Reimbursement French national health insurance and supplementary health insurance providers

Eyeglass Reimbursement: The '100% Santé' scheme (full cover)

Now you have a choice between two options:

You are, of course, completely free to choose the frames and type of lenses that suit you, at the prices listed by your optician. The '100% Santé' scheme (full cover) includes 10 frames for children and 17 frames for adults. They are available in only two colors. The retail price of these frames is capped at €30. At Mymonture, we offer more than 500 frames to choose from.

As for the lenses, they cover all vision corrections (nearsightedness, farsightedness, astigmatism, and presbyopia). In addition, these lenses must meet certain aesthetic standards and various technical requirements: thinning, anti-reflective coatings, and scratch-resistant coatings.

Who is eligible?

All French citizens are eligible for the '100% Santé' scheme (full cover). You simply need to be enrolled in CMU-C (supplementary universal health coverage) or the complementary solidarity health insurance (CSS). The CSS is a government assistance program that helps low-income households obtain health coverage. The complementary solidarity health insurance is provided to employees in the private or nonprofit sectors.

Other categories of individuals can contact the various “solidarity-based” supplementary health insurance providers. These account for 95% of all supplementary health insurance providers. To ensure that your provider is one of them, check the coverage details in your policy: this information must be included.

Reimbursement for Eyeglasses by French national health insurance

First, French national health insurance will only reimburse the full cost of eyewear upon presentation of a prescription from an ophthalmologist. You are not required to see your primary care physician before consulting this specialist. The reimbursement rate for the consultation is 70% of the set rate. The remaining 30% is reimbursed by your supplementary health insurance provider, or paid out of pocket if you do not have supplementary health insurance.

The reimbursement rates for your eyeglasses are set differently by the National Health Insurance for eyeglass frames and lenses. The reimbursement takes the patient’s age into account (under 18 and over 18). It also varies depending on the degree of correction and the type of lens.

Children

If your child is under 6 years old, and provided there is a valid prescription, one or more pairs of glasses per year may be reimbursed if the condition progresses. If your child is between 6 and 18 years old, only one pair of glasses per year is reimbursed.

Validity Period of the Prescription

The validity period of a prescription issued by an ophthalmologist varies depending on the patient’s age:

However, the healthcare provider may shorten the validity period or renew corrective lenses if they determine that a new prescription is necessary.

French national health insurance reimbursement for contact lenses

Health insurance reimbursement for contact lenses applies only to certain vision problems:

• accommodative strabismus
• myopia equal to or greater than 8 diopters (the strength a lens must have to correct a visual impairment)
• irregular astigmatism
• various other conditions that cannot be corrected with glasses

French national health insurance reimburses 60%, or €23.69 per eye. The annual flat fee is €39.48; the remaining cost is covered by the supplementary health insurance providers or the patient. Of course, a prescription from an ophthalmologist is required.

Reimbursement for Eyeglasses Through Your Supplementary Health Insurance Providers

Reimbursement from your supplementary health insurance providers supplements the reimbursement from Social Security. It covers the cost of your eyewear based on the level of coverage you have purchased. Some supplementary health insurance providers reimburse based on the French national health insurance percentage, others take into account the French national health insurance monthly cap (known as the PMSS), or reimburse a specific, predetermined amount. Since the reform, more than 90% of “responsible” supplemental health insurance plans have adopted this approach.

For lenses, six reimbursement tiers have been established. These apply to simple lenses—known as single-vision lenses—which correct a single vision problem, and complex lenses, which correct multiple vision problems, including progressive lenses. Here is a rough guide to the minimum and maximum reimbursement amounts for your eyeglasses, as set by supplementary health insurance providers:

1. from €50 to €470
2. from €125 to €610
3. from €125 to €660
4. from €200 to €750
5. from €200 to €800
6. from 200 to 850 €

One pair of eyewear every two years

Supplementary health insurance providers only reimburse the cost of eyewear every two years. If you break your lenses or frames, you will not receive any reimbursement from your supplementary health insurance provider for two years. However, with a doctor’s prescription, if your vision changes, the waiting period is reduced to one year.

Regarding lens replacement following cataract surgery, a 2020 decree requires supplementary health insurance providers to reimburse a first set of lenses after the first surgery and a second set after the second surgery. You therefore do not need to wait until both surgeries are complete to obtain the appropriate lenses.

Online Third-Party Payment with Mymonture

MyMonture.com is the first online optician to offer online third-party payment. We are the only ones to provide the same services and the same quality of eyewear as a traditional optician. Another key strength is that we offer our customers frames from the leading brands at the most affordable prices.

Our business is certified by Bureau Veritas, which guarantees the compliance and quality of the products we sell.

With MYMONTURE, you can take advantage of a variety of services

On our website, you’ll also find over 100 major brands and 10,000 products—10 times more than a traditional optician. For those who wear progressive lenses, our team of state-certified opticians specializes in fitting this type of lens (Freeform).

Customer satisfaction and service are a priority at Mymonture: that’s why we guarantee after-sales service on all our frames and on our “Origine France” lenses from the Essilor Group.

High-Quality Optical Equipment

The lenses fitted into the frames by our state-certified opticians are made in France by the Essilor Group, the world’s leading lens manufacturer. In the event that your glasses break, Mymonture Sérénité guarantees their replacement for 2 years against manufacturing defects, or with a 40% copay (Mymonture covers the remaining 60%).