.jpg?fit=%2C&ssl=1 "Health: mutual or insurance, which reimburses the best in 2023?")
To cover your health costs, you can subscribe to an insurance company, a mutual insurance company or a provident institution, three types of complementary organizations which have the same utility but which operate differently. Some charge higher management fees than others, which reduces the level of benefits paid to policyholders. Review of details with Magnolia.fr.
Benefits on the rise
According to the latest report from the DREES (Research, Studies, Evaluation and Statistics Department) published in December 2022 on the financial situation of complementary organizations providing health coverage, health benefits paid by these organizations increased by 11.6% in 2021i.e. €31.6 billion compared to €28.5 billion in 2020. During this year 2021, still marked by the health crisis due to Covidthe sharp increase in benefits can be explained by a catch up after 2020 drop due to postponing many treatments and at the 100% coverage of Covid-related expenses by Health Insurance.
It is also necessary to add an increase in reimbursements for the care concerned by the 100% health reformin particular the dental care. As a reminder, this reform was rolled out gradually from January 2019 before its full implementation in January 2021: after the intervention ofameliathe complementary bodies said to be responsible have an obligation to refund 100% equipment expensesopticalof dental (prostheses) andaudition selected from the entry-level basket.
According to figures from the Mutualité Française, which federates the majority of health mutuals, the benefits paid in 2021 by these same organizations have increases by :
- 130% and audiology
- 43% in dentures
- 20% in optics.
Refund rate of 80%
In 2021, organizations have paid back to the insured 80% of the contributions collected in the form of benefits. This ratio is slightly higher than that of 2020, i.e. 78%, reduced to 74% excluding the exceptional contribution known as the Covid tax.
It is observed that the collective contracts pay more than the individual contracts all types of organizations. This is explained by lower management costs for pension institutions. These management fees represent the following three expense items:
- acquisition costs (advertising, marketing, remuneration of intermediaries or brokers)
- claims handling costs
- administrative costs and other technical charges.
source Drees
On average, these costs absorb 20% of contributions. In detail, on the segment of the individual contract, we note that the mutuals pay on average 80% of the contributions to their customers, against 69% for the insurance companies. The institutions are the good students with only 6% management fees and a redistribution of 85%.
Know that since 1is September 2020, complementary organizations are obliged to make their redistribution rate public, which corresponds to the ratio between the amount of contributions and the amount of benefits paid to the insured. This rate is important to know, because it serves as a compass for compare market offersmaking it possible to realize that some display exorbitant management fees.
Reread your insurance contract and check the redistribution rate. If you consider it insufficient, terminate and subscribe to a more generous contract. Select the formula adapted to your health needs at the best price thanks to a health mutual comparator. You have access to dozens of the most competitive contracts on the market. The mutual health quote allow you to put the offers in competition. You can apply for freesupport from a specialized broker to help you in your choice and take charge of all the cancellation/subscription procedures for you.
The number of mutuals divided by five since 2001
The complementary health market is vast and very competitive, but it has tended to shrink, and has done so spectacularly for twenty years. In 2021, it was distributed as follows:
- 288 organizations mutual health
- 104 insurance companies
- 25 provident institutions.
The number of organizations carrying out a health activity was divided by four since 2001, and up to five for mutuals alone. At the time, there were 1,528 mutuals. The number of provident institutions has been halved since that date, unlike the insurance companies present in the field of health: their number has decreased little since 2001, it has even increased since 2010, from 93 to 104.
Even if they tend to group together, mutuals are still numerous, but in the top 10 largest organizations in terms of health turnover, they are only 4, against 3 for insurance companies and 3 for provident institutions. These 10 organizations represented 41% market share of complementary health insurancecompared to 29% in 2011.
The 3 players in complementary health insurance
Three types of organizations share the complementary health insurance market:
- mutuals : non-profit organizations governed by the Mutuality Code. Belonging to their members, they donate all their profits to their benefit. They mainly cover the social risks (health, disability and invalidity as in borrower insurancedependency, death, retirement, employment, family).
- insurance companies which come under the Insurance Code: their field of activity is wider (car/motorcycle insurance, home insurance, civil liability, natural disasters, property damage, capitalization and life insurance, etc.).
- provident institutions which are also non-profit: they are subject to the Social Security Code and are specialized in the protection of companies and professional branches (collective contracts).
