The various items of expenditure on health

Coverage of physician fees

There are 3 categories of doctors: 

Doctors Area I: they apply the conventional tariff (includes 3/4 of doctors) 

The doctor Sector II: they are allowed to go beyond the conventional tariff (includes 1/4 of doctors) 

The Doctors of Sector III: they have not signed an agreement with the Social Security (about 500 doctors). In this case, the compulsory scheme bases its reimbursement on a symbolic tariff: the authority tariff. 

A mutual insurance company can cover any overpayment of physicians' fees.

Drug Coverage

The social security reimbursement rate varies:

- 100% of the convention rate for irreplaceable and expensive medicines 
- 65% of the convention rate for other reimbursed medicines (white stickers) 
- 35% of the convention rate for so-called " (Blue stickers) 
- 15% for medicines for which the "actual service rendered is insufficient" (orange sticker) 
- 0% for non-reimbursed medicines 

Similarly, your health insurance may cover the amount not reimbursed by the secu.

Coverage of optical costs

Optics are poorly repaid by the Social Security:  

Glasses
Even if the glasses of children under 16 years are better reimbursed, the conventional rates do not correspond at all to the market prices. 

The frames
The conventional price is 30,49 € for a child mount and 2,34 € for an adult mount! 

Lentils
They are rarely refunded (except for children) and when they are, the convention rate is not related to actual prices.

Coverage of dentist fees

Dental care: Dental
care is reimbursed up to 70% of the convention rate by the Social Security. 

Orthodontics
Orthodontics is only reimbursed by the Social Security for children whose request for preliminary agreement was transmitted before the 16th birthday. The request for an agreement must be renewed every 6 months. The duration of orthodontic care is 3 years on average. 

Dental prostheses
There are 2 broad categories of prostheses: 
- fixed prostheses 
- removable prostheses. 
Regardless of the type of crown, the mandatory regime repays 70%.

Coverage of radiology and laboratory costs

The Compulsory Plan reimburses: 

- radios at 70%, 
- analyzes at 60%

Coverage of Hospitalization Expenses

Social Security reimburses: 

- 80% if there is no surgery or if it is a minor intervention (vegetation, ingrown toenail ...). Beyond the 31st day, 100% coverage 

- 100% for the most important interventions 

Attention to the choice of the establishment ! 

- In the case of a hospital in the public sector : the conventional rate (TC) is respected. Depending on the nature of the hospital stay, you may be charged 20% of the CT, hospital and ancillary costs (private room, telephone, etc.). 

- If the hospital is private or Of a convention clinic : The conventional tariff is not always respected and it can therefore remain at your charge: 20% of the CT, the overtaking of the CT, the fixed hospital and ancillary costs. 

- In the case of a non-contracted clinic : the tariffs are free and the Social Security reimbursement is based on lower tariffs than those used for the approved establishments.