July 18, 2024

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Supplementary health insurance contract: what you need to know

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health insurance contract
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Complementary collective health insurance contracts taken out by companies for the benefit of their employees

The implementation of this contract is done by way of convention or collective agreement, company agreement or by unilateral decision of the employer. Depending on the case, membership of the collective contract is compulsory or optional.

Collective company contracts with compulsory membership

Since January 1, 2016, all companies in the private sector have been required to offer complementary health insurance to their employees (law of June 14, 2013). Several complementary health insurance contracts may be offered in the same company, but all employees must be covered. The rate and the employer’s contribution are identical for all employees within the same contract.

Membership of the contract is compulsory but there are cases of exemption, that is to say cases where the employee, due to a particular situation, can ask to waive this cover.

If the contract so provides, the employee may allow his dependents to benefit from his company coverage.

In addition to the base of guarantees provided on a mandatory basis, the mandatory collective contract may provide for the subscription of options; these, intended to supplement the basic guarantees, are left to the free choice of the employee and are taken out on an individual basis.

The contours of mandatory collective company contracts and their implementation methods were specified by the law of June 14, 2013 generalizing complementary health insurance to all private sector employees from January 1, 2016.

The guarantees and the price of a compulsory collective contract may change annually. The company and the insurer each have the option of terminating the contract on its principal expiry date, subject to compliance with the applicable notice period.

Since December 1, 2020, the company can terminate the contract at any time after the expiry of a period of one year from the first subscription, without costs or penalties.

If the company wishes to terminate its contract to take out a new one with another organisation, this new organization carries out the termination formalities with the old one and ensures that the cover is not interrupted during the procedure. .

Termination takes effect from one month after receipt of the notification of termination by the insurer.

In the context of a mandatory collective contract, the employee cannot make use of this option to denounce his adherence to the contract.

In the event of departure from the company, the employee may, under certain conditions, retain the benefit of his coverage or of an exit contract.

Maintenance of guarantees in the event of dismissal or contractual termination

The employee whose employment contract is terminated (except for gross negligence) and whose termination opens up coverage by unemployment insurance, benefits from the portability of his rights, i.e. maintenance of the additional cover in force in his former company, free of charge and for a period equal to the duration of the last employment contract, within the maximum limit of 12 months.

Compulsory collective contract exit contract

Former retired employees, beneficiaries of an incapacity or invalidity pension, former employees compensated for unemployment (at the end of the portability period) can benefit from an exit contract from their complementary company insurance ( law of 31 December 1989).

The exit contract cannot be subject to any probationary period or to any medical questionnaire and must be unconditional in duration. It should be noted that the entire contribution is payable by the former employee (there is no longer any employer contribution). The rate cannot be higher than the overall rates applicable to active employees the first year. It cannot exceed the rate paid by active employees for this contract by more than 25% the second year and 50% the third year.

The insurer of the company’s collective contract must send a proposal for an exit contract at the latest within 2 months of the termination of the employment contract or, where applicable, the expiry of the portability. The former employee must make his request to subscribe to an exit contract within 6 months of the end of his employment contract or, where applicable, within 6 months of the expiry of the portability period.

The heirs of a deceased employee, head of the family, can, under the same conditions, benefit from an exit contract.

The exit contract is generally an individual contract or a collective contract with optional membership. The former employee is free to subscribe or not, to subscribe to another contract (for example deemed more suited to his needs as a retiree) or to change insurer.

Collective company contracts with optional subscription (“additional supplements”)

To enable employees to complete the services offered under a compulsory collective contract, an employer can offer a collective contract with optional membership. This second contract, also known as the “additional contract”, is taken out by the company but is for individual membership: each employee decides whether or not to benefit from it and can, if the contract provides for it, allow their beneficiaries to benefit from it.

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