Who can benefit from Complementary Solidarity Health and how?

Arises from the merger between Universal Complementary Health Coverage (CMU-C) and Complementary Health Insurance Payment Assistance (ACS): Complementary Health Insurance (CSS) allows low-income policyholders to benefit from better coverage of their costs sanitary. In concrete terms, these two schemes have allowed low-income people to benefit from additional coverage of health care costs. However, the ACS struggled to achieve its goals as, according to the Ministry of Health, the failure to use the ACS affected half of the eligible people. “ This phenomenon is worrying when we know that more than half of policyholders who declare that they are giving up treatment do not have any supplementary health insurance. Additionally, people who benefit from ACS sometimes have to pay high contribution amounts and may have significant outstanding amounts to pay when their care is provided. “, He indicated in announcing the launch of complementary health solidarity from 1 November 2019.

Complementary health insurance is therefore an aid to cover health costs not covered by compulsory health insurance, within the limits of the rates established by the social security reimbursement base. It allows you to cover all costs without having to anticipate them on a very large basket of treatments including in particular: consultations with health professionals (doctor, dentist, nurse, physiotherapist), drugs in pharmacies, hospitalizations, medical devices (bandages, sticks, chairs wheels, etc.) and most glasses and hearing and dental prostheses. “ Your medical expenses are paid by the compulsory health insurance bodies and the organization you have chosen to manage supplementary health insurance. “, Underlines the Health Insurance on this issue. Depending on the beneficiary’s resources, the system costs nothing or costs less than 1 euro per day and per person, and can cover the entire household, knowing that anyone can apply for complementary health insurance.

How can I apply for Complementary Solidarity Health?

However, two criteria are essential, namely whether you benefit from the Health Insurance taking responsibility for your health costs due to your professional activity or residence in France and that your resources are less than an amount that depends on the composition of the servant. As such, health insurance provides concrete examples in the list of maximum annual resources to be eligible for it. For a single person, this limit is set at 12,921 euros, therefore 19,382 euros for a family of 2 people, 23,259 euros for 3 people and 27,135 euros for 4 people. “ The declaration of resources refers to the 12 months preceding the penultimate month during which the request is submitted. For a request submitted in January 2023, the resource consideration period is from 1 December 2021 to 30 November 2022. “, notes the organization. You can apply for supplementary health insurance from your ameli account (section My procedures) or by sending form S3711 and the required supporting documents to your health insurance.

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It should be noted that a dedicated simulator on the government portal mesdroitssociaux.gouv.fr allows you to find out in just a few clicks whether a person is entitled to supplementary supportive health or not. To carry out this simulation, information will be requested on: the tax return, pay slips, the lease agreement (rent) of the accommodation, the amounts of aid in progress. Upon receipt of the complete file, the health insurance fund examines the application within 2 months. If the decision is positive, the certificate of rights will be available on the ameli account or otherwise sent to a postal address in paper format. What about employees who already have corporate health insurance? Employees who benefit from supplementary health insurance can be exempted from enrolling in their employer’s mandatory collective agreement, knowing that this exemption is valid until the date the employee ceases to benefit from supplementary health insurance (it is available online an example of a letter to submit the request for exemption through the Ministry of Health).

An essential renewal every year and a possible appeal in case of refusal

On the contrary, the health insurance says “ that from 1 June 2022 it is possible to renounce one’s supplementary health insurance at any time, without reason, without penalties. This can be useful for beneficiary employees who have signed an employment contract with an employer that offers group coverage. Since 2022, the procedures have also been simplified for the recipients of the minimum social security contributions, i.e. that the request and renewal of the system are easier in two situations:complementary solidarity healthActive solidarity income earners(RSA)is automatic (when a request is madefrom RSA on the caf.fr website, the request is automatically sent to the health insurance company) unless they object, and beneficiaries of the solidarity allowance for the elderly (ASPA)automatically receive documents to subscribe to the device. The last essential step is, at the time of the request, to indicate the organization (complementary or healthcare) that will manage it.

However, it should not be forgotten that the right to supplementary health insurance is open for one year, starting from the 1st day of the month following the date of the health insurance decision. Its renewal is not automatic (with the exception of RSA and ASPA recipients), it is therefore advisable to make a new application as long as the same conditions are met as for the first time. And it is better, to avoid a violation of rights, to think about it a maximum of 2 months before their end (and not earlier than 4 months) on the ameli account. In case of refusal of a right to supplementary health insurance, it is possible to appeal against this decision by writing directly to the friendly appeals commission of your fund, whose address is given in the refusal letter, and this within a period of 2 months from the decision to refuse to exercise this appeal. When it was launched, the Ministry of Health estimated that at the end of June 2019 7.1 million people were covered by complementary health insurance thanks to the CMU-C and the ACS, but that this is more than 10 million people who could benefit from the Complementary Health Solidarity.

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