Your right to health care

Whenever you receive a visit from or consult the doctor, dentist, physiotherapist..., you pay the full amount of the fees. In exchange, you receive an "attestation de soins donnés" (a green, white, blue or orange "health-care provided certificate"). You stick a yellow sticker on this certificate, then send it to your health mutual, to have part of the fees refunded to you. Thus, you only pay the ticket modérateur or the quote-part personnelle, the part of the fee you have to pay yourself.
You have two years in which to apply for and obtain the refund on an "attestation" health-care provided certificate.

In exchange for the health-care provided certificate sent to your health mutual, you may if you wish have sent to you a "quittance de soins" (a health-care receipt), providing a series of data enabling you, among others, to check the payment made and the amount of the refund. This quittance (receipt) can also be used as proof of the amount refunded when required for another insurance scheme.

The amount of the health-care practitioner’s fees, and the amount refunded to you by the health mutual are determined by the health-service practitioner agreements ("convention"). However, practitioners are free to decide whether to subscribe to those agreements. Most of the "conventionnés" doctors undertake to align their fees with those agreements. Doctors should, in principle, display a notice in their waiting-rooms saying whether the do so align their fees. 
As a rule, the health mutual refunds you approximately 70 to 80% of the fees pay for health-care services such as visits by and to general practitioners (médecins généralistes). For treatment given by physiotherapists, as a rule, the refund is only 60% of the fees paid.

When you are admitted to hospital, the health mutual’s share of the cost is based on the charge for a shared room. The health mutual pays this amount directly to the hospital. This method of payment is called the "tiers payant".
As a hospital in-patient, you have numerous other expenses to pay  : a personal share of costs per admission, a few compulsory flat-rate fees, a personal contribution to the daily rate of charge, supplementary charges for a private room, additional expenses for telephone calls...

Important Note : If the medical expenses result from an accident, you should inform us for each refund application, specifying the date of the accident. You should keep your proofs of payment and refund.

The "prescription de medicaments" or "ordonnance" (prescription form) is the document you give to your pharmacist, on which the doctor indicates the medicines you need. This document is important, since it enables you to obtain medicines that are not freely sold over the counter, and using it, you pay less for medicines that carry a refund by the health mutual.

In every case, your pharmacist will ask you to produce your SIS card. This will satisfy the pharmacist of your health-care entitlements.

In most cases, therefore, you will on pay to the pharmacist that portion of the cost that is not paid by the health mutual.
The "ticket modérateur" (the portion of the cost borne by patients themselves) varies according to the medicine’s social and therapeutic value. Here are the different categories and their rates of refund * :

Alongside the letter codes, the boxes of refundable medicines display three prices. The highest price (the full price) is the full price you have to pay if your health mutual makes no contribution to the cost, should your entitlement be expired. The middle price is the one you pay the pharmacist if your entitlement is up to date and you have a prescription. The lowest price is paid by a beneficiary entitled to increased support (see above).

Whenever possible, you should ask your doctor to prescribe generic medicines for you (a brochure is available from our offices on request). These medicines have the same therapeutic effectiveness and cost at least 30% less than the original reference medicine.

* The cost of a whole series of medicines is now based not on the actual cost, but on the reference price. These are medicines for which a less expensive alternative exists, or of which the active ingredient has already been refunded for more than 12 years.