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what reimbursement to expect from the social security and the mutual?

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Each person with symptoms of Covid or being in contact must isolate themselves and consult their general practitioner. It is then a question of being screened via one of the three different tests available. However, one of the concerns of citizens is the reimbursement of this service by Social Security and their mutual.

Everything you need to know about reimbursement of expenses

A few weeks ago, a publication of the site Public service evoked new medical procedures and the handling of procedures in connection with the coronavirus. In the case of people with symptoms (or contact cases), it is the responsibility of consulting their general practitioner. However, some citizens ask themselves the reimbursement question from the Health Insurance and try to understand the list of mutual insurance coverage.

Reimbursement of medical consultations

This consultation is reimbursed according to the same conditions as for another pathology: the Health Insurance covers 70% of the bill and the co-payment (the remaining 30%) are reimbursed by the mutual if the patient has one. A flat-rate contribution of 1 € remains to be paid, except for children and adolescents, pregnant women over 6 months and beneficiaries of complementary solidarity health (CSS) or state medical aid (AME). Concretely, for a Covid consultation with an attending physician by an adult, Social Security reimburses € 16.50 and patients with a mutual receive € 7.50 additional.

To limit the risk of transmission of Covid-19, it is possible tohave recourse to teleconsultation which, like the nursing tele-monitoring, is 100% covered by health insurance. Normally, the attending physician should be consulted, but if unavailable, the patient may turn to another physician. Even if the consultation is fully reimbursed, the amount must be advanced if the professional does not use third-party payment.

Credit: Pixabay / DarkoStojanovic

Coverage of tests and vaccines

There are currently three different types of tests: PCR, antigenic and serological. Both first are 100% supported without prescription by the Health Insurance. In the case of the serological test, the coverage is complete with prescription only. For 100% coverage without a prescription, it is necessary to go through a mutual. Since April 12, 2021, the self-tests are on sale in pharmacies. They are not covered by the Health Insurance, but they can be by a mutual.

The vaccines are covered 100% by Health Insurance for all French people, as and when they become eligible.

Other reimbursements related to the Coronavirus

The list of mutual insurance coverage does not stop with consultations and tests. Masks, hydroalcoholic gel and treatments are also concerned.

Currently, there is no reliable treatment for Covid. In general, patients are prescribed paracetamol to treat symptoms including reducing fever. The reimbursement portion of theHealth Insurance is 65% and the reimbursement of the mutual will amount to 35%.

The masks are covered by Social Security in certain cases only: patients positive for the coronavirus or vulnerable patients. A prescription is necessary in this second case. For other people, only a few mutuals offer reimbursement for masks. In this case, the invoice must be sent to the complementary health organization.

The hydroalcoholic gel is not covered by Health Insurance, but its price is capped at 1.79 € / 50 ml bottle. Some mutuals reimburse it as part of a Covid-19 package or the self-medication guarantee.

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Management of work stoppages

Work stoppages related to Covid-19 are variable: patient with coronavirus, contact case, parent on leave for childcare, vulnerable person … Depending on the case, it is necessary to declare your sick leave online on the website or be prescribed a stop by a health professional or by the Health Insurance.

For a judgment concerning employees, the Health Insurance covers 90% of gross salary with 0 days of waiting. The mutual insures the remaining 10%. For the self-employed, health insurance coverage varies and is associated with a waiting period of three days. On the other hand, a mutual fund can take care of the gross salary up to 100%.

Finally, remember the possibility of joining an intelligence platform on 0800 130 000 in order to obtain information on Covid-19. If rapid intervention is required, joining the Samu (15) is required. We can also mention the European emergency number (112) for a call from a European country (or from a cell phone).


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