How does reimbursement by supplementary health insurance providers work, and when can you benefit from it? Mymonture gives you all you need to know about the third-party payment.

What is the third-party payment?

Third-party payment via your complementary health insurance is above all the possibility of not having to pay in advance when you visit an optician who is a partner of your supplementary health insurance provider. All you have to do is present your health insurance card, and you'll only have to pay for the portion of your bill that remains unpaid.

The main advantage of Third-party payment is that you don't have to pay in advance, as the optician will then be reimbursed for your supplementary insurance provider's share.

However, third-party payment exists for both supplementary health insurance providers and French national health insurance, but what are the differences?

With third-party payment via a supplementary insurance provider, your supplementary insurance provider reimburses the optician directly for the amount specified in your supplementary insurance provider contract, which is valid every two years.

With third-party payment via the French national health insurance, the French national health insurancereimburses a small part of the cost of your eyewear. In the same way as for the third-party payment via a supplementary insurance provider, if you opt for third-party payment via the French national health insurance, the French national health insurance will pay the amount it covers directly to the optician, and you will not receive a healthcare reimbursement form as the reimbursement will be requested directly by the optician.

How does it work in practice?

Let's take a look at each step to understand the impact of supplementary health insurance on your visit to the optician.

-First, your optician helps you choose the frames and lenses you want.

- The optician will then request a quotation from your supplementary health insurance provider to determine the amount it will reimburse.

-Once you've requested a quotation, the optician will ask your supplementary health insurance provider to reimburse you. This will then confirm that your glasses are covered.

-If your supplementary health insurance does not cover the full cost of your equipment, you will have to pay the difference between the price of your glasses and the amount covered by your supplementary health insurance.

Once this has been done, the supplementary insurance provider will pay the optician directly. Third-party payment makes life easier for you, because transactions are faster, and if the reimbursement is greater than or equal to the price of your equipment, you don't have to pay anything.

In some cases, opticians may not be able to offer their customers third-party payment. Several conditions must be met:

-the optician must have a third-party payment agreement with the supplementary health insurance provider.

-you must have a health insurance contract with a supplementary health insurance that can offer third-party payment (this is not a general rule)

-the equipment to be reimbursed must be a pair of prescription glasses with corrective lenses

-your optical package has not yet been used.

Different types of reimbursement

There are several types of reimbursement that supplementary health insurance providers can use. The first is reimbursement based on a percentage, the Base de Remboursement (BR). Be careful, however, as 100% of the reimbursement base does not correspond to 100% of the price of the equipment. In reality, this type of reimbursement is based on French national health insurance reimbursements, which vary according to the patient's age and correction.

For example, if the contract provides for an optical reimbursement of 300% BR, this represents for a beneficiary over 18 with frequent optical correction and single lenses :

300% x 2.84€ = 8.52€ on the frame

300% x 3.66€ = 10.98€ on lenses

Of course, this is just an example.

Flat-rate reimbursement

This is the type of reimbursement most often used by supplementary health insurance providers, as it gives policyholders a clearer idea of the coverage to which they are entitled. Here too, the lump-sum reimbursement varies according to the correction.

Since April1, 2015, reimbursement by supplementary health insurance providers is only effective every two years, unless you change your correction significantly before the end of the two-year period, in which case you will be entitled to reimbursement again.

What's more, reimbursement for frames is capped at €150 by all supplementary health insurance providers.

As for lenses, reimbursement is included with that of the frame, and corresponds to :

-50€ to 470€ for a pair of spectacles fitted with single vision lenses (single vision lenses with a sphere between -6.00 and +6.00 dioptres or with a cylinder less than or equal to +4.00 dioptres).

-200 to €750 for a pair of spectacles with complex lenses (single vision lenses with a sphere of less than -6.00 or greater than +6.00 dioptres or with a cylinder greater than +4.00 dioptres, or multifocal or progressive lenses).

-850 for a pair of spectacles with very complex lenses (multifocal or progressive spherocylindrical lenses with a sphere of less than -8.00 or greater than +8.00 diopters or spherical multifocal or progressive lenses with a sphere of less than -4.00 or greater than +4.00 diopters).

This means that if you decide to buy a €150 frame with a single lens correction, your lenses will be reimbursed up to a maximum of €320.

Reimbursement based on a percentage of the PMSS (monthly French national health insurance ceiling)

The PMSS for 2017 is set at €3269, so all you have to do is apply the percentage set by your supplementary health insurance to find out how much you're entitled to be reimbursed.

For example, you are reimbursed 5% of the PMSS for your frames:

3269 x5% = 163,45€

What about online reimbursement?

Mymonture is currently the only optician on the Internet to have integrated online third-party payment. Since the creation of Mymonture.com, our aim has been to offer you the same services as a traditional optician, but generally at half the price. In addition to our online third-party payment service, we are also the only opticians on the Internet to offer you :

-an unrivalled choice of over 100 brands and a selection of 10,000 frames - 10 times more than a traditional optician.

-hand-crafted products from the world's leading brands, plus guaranteed French-origin lenses (Mega Optic, BBGR, Essilor).

-quality service: we take care of everything, with online supplementary health insurance coverage from over 300 supplementary health insurance providers.

-a 2-year guarantee for lenses and frames, as well as an adaptation guarantee for progressive lenses.

-qualified opticians at your service, ready to listen and give you the best advice.

-a showroom dedicated to your well-being, staffed by the same team of professional opticians who will help you make the best choice.

Thanks to our online third-party payment service, Mymonture makes the whole process as simple as possible. You no longer need to go into a store to get access to it, you can order your equipment on our site without having to pay in advance. Mymonture combines the expertise of a traditional optician with the convenience of the web, at your service.