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 Post subject: Mutuelle
PostPosted: Tue Jan 16, 2018 10:06 am 
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Posts: 137
The dilemma is that is it worth having it, we both have regular medication, doctors visits, blood tests etc., so what might be termed as the norm when you are cracking on a bit. I recently, on a 3 monthly doctors visit was told I had an irregular heart beat, spent three days in hospital, given different medication and within a couple of days it was back to normal, then on a further visit our GP said he was going to put me on ALD, and for some reason put the Mrs on it as well. I feel sure that mine is for the heart, but hers he mentioned her diabetes, but she doesn't have diabetes, but anyway all of our regular medication is now covered by CPAM. On a recent visit to the clinic to have our eyes checked, again all of the costs were treated as 100% reimbursement by CPAM, albeit that fell slightly short of what was actually paid out. The thing I am trying to ascertain is the viability of paying out around 1000€ a year to Pacifica, because since this ALD was announced last September, they have made not made a € contribution to any expenses whatsoever. I am informed by Pacifica, when questioned that yes 100% cover for the nominated complaints but should anything else crop up I will only get 70% from CPAM, but I can't reconcile the eye test, in my case with a heart problem, a heart problem which I am told is a very common thing and which, at the moment, I seem to be free of. They added that is the nature of insurance, it is there if you need it but if you don't it is money down the drain, however should I be looking at a different type of cover, after all if you bought a 15 year old car for say 300€ you would hardly pay out 450€ a year on all singing insurance. There seems IMHO a sort of scare tactic over this insurance, I know that hospital stays etc. are not cheap, but in any event if you are getting 70% back it's not as if it is going to bankrupt you, hopefully, if you have to find the rest. Any pointers appreciated.


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 Post subject: Re: Mutuelle
PostPosted: Tue Jan 16, 2018 10:46 am 
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Joined: Sun Feb 01, 2009 6:50 pm
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Location: somewhere in the "pays de dropt"
As with any insurance its expensive paying out , till you need it.
We have had mutuele for years but when I was hospitalised back in 2010 for a hernia even with cpam it would have cost a lot.
Last year I had an emergency ulcer operation in April followed by my complete right hip replacement in October with both we are glad of the mutuele.

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 Post subject: Re: Mutuelle
PostPosted: Tue Jan 16, 2018 11:21 am 
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Joined: Sat Jan 31, 2009 4:03 pm
Posts: 24537
Location: Ille et Villaine (35)
Normalement ALD kicks in if you have a life threatening illness, such as cancer, heart problems and diabetes, though it doesn't cover everything. I had to pay for my hospital bed (2 nights) when I was operated on for cancer and perhaps a mutuelle would have covered that.
OH has always been unwilling to pay out for a mutuelle despite what the docs recommend and my pleas. I am no longer on ALD but OH is for the next 5 years. So far we haven't been out of pocket and at the moment, neither of us is on any sort of medication. But as one advances in years, it does seem the sensible thing to do - it only takes one complicated operation or a serious accident with weeks in hospital to run up a massive bill.

Sorry, Hughnique, this isn't really of help to you ! Why not discuss it with your doc next time you see him or CPAM - they would be less biased than going to Pacifica, who have a vested interest !


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 Post subject: Re: Mutuelle
PostPosted: Tue Jan 16, 2018 12:19 pm 
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Joined: Thu Mar 19, 2009 9:20 am
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Location: Le Périgord Vert (24)
I thought it was obligatory to have a mutuelle. My one hospital stay, 10 days for 2 operations didn't cost a penny for which I was thankful. Apart from that the insurance company is definitely in the black on my account.

However, not all are the same, I am on my 4th in 20 odd years. The first only paid out on production of receipts from me, even at the pharmacie. The second, Generali, failed to answer a simple question over several weeks so I dumped them, giving all the correct notice etc. yet despite the fact that they agreed that I had, still demanded €1400 for the following year and threatened me with bailiffs.

The next, Sofincas, wasn't much better. They actually downgraded my plan to a lesser one, took the same money and then denied what they had done.

Now with Aviva, so far so good, and if they give anything like as excellent a service as they do for the car, they'll do for me. Around €1200 pa.

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 Post subject: Re: Mutuelle
PostPosted: Tue Jan 16, 2018 1:31 pm 
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Location: Ille et Villaine (35)
Spardo wrote:
I thought it was obligatory to have a mutuelle.

Not at all - medical folk always ask if you have one though !


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 Post subject: Re: Mutuelle
PostPosted: Wed Jan 17, 2018 7:23 am 
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Location: The Republic of Limousin
It's a big problem unless you're relatively young, a fonctionnaire or employed. The older you get, the more expensive it becomes, but depending on income there are government grants towards mutuelles. You can input your data heare to see what help you might get https://www.ameli.fr/assure/droits-demarches/difficultes-financieres/complementaire-sante/aide-paiement-complementaire-sante

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 Post subject: Re: Mutuelle
PostPosted: Wed Jan 17, 2018 10:59 am 
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Joined: Thu Jan 26, 2012 9:43 pm
Posts: 137
Thanks Mad, I have been in benefit in the past of the government assistance, firstly they paid it all for one year then they gave 500€ each towards the cost for the following year, then it disappeared. I think my revenus hover just under the ceiling and dependent on the rate of exchange, as pensions are UK sourced, as to whether or not I get anything. I did a quick simulation with your link and it looks as though there might be a glimmer of the contribution assistance again. Possibly the ceiling for benefit has raised, and coupled with the crap rates, might have dropped me back in it. Worth a go, didn't really come here to sponge but circumstances as we all know, can dramatically change due to financial matters, remember when I was getting 8% + on savings that changed not long after we moved here so income based on that quickly evaporated along with the capital invested.


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 Post subject: Re: Mutuelle
PostPosted: Wed Jan 17, 2018 11:32 am 
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Location: The Republic of Limousin
It's not a question of sponging! I've been doing it myself in anticipation of the day we stop work (no plans yet). Our SwissLife mutuelle is a Madelin contract for business deduction purposes, so not too painful at the moment. The French shop around too and I'm waiting to find one of these famous "contrats groupés" I keep hearing about but never see....

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 Post subject: Re: Mutuelle
PostPosted: Wed Feb 14, 2018 2:42 pm 
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Joined: Thu Jan 26, 2012 9:43 pm
Posts: 137
Done the simulation put in the pensions and the fact that we didn't pay rent as house is ours and it came up as I was eligible for assistance.
Great, went down to CPAM for the form and told I had to make a RDV to fill it all out with them to help me, earnings OK for assistance but the fact that we own our property bangs 135€ a month on to my earnings which takes us slightly over the ceiling, so no joy therein.
Same old story as the UK if you try and help yourself in life it backfires sooner or later, just when I thought we might afford a bit of beef at the weekend.


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 Post subject: Re: Mutuelle
PostPosted: Wed Feb 14, 2018 9:13 pm 
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Joined: Sun Feb 04, 2018 6:31 pm
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I think you'd expect the thresholds to be different for someone whose income has to cover rent or a mortgage as opposed to someone who doesn't. In the UK you'd be assessed for means tested benefits on your capital, so I wouldn't complain.


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 Post subject: Re: Mutuelle
PostPosted: Fri Feb 16, 2018 10:53 am 
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Joined: Thu Jan 26, 2012 9:43 pm
Posts: 137
Hardly a complaint but it is annoying when the simulation asks for the information and then says you are eligible so 2 trips to the CPAM offices and then it's a no. Can't see the point in the simulation if that is the case.


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