#2014-1374Decree on Complementary Health Insurance Contracts and Fiscal and Social Aids
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
This decree outlines the structure of complementary health insurance contracts in France, particularly focusing on coverage related to fiscal and social aids. It sets limits for optical equipment reimbursements and establishes an observatory to monitor pricing and coverage trends in the optical market. This affects insurers, healthcare providers, and individuals relying on supplementary insurance.
AI-generated summary. May contain errors. Refer to official sources for legal decisions.
Key Changes
- Limits set for reimbursement of optical equipment.
- Establishment of an observatory to monitor optical market trends.
- Coverage requirements adjusted for fiscal and social aids.
Obligations
What this law requires
Complementary health insurers must cover the full insured participation as defined in Article R. 322-1 of the social security code, except for mental health services and specific healthcare categories (6°, 7°, 10°, 14°).
Complementary health insurers offering optical equipment coverage must reimburse costs within defined minimum and maximum thresholds by lens type: simple lenses €50-€470, progressive/multifocal lenses €200-€850, with frame coverage capped at €150 per equipment.
For eyeglasses, optical equipment reimbursement applies once per two-year period; for minors or justified prescription changes, once per one-year period.
Complementary health insurers may optionally cover physician fee overages for non-contracted doctors up to 100% of the reference tariff (125% for 2015-2016), limited to the amount paid for contracted doctors minus 20% of the reference tariff.
Create and maintain an observatory for optical medical pricing and coverage that analyzes market prices, equipment characteristics, quality, and insurance contract coverage levels.