#NEWS

06/12/2017

Complementary social protection – a quick overview before new reforms take place

Social protection featured prominently in debates during the last election campaign. Findings and imperatives largely concur in terms of dealing with the healthcare deficit or improved access to care. Social Security for its part continues to complicate its nomenclature and pass on the burden to complementary insurance (cf. recent announcements regarding the Draft Budget Bill). It remains far removed from the reality of medical practices and the costs suffered by insured parties (e.g. medical procedures that are not recognised by the Social Security).

 

As a presidential candidate, Emmanuel Macron already started to reveal the roadmap for his five-year term: coverage for dentures, clarity in complementary health insurance contracts, development of preventative care, etc. Many French people can of course adhere to these objectives, and to reach them, a paradigm shift might be necessary.

In this respect, the reinforcement of “Social Security/complementary insurance companies” is a major task. A better distribution of roles, increased communication flow, technological innovations and more would certainly bring French people perceivable benefits.

 

While we wait for the next steps, let us look at three important changes from the latest Parliamentary session:

 

Designation clauses struck out by the Constitutional Council (CC)

 

The CC decision (June 2013) was of fundamental importance as it underlined companies’ freedom to choose an insurer and counters the practice of designation clauses in branch agreements. Since then, many companies have chosen to leave the insurer that they had been tied to previously, basing their decision on value for money, management quality and the services offered to their employees.

 

Making complementary health insurance available to all

 

Since 1 January 2016, complementary health insurance applies to all employees. The employer, regardless of the business sector or size of its staff, must offer and finance 50% of the collective, compulsory plan that is put in place. In deploying this measure, the legislator has managed to add an extra layer of complexity between “health voucher” rules and waiver of affiliation for which secure processes must be adopted.

 

New rules for the so-called “responsible” contract

 

The purpose of the rules applying to healthcare coverage contracts is to influence the behaviour of insured parties and healthcare professionals. Non-compliance will lead to heavy fines for employer and employee alike. The implementation of these standards (e.g. coverage ceilings) has negative consequences in that it considerably increases the remainder to be paid on specialist procedures and fees (> 10% on all expense items). Possible solutions should come from a thorough analysis of medical consumption and geographic location (e.g. Paris or Regions).

 

What are the prospects for 2018?

 

The French Government has set the national growth target for health insurance expenditure (ONDAM) for 2018 on 2.3%. In the past twenty years, health expenditures covered by Social Security have increased by an average 3% per year.

 

In this context, risk control (inability to work, etc.) and the management of collective health and providence schemes remain an imperative in order to control healthcare budgets.

 

Besides the budgetary aspects, the efficiency of these measures must also be assessed in terms of how they match economic and social specificities (average age, family structures, etc.) and the quality of management offered to HR teams and employees.

 

Healthcare plans that make use of a collective base and optional further complementary benefits are the dominant pattern today, and offer solutions that are better adapted to different families’ needs.

 

Another optimal solution is to offer new services (medical teleconsultation, online quotes, healthcare networks, prevention programmes, etc.) and ample digital facilities.

New employees pay attention to such measures which enhance a company’s social competitiveness.