Anyone with symptoms of Covid or being a contact case must isolate themselves and consult their general practitioner. It is then a question of being screened via one of the three different tests available. However, one of the concerns of citizens is the reimbursement of this benefit by Social Security and their mutual.
A few weeks ago, a publication on the Service-Public site mentioned new medical procedures and the management of procedures in connection with the coronavirus. In the case of people with symptoms (or contact case), it is incumbent to consult their general practitioner. However, some citizens are asking the question of reimbursement from Health Insurance and try to understand the list of coverage by mutuals.
This consultation is reimbursed according to the same terms as for another pathology:Health Insurance covers 70% of the bill and the co-payment (the remaining 30%) are reimbursed by the mutual if the patient has one. A flat-rate contribution of €1 remains to be paid, except for children and adolescents, pregnant women over 6 months and beneficiaries of complementary health insurance (CSS) or state medical aid (AME). In concrete terms, for a Covid consultation of a general practitioner by an adult, Social Security reimburses €16.50 and patients with mutual insurance receive an additional €7.50.
To limit the risk of transmission of Covid-19, it is possible to use teleconsultation which, like tele-nursing monitoring, is 100% covered by Health Insurance. You should normally consult your doctor, but if he is unavailable, the patient can contact another doctor. Even if the consultation is fully reimbursed, the amount must be advanced if the professional does not practice third-party payment.
There are currently three different types of tests:PCR, antigenic and serological. The first two are 100% supported without a prescription from health insurance. In the case of the serological test, coverage is complete with a prescription only. For 100% coverage without a prescription, it is necessary to go through a mutual insurance company. Since April 12, 2021, self-tests have been on sale in pharmacies. They are not covered by health insurance, but they can be covered by mutual insurance.
The vaccines are 100% covered by the Health Insurance for all French people, as they become eligible.
The list of coverage by mutual insurance companies does not stop at consultations and tests. Masks, hydroalcoholic gel and treatments are also affected.
Currently, there is no reliable treatment for Covid. In general, patients are prescribed paracetamol to treat symptoms by reducing fever in particular. The reimbursement share of the Health Insurance is 65% and the reimbursement of the mutual will amount to 35%.
Masks are covered by Social Security in certain cases only:patients positive for coronavirus or vulnerable patients. A prescription is necessary in this 2nd case. For other people, only a few mutuals offer reimbursement for masks. In this case, the invoice must be sent to the complementary health organization.
The hydroalcoholic gel is not covered by Health Insurance, but its price is capped at €1.79/50 ml bottle. Some mutuals reimburse it as part of a Covid-19 flat rate or self-medication guarantee.
Work stoppages linked to Covid-19 vary:patient with coronavirus, contact case, parent on leave for childcare, vulnerable person... Depending on the case, you must declare your work stoppage online at the website ameli.fr or be prescribed a stop by a health professional or by the Health Insurance.
For a stoppage concerning employees, the Health Insurance covers 90% of the gross salary with 0 waiting days . The health insurance covers the remaining 10%. For the self-employed, health insurance coverage is variable and is associated with a waiting period of three days. On the other hand, a health insurance fund can cover the gross salary up to 100%.
Finally, remember the possibility of joining an information platform on 0800 130 000 in order to obtain information on Covid-19. If a rapid intervention is necessary, contacting the Samu (15) is a must. Let's also mention the European emergency number (112) for a call from a European country (or from a mobile).
