My contract and me: 100% health

A. PREAMBLE

This reform is the consequence of an electoral commitment by Mr Macron.

The objective is a balance of 0 € on the following items:

• Optics;

• Dental;

• Hearing aids.

It is important to specify that this reform is gradual, from 2020 to 2023, with a majority of changes between 2020 and 2021.

B. THE MAIN MEASURES OF THE REFORM

The main measures of the reform are :

• The introduction of sales limit prices (POS) in optical and audio and billing limit fees in dental.
• The revaluation of the reimbursement bases of the Compulsory Health Insurance.
• The modification of the responsible contracts (by the decree of 11 January 2019 and article 51 of the SS 2019 Finance Law):
  
  1. Introduction of a ceiling for audio coverage: limitation of the reimbursement of the Compulsory Health Insurance and the Complementary Health Insurance to 1700€.
  2. The reduction of the existing ceilings of csupport in optics: reduction of the reimbursement of frames from €150 to €100.
  3. The obligation to reimburse the acts contained in the optical, audio and dental care treatment baskets.

C. OPTICS

As of 1 January 2020, 2 classes of equipment will be distinguished:

1. The "Rest à Charge Zéro", which means that the equipment concerned will be fully and compulsorily covered by the Compulsory Health Insurance (AMO) and the Complementary Health Insurance (AMC).
2. Class 2: "Free rates", which means that the equipment will be partially covered by the Compulsory Health Insurance and the Complementary Health Insurance and that the coverage beyond the moderating ticket will be optional for the responsible contracts. In case of coverage, the responsible contracts will have to respect the following limits:
   • Compliance with the floors and ceilings fixed in article R.871-2 of the Social Security Code of the ceilings of 50 €, compared to the pre-reform) - 6 categories according to the type of glass (simple, complex, ...);
   • Support for the mount within the equipment limited to 100 € (i.e. one lowering of the pre-reform ceiling by €50).

D. THE DENTAL

As of January 1, 2020, there will be 3 baskets of care:

• The "Zero Remaining Charge" basket: limit fees, variable according to the material and location of the tooth. These fees are fully reimbursed by the Compulsory Health Insurance and the Complementary Health Insurance. The content of this basket is expected to evolve between now and 2023.
• The "Rest à charge maîtrisé" basket: limited billing fees, but still chargeable to patients. The Assurance Maladie Complémentaire is not obliged to reimburse the full amount of these baskets of care (payment of the moderating ticket is compulsory).
• The "Free Tariffs" basket: no limit fees, so there is a higher charge, since the Assurance Maladie Complémentaire is not obliged to reimburse these baskets of care in their entirety (payment of the moderating ticket is compulsory)..

E. HEARING AIDS

As of 1 January 2020, 2 classes of equipment will be distinguished:

• Class 1: "Zero Load Remaining", which means that the devices concerned will be fully supported by the AMO and AMC.
  
• Class 2: "Free rates", which means that the devices concerned will be partially paid for by the AMO and AMC, with a ceiling of €1,700 per ear. Coverage by the responsible contracts is optional beyond the co-payme
  
  1. For under 20 year olds: coverage = 1700€ / ear; Social Security reimbursement basis = 1400€ / ear
  2. For over 20 year olds: coverage = 1700€ / ear; Social Security reimbursement basis = 400€ / ear