Eric Maumy, Chief Executive of Verlingue, explains in the dossier by L’Opinion focusing on social protection.
L’Opinion: What preliminary assessment can you make of the generalisation of healthcare insurance?
Eric Maumy, Chief Executive of Verlingue: “All businesses have been under an obligation to offer health insurance to their employees since 1 January 2016. This has not made much difference in large firms which were, for the most part, already covered. The generalisation has above all concerned
and, from that point of view, the assessment is positive. The government has made businesses the central pivot in terms of complementary health insurance.
As a general rule, all businesses have started to assume responsibility for this role and have become increasingly active in this area, for example on aspects such as the prevention of health risks. Businesses have also realised that they had every interest in looking after their healthcare plans and their major balances, by involving the employees and social partners. ”
At almost the same time, there was a reform of responsible policies. What conclusion do you draw from this?
“In fact, the reform of responsible policies came on top of the generalisation of complementary insurance with major financial penalties for businesses that were not in compliance. This has required significant legal back-up from us to safeguard the arrangements of our customer businesses and make their policies “responsible”. In reality, the public authorities have introduced coverage ceilings for medical consultations and on eye care. In order to bring themselves into line with these new regulations, the best insured businesses had to align their coverage downwards.
From 1 January 2018, all business healthcare systems must follow these new rules and apply reimbursement ceilings. For eye care, the ceiling is relatively high, but things are different for medical consultations. Businesses with good insurance provided for reimbursements that were often considerably higher than the new rules. All medical fees for an amount in excess of the ceiling will remain solely at the expense of employees. However, the prices for specialist consultations are often higher, especially in large cities. With this move, the average after-insurance cost for employees has literally taken off. ”
“This is a very painful situation for employees, especially those needing ongoing healthcare treatments in hospital”
What do employees think of this? Are they aware of this potential explosion of their after-insurance cost?
“They have begun to notice. 80% of businesses in our portfolio have already switched over and 20% have chosen to wait until the last minute, 1 January 2018, before applying the new rules. In this way, they have allowed their employees more time to enjoy the better coverage . Since 1 January however, all businesses have switched over and the employees concerned are about to discover that their coverage is not as good as before. ”
On what items exactly are these after-insurance costs the highest?
“There is an uneven distribution depending on the medical disciplines. It is mainly on hospital consultations – fees paid not only to the surgeon carrying out the operation, but also the anaesthetist – that the after-insurance costs have sky-rocketed, by more than 140% on our portfolio. For specialist fees, the increase in after-insurance cost reaches 38%. This is a very painful situation for employees, especially those needing ongoing healthcare treatments in hospital and who now, from one day to the next, find themselves with a substantial after-insurance cost. ”
Have businesses found ways to alleviate this reduction in coverage?
“Yes, the dominant model on the market combines an additional voluntary contribution with a basic plan: the employer commits to a first level of group and compulsory coverage and allows employees to access additional coverage on a voluntary basis. This solution enables us to limit the after-insurance costs and protect the level of coverage. At Verlingue, close to 70% of policies put in place for our customers in 2017 are based on this model. ”
“The increase in the after-insurance cost has therefore often affected the most serious and painful cases. This shows that reforming the responsible policy has no logical basis”
Does it not seem paradoxical to look for zero after-insurance cost on glasses, dentures or hearing aids when hospital treatments, to the contrary, will be showing new after-insurance costs?
“It is indeed a real paradox. The items concerned by the zero after-insurance cost are eye care, dental care and hearing aids. The change in the after-insurance cost due to the responsible policy concerns the items fees and hospitalisation. The increase in the after-insurance cost has therefore often affected the most serious and painful cases. This simply shows that reforming the responsible policy has no logical basis. It does not take the reality of medical costs and practices into consideration, especially as healthcare insurance operators were not involved in the decision. ”
What do you think of the French President’s promise to achieve a zero after-insurance cost on glasses, dentures and hearing aids?
“These are noble objectives. We support them. The key question is how will they be achieved. At present, the taxes on complementary healthcare insurance systems amount to almost 5 billion euros. In order to arrive at a zero after-insurance cost, it is necessary to find a way to fund the current after-insurance costs on dental care, eye care and hearing aids, standing at 4.4 billion euros in total.
Reducing the taxes on complementary healthcare insurance would make it possible to absorb part or even all of the new amounts to be funded. This would be a good indicator of the government’s intention to alleviate the tax burden that is weighing on businesses and employees. ”
Interview by Mireille Weinberg – L’Opinion
Verlingue, insurance broker
Verlingue is one of the top French insurance brokers. It covers all the needs of businesses: non-life and third party liability insurance, as well as social protection for employees.