Comprendre les critères de tarification d'une mutuelle santé

The pricing criteria of a mutual health insurance: a guide to understanding

Mar 29, 2023

Mutual health insurance, also called complementary health insurance, is an additional cover intended to reimburse health expenses not covered by compulsory health insurance. The contributions of these contracts vary according to several criteria, which it is important to know in order to make an informed choice. Understanding the pricing criteria allows policyholders to select the mutual health insurance best suited to their needs and budget. This article offers you an overview of the factors influencing the price of health insurance.

I. Demographic criteria

1. The age of the insured

Age is one of the main pricing criteria for mutual health insurance. In general, the older the insured, the higher the premiums. Indeed, the risk of disease and health care costs increases with age.

2. The gender of the insured

The sex of the insured can also influence the rates. Women can sometimes pay higher contributions, in particular because of their longer life expectancy and their specific health needs.

3. Family situation

The composition of the household impacts the price of the mutual health insurance. Mutuals generally offer formulas adapted to singles, couples and families, with decreasing rates according to the number of insured persons.

4. The geographical area

The place of residence of the insured can affect the price of the mutual. Prices vary by region, in particular due to differences in the cost of living and the pricing practices of healthcare professionals.

II. Criteria linked to the professional profile

5. Professional status

The professional status of the insured (employee, self-employed, retired, etc.) influences the rates of mutual insurance companies. Certain categories benefit from preferential rates or specific aid.

6. Socio-professional category

Mutuals take into account the socio-professional category (CSP) of the insured to determine the rates. Higher CSPs, generally with higher incomes, often pay higher dues.

7. Affiliation to a collective or company agreement

Employees benefiting from company mutual insurance often benefit from preferential rates. The employer covers part of the contributions, which reduces the amount payable by the insured.

III. Guarantees and levels of coverage

8. Basic guarantees

The basic guarantees include reimbursements for routine care, such as medical consultations, medications and analyses. The level of reimbursement of these guarantees influences the price of the mutual. You can find the rates of mutual health insurance on this page in order to establish a first comparison.

9. Optional guarantees

Optional guarantees, such as dental care, optics, alternative medicine or spa treatments, can be added to the basic contract for an additional contribution. Policyholders can thus personalize their cover according to their specific needs.

10. Reimbursement ceilings and deductibles

Reimbursement ceilings limit the annual amount covered by the mutual insurance company for certain treatments. Deductibles may also be applied to certain refunds. The higher the ceilings and deductibles, the lower the contributions.

11. Third-party payment

Third-party payment is a system that allows the insured not to advance health costs. It is covered by the mutual insurance company and can be offered for certain treatments. Its inclusion in the contract may influence the rates.

IV. Criteria related to the state of health of the insured

12. The medical questionnaire

Some mutuals submit new members to a medical questionnaire. The answers provided may influence the rates, particularly in the event of a medical history or pre-existing pathologies.

13. Medical History

The medical history of the insured can impact the rates of the mutual. Certain pathologies or past treatments may lead to an increase in contributions or an exclusion from cover for certain services.

14. Chronic or pre-existing illnesses

People with chronic or pre-existing conditions may face higher rates, due to the increased risk of healthcare costs.

V. Benefits and reductions

15. Loyalty and seniority bonuses

Some mutuals offer loyalty or seniority bonuses, rewarding policyholders for the duration of their contract. These advantages generally result in reductions in contributions or improvements in guarantees.

16. Discounts for non-consumption

Mutuals can offer reductions in contributions to policyholders who have not consumed all of their reimbursement ceilings over a year. This encourages policyholders to adopt responsible health behaviour.

17. The benefits of prevention and support

Some mutuals offer prevention and support programs to improve the health of their policyholders. These services can include workshops, free health checks, or personalized advice, and can impact the rate of the mutual.

VI. Competition and regulatory criteria

18. The impact of competition on prices

The mutual health insurance market is very competitive. Organizations can adjust their rates to attract new customers or retain existing customers.

19. Regulatory and legislative requirements

The laws and regulations in force, such as the establishment of responsible contracts or the generalization of complementary company health insurance, influence the rates of mutual insurance companies. Organizations must comply with legal requirements, which may result in price adjustments.

20. Developments in the healthcare market

Changes in the health sector, such as the increase in the cost of care, medical innovations or demographic developments, can impact mutual insurance rates. Organizations adapt their offers and prices according to these changes.

VII. Conclusion

21. Summary of main pricing criteria

To sum up, the pricing criteria for mutual health insurance are numerous and varied. They include factors related to demographics, occupations, guarantees and levels of coverage, the state of health of the insured, benefits and reductions, as well as elements related to competition and regulation.

22. The importance of comparing offers and choosing the right health insurance

Faced with the diversity of offers and prices, it is essential to compare health mutuals in order to find the one that best suits your needs and your budget. Take into account the different pricing criteria, evaluate the guarantees offered and the levels of reimbursement, and do not hesitate to ask for personalized quotes. By taking the time to research the different options, you can make the best choice for your health and your wallet.

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