WHAT DOES the 100, 150, 300 in the Argent Plan names actually mean?
The meaning of terms such a 100, 150, 300 etc. that you may see in connection with Medical Insurance Plans often causes confusion. The figures represent percentages
The 100% question is complicated. There is a List published in France called the Tarif de Convention (TDC). This is an official pricelist for all medical and surgical treatment and medications; reimbursements made by CPAM and all top-up insurers are based on it..
For instance the official price for a consultation with a doctor is €21.
- CPAM’s reimbursement is € 21 x 70% = €14.70 – €1 statutory charge = €13.70
- If you have purchased Argent 100 we would reimburse €6.30 leaving €1 as the statutory charge that no one is permitted to reimburse.
- However, had the doctor charged €30 you would be left with the extra €9 to pay as well.
- If you had taken the Argent 150 the guarantee would be € 21 x 150% = € 31.50 so we would have met the extra €9 and you would be left with only the Statutory Charge to pay.
Had you bought the ARGENT 300 Plan we would cover up to 300% of the TDC. That means up to €60. In addition, the higher level Plans normally cover higher levels for Dental Care and private rooms.
Such exotic charges are unusual for doctors except in high cost areas such as Paris and Nice. However, extra charges called Depassements are usually made by specialists everywhere and often by surgeons.
The solution for you is to consider your pocket, where you live and to take care to use the right practitioners. These are Conventionée Sector 1. and even then always ask for the price.
You may well ask why medical practitioners are permitted to charge more than the TDC and why does the Depassement system exist. As you are possibly aware the French NHS is officially rated by the World Health Organistation as the No 1 with the UK and the USA trailing far behind. Your expectation of life in France is said to be 7 years more than it is in the UK; that is the upside but there is a downside. Possibly the French system is the most expensive NHS to maintain at such a high level of excellence and availability and the cost has to be met. This is done in a number of ways one of which is the Depassement system resulting in the patient paying an increased share of the cost of treatment.
The level of insurance you need to cover these extra charges depends on where you live and your life style. If you live in Paris or Nice where costs are high you need an Argent 300 Plan. If you live in a more rural area an Argent 100 or an Argent 150 may be sufficient. If you have an extravagent life you can spend money wherever you live.
We provide an advisory service on this aspect of healthcare for our clients and send them regular reports when there are changes. We aim to ensure they have the best healthcare at the correct cost.
If you want to discuss this important matter you can contact us
|
|