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):
- Introduction of a ceiling for audio coverage: limitation of the reimbursement of the Compulsory Health Insurance and the Complementary Health Insurance to 1700€.
- The reduction of the existing ceilings of csupport in optics: reduction of the reimbursement of frames from €150 to €100.
- 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:
- 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).
- 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
- For under 20 year olds: coverage = 1700€ / ear; Social Security reimbursement basis = 1400€ / ear
- For over 20 year olds: coverage = 1700€ / ear; Social Security reimbursement basis = 400€ / ear
Premium bases: exclusive of tax or inclusive of tax?
Why are the premium bases in construction insurance expressed in exclusive of tax or inclusive of tax?
The premium bases are in fact expressed in exclusive of tax or inclusive of tax depending on the type of guarantee concerned:
- The premium base for the project owner's Civil Liability cover is expressed in inclusive of tax because the compensation will be paid to a third party, who, in turn, will have to pay a company in inclusive of tax to have it carry out the repairs following the damage
- The premium base of the All Risks Construction Site guarantee is, most often, expressed in exclusive of tax. In fact, repairs are usually carried out by the companies in question. The repair borne by the company responsible for the damage is then considered as the fiscal accessory of its market of origin on which it has already paid the VAT. It is therefore not liable to pay any new VAT on the repair work which it carries out itself or which it subcontracts to another firm..
The basis of assessment will therefore only be expressed in euros including inclusive of tax if the Contracting Authority takes on the task of selecting a new firm (which has not already paid VAT on an original contract and will therefore have to pay VAT for this new contract) to carry out the repairs.
- The premium base for the Work Damage Guarantee is expressed in inclusive of tax, which is easy to understand, since the repairs can take place 10 years after acceptance and can be made by the company that carried out the initial work or not. Moreover, the repair can no longer be considered as a fiscal accessory of the first building site.
The news : The Coronavirus
Does a contract cover the risk of an epidemic?
If we consider COVID-19 in terms of its consequences on people's health, then no contract strictly speaking covers the risk of an epidemic, but it is health insurance that is at the heart of compensation and medical care.
Health insurance even intervenes to pay daily allowances to people who are confined to their homes and cannot work from home.
As a result, the insurance market will be impacted in its mutual and provident branch:
- Mutual insurance, for the usual care coverage;
- provident if employers have to compensate for the variations between the daily allowances paid by the health insurance and the salaries usually paid.
However, COVID-19 is also becoming increasinglytalked about because of the economic consequences it causes: according to the World Bank, a pandemic on the scale of the 1918 Influenza epidemic could reduce world GDP by 5%. de 5%.
Many traders are already feeling the negative effect of this
epidemic and the restrictions and fears that accompany it. And, it must be admitted, very few traders are insured against the risk of Business Interruption due to an epidemic, since most often only Business Interruption due to a guaranteed damage is covered: for example, Business Interruption
due to fire or water damage - which is itself supported - is covered.
On the other hand, cancellation insurance taken out by event organisers should be able to function, as long as the cancellation of events is decreed by the government.
What could be the insurance solution?
The insurance solution does exist, it would be necessary to have taken out a Business Interruption policy without damage. To be clear and concise, we are on the same principle as Cyber or Terrorism Risk insurance. It is hard not to think of the long, even tedious beginnings of cyber risk insurance: high premiums, high deductibles, difficulties in defining the scope of coverage, many new entrants to the market for this insurance... And, this is what also appears in the case of insurance against health risks.
Indeed, according to a survey of risk managers conducted by AMRAE last December, 55% of the companies surveyed considered taking out a specific policy without damage... before giving up because of an almost non-existent offer, with both high premiums and deductibles and a very complex and tedious underwriting process.
Following COVID-19his market will undoubtedly develop, but, if we are to believe Christophe Eberlé, Managing Director at Optimind: "On health risk, as well as cyber risque, insurers are faced with a difficulty in assessing the scope of the risk and the insurable mass. But, over the next ten years, these two risks may create more turnover for insurers but also more uncertainty".
Can I take out this type of contract?
If, unlike other companies, you are not discouraged by the underwriting procedure and the high rates, then yes, you can take out this type of insurance, since some insurers distribute it.
But keep in mind that, for COVID-19, it is already too late! Indeed, the purpose of insurance is to insure a hazard, not a certain risk! You can only anticipate the next epidemic, while being well aware that insurance models give this risk very little probability, between 0.5 and 1% annually.
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