Since 2016, all employers in the private sector have been required to take out collective health insurance for all their employees. Insofar as the Social Security Health Insurance does not reimburse all of the health costs of its members, complementary health insurance is necessary to cover health costs that are likely to be very expensive. With the collective health mutual, the employer is able to provide adequate coverage to its employees.
Collective mutual health insurance is similar to any complementary health insurance. Negotiated and subscribed by the company, it is intended to cover the health costs of private sector employees and their families in addition to reimbursement by social security. Since 2016, every business leader has had the obligation to set up a company health mutual. At the same time, it is required to finance at least 50% of the amount of the total contributions. Thus, for a mutual fund of 50 euros per month, the employee will only pay 25 euros. If he wishes, the employer can finance more than 50% of the contributions in order to relieve his employees of this expense, however, he must not choose any mutual insurance company.
The proposed collective health insurance contract must offer a minimum level of guarantees defined by the decree listing the responsible guarantees. The employer is therefore obliged to provide a responsible contract, however nothing prevents him from providing broader coverage. Moreover, the collective agreement for its sector may require the company to take out a certain level of coverage. To meet everyone's health needs, the employer has the choice between the best collective health insurance offers.
In principle, company mutual insurance is compulsory for all employees and takes effect upon hiring. The employee will then have to terminate his previous complementary health insurance to join that of the company without waiting for the legal termination period. However, there are a few cases in which it is possible to refuse collective mutual insurance. This is particularly the case of the employee already covered by another compulsory complementary insurance such as the collective mutual insurance of his spouse for example. Employees benefiting from complementary universal health cover (CMU-C) or from assistance for complementary health insurance (ACS) may also be exempted from affiliation to the collective mutual insurance company as long as they are entitled to it. In addition, collective mutual insurance is generally only compulsory for employees on permanent contracts.
Employees on fixed-term contracts of less than 12 months are able to request an exemption from membership of the collective mutual insurance company. However, he must make a request in writing and provide proof of additional health cover taken out elsewhere. The employee is also able to terminate his collective mutual insurance contract if he considers that he no longer needs it. This possibility is offered to the employee in very limited cases such as the end of the employment contract whether by resignation or dismissal, departure abroad. Termination of the mutual must be done by registered letter with acknowledgment of receipt within 3 months of the change of situation. This letter must be accompanied by proof, especially in the case of another compulsory supplement.
The law obliges companies to subscribe to a so-called responsible and joint contract, that is to say respecting certain prescriptions in terms of coverage and reimbursement rates. The obligatory guarantees of a company mutual fund concern the full co-payment for consultations, procedures and services, the hospital daily rate, dental costs and optical costs. The collective mutual fund may include other benefits such as third-party payment, assistance or prevention and support. On the other hand, the responsible contract excludes the reimbursement of drugs up to a flat rate as well as the overrun of fees linked to non-compliance with the course of care.
Some contracts allow employees to cover their dependents and benefit from long-term care or death cover. Thanks to the company health mutual, part of the contribution is paid by the employer, which is really advantageous for the employees. Therefore, this type of contract provides access to unbeatable prices, because the company is able to negotiate offers by playing on the volume.
