (level 6. Ex. Hospitalization 300%, Consultation 300%, Dentaire 350%, etc...I want the maximum coverage for peace of mind) seem reasonable in the Paris area? I searched everywhere and all the prices people are quoting seem lower hence asking... (but I realize maybe they are single, students, or live elsewhere where, etc.). Merci beaucoup.


Don't worry about finding the "lowest" price - and especially if you'll be in the Paris area. Or if you will be traveling into Paris for specialists and services not readily available wherever you are. (Plenty of people come into Paris from outside the area for specialty treatments.) Paris is one of the big reasons the various categories were created, since rents and all are higher here so they had to create a second tier of higher fees to handle that.

Actually, 270 a month for a family like yours doesn't sound like too bad a deal. There are plenty of cut rate mutuelles out there - and for those who get their mutuelle through their employer, the employer pays 40 or 50% of the monthly fee - at least for the employee. But generally for retirees who get a mutuelle on their own I've seen the monthly fees range anywhere from 50 to 175+€ per adult, with a child covered for about half the adult rate. You won't really appreciate your mutuelle until someone in the family needs to be hospitalized (even for something simple like tonsilitis) and on discharge you're asked to pay a whopping 50 or 60€, no more. Depending on your mutuelle, you may wind up submitting that to the mutuelle, but even if that's the only amount you pay for 2, 3 or 4 days of hospitalization, it's a HUGE difference from the US system.

PS - we ARE in the Paris area. And plenty of folks in this area go into Paris for various specialists and treatments (including going to the American Hospital in Paris, which is definitely expensive). The figure you quote for the 3 of you is less than what we pay for just the two of us. See how it works out for you - and don't forget, you can change after a year or so if you don't like how it's working out for you.


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## BackinFrance

The figure quoted is lower because they are younger, though it does seem teasonable to me for top cover for a young family in Paris, so if they can afford it and it gives them what they want, why not? They can always change a year from now, subject to giving proper written notice within the required timeframe.


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## Bevdeforges

BackinFrance said:


> The figure quoted is lower because they are younger,


Possibly - or their selected policy may have somewhat different features and limits than ours does. Some policies will get you a private room if one is available, others have higher limits on eyeglasses or may actually include some forms of alternative medicines (homeopathy or osteopath treatment). You find a policy that offers what you need and want - and honestly, having had to compare policies to change mutuelles when we retired a few years ago, it ain't easy making nice, neat comparisons across companies.


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## DC12345

Bevdeforges said:


> Don't worry about finding the "lowest" price - and especially if you'll be in the Paris area. Or if you will be traveling into Paris for specialists and services not readily available wherever you are. (Plenty of people come into Paris from outside the area for specialty treatments.) Paris is one of the big reasons the various categories were created, since rents and all are higher here so they had to create a second tier of higher fees to handle that.
> 
> Actually, 270 a month for a family like yours doesn't sound like too bad a deal. There are plenty of cut rate mutuelles out there - and for those who get their mutuelle through their employer, the employer pays 40 or 50% of the monthly fee - at least for the employee. But generally for retirees who get a mutuelle on their own I've seen the monthly fees range anywhere from 50 to 175+€ per adult, with a child covered for about half the adult rate. You won't really appreciate your mutuelle until someone in the family needs to be hospitalized (even for something simple like tonsilitis) and on discharge you're asked to pay a whopping 50 or 60€, no more. Depending on your mutuelle, you may wind up submitting that to the mutuelle, but even if that's the only amount you pay for 2, 3 or 4 days of hospitalization, it's a HUGE difference from the US system.
> 
> PS - we ARE in the Paris area. And plenty of folks in this area go into Paris for various specialists and treatments (including going to the American Hospital in Paris, which is definitely expensive). The figure you quote for the 3 of you is less than what we pay for just the two of us. See how it works out for you - and don't forget, you can change after a year or so if you don't like how it's working out for you.


Thank you Bev! You said exactly what I needed to know....I'm not necessarily looking for the cheapest...just making sure 270 a month is within a reasonable range which sounds like it is. And yes about the US system...even if 270 a month is at the high end of the range, vs US it is a steal...in US 270 a month could easily be someone's deductible requirement+co-pay per visit. 

btw, as the discussion starter, I say Groupama is a Mutuellle!!! (fueling the fire..😉)


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## Crabtree

I have used Aviva and they offered good service at a reasonable cost 
and NO they are not a mutuelle .They are an insurance company so offer a complementaire. 
So many people including health professionals call the "top up" a mutuelle because in the dim and distant past I believe that health care and insurance was organised on a "mutuelle" basis by various employment groups or unions so the term has stuck over the years IMO. A bit like calling a vacuum cleaner a Hoover even though its a Dyson....


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