Supplemental Healthcare Insurance Mandatory for French Employees

Beginning January 1, 2016, companies of every size operating in France must offer their staff supplemental healthcare insurance. Asinta’s French partner GEREP shares their insights with us.

The ANI “basket of covers”: minimum basic cover

An obligatory healthcare scheme must offer all staff minimum basic cover. This is known as the ANI “basket of covers”. The scheme should, in particular, cover the entire Social Security co-payment amount (i.e. the amount to be borne by the insured on reimbursable visits to the doctor and on treatment – ticket modérateur in French), the daily hospital charge (forfait hospitalier), dental expenses up to 125% of the SS regulated tariff as well as various ophthalmic benefits. It is the employer’s obligation to make sure your supplementary healthcare plan complies with this minimum “basket of covers”.

50% of contributions are borne by the company

Likely rate quotes on supplementary healthcare schemes that are compliant with the basket of covers are between €15 and €20 per month depending on the insurer and the services offered. At least 50% of that amount must be paid for by the company. As long as the scheme is a “responsible” policy then contributions will be subject to CSG and CRDS social charges but exempt from all other social charges and from the flat social charge in the case of companies with under 10 staff. The rules that make a policy “responsible” do actually put a cap on the covers provided to staff. If you decide to offer covers that go beyond the basic core covers then do make sure that this does not mean that you are outside the scope of a “responsible” policy.

Transferability: can this be a trap for the employer?

Transferability of cover is one of the major innovations in recent French legislation on supplementary health insurance. After leaving the company, staff who are receiving unemployment benefits as job seekers remain covered by the scheme to the same extent as current employees, for up to 12 months. As the employer, you do not have to do anything. Your insurer takes care of things, provided, of course, you do not change insurance providers during that time. If that happens then it is up to you, the employer, to provide the new insurer with a list of staff members enjoying maintenance of coverage. This is an additional burden that involves a risk for the company.

Formalities and things to watch out for when setting up a healthcare scheme.

These new obligatory healthcare schemes are not necessarily mandatory for all staff members. The law provides for a number of cases for contracting-out. For instance, if an employee is already covered under his/her spouse’s supplementary health insurance then that staff member is not obliged to join your company’s scheme. This is a sensible decision for both parties and will save money, but this option to contract out must be stipulated in the scheme terms and conditions at the outset.

Once the scheme document has been drafted, employees must approve it. In small to medium companies (SMEs) this will generally happen through a process known as an Employer Unilateral Decision. This does not involve any discussion with staff but carries with it the obligation to publish the decision and keep evidence that staff have been informed i.e. by registered letter with return receipt, a letter delivered by hand against a receipt or a register of signatures, etc.

Employee benefit requirements are changing all the time. If you need assistance or have questions about this legislative requirement in France, please contact us and we will respond to you within two business days.