Supplementary optical insurances
Optician networks and supplementary health insurance providers partnering your Mymonture optician
To be reimbursed for your Eyeglasses or contact lenses by the French health insurance scheme, you need to meet a number of conditions. First of all, you need to present your optician with a medical prescription from your ophthalmologist or orthoptist. Only certain pathologies are covered: myopia, astigmatism, hyperopia, presbyopia and amblyopia. The same applies to contact lenses, which are only covered if you suffer from myopia of at least 8 dioptres (the measurement required for a lens to correct visual impairment), irregular astigmatism, accommodative strabismus, aphakia, keratoconus and anisometropia of 3 dioptres that cannot be corrected by lenses. As for supplementary health insurance providers, they reimburse an amount defined by a contract that you are free to sign. Find out more about supplementary health insurance providers and optician networks - Mymonture.
What is a supplementary health insurance provider?
A supplementary health insurance provider's mission is to cover some or all of the healthcare expenses not covered by health insurance. Unlike health insurance, which is compulsory, supplementary health insurance providers are open-ended. You pay the premiums yourself. The rate depends on the coverage you choose. The main benefits covered are medical consultations and care, drugs purchased from a pharmacy, hospitalization costs, optical care and equipment, dental care and prostheses, and hearing aids. Depending on the insurer and your wishes, other benefits can be added: non-conventional medicine (homeopathy, nutritionist, osteopath, acupuncturist, home assistance, spa treatment, etc.). Obviously, the more benefits you subscribe to, the higher the premium.
How does a supplementary health insurance provider work?
Health insurance covers only a certain percentage of the cost of medical treatment. To better understand how a supplementary health insurance provider works, you need to be familiar with these three terms:
- Conventional tariff: this corresponds to the tariff set by the health insurance scheme. Each act is coded and represents a percentage of reimbursement. For example, a general practitioner's consultation costing €25 is coded with the letter C. It is reimbursed at 70% of the amount you paid to the practitioner, i.e. €17.50.
- Co-payment: this is the portion not covered by health insurance. In our example, this is around 30%, or €7.50.
- Extra fees: this is the amount charged by certain doctors in addition to the fees set by French national health insurance.
Supplementary health insurance providers generally offer 3 levels of cover and different premiums. The first level reimburses only the co-payment. The second level offers an intermediate level of coverage, providing better cover for hospitalization (private room, for example) and certain non-conventional medical services. The third level covers many of the expenses associated with the specialized care mentioned above (nutritionist, osteopath, acupuncturist, home care assistant, extra fees, etc.). The latter level may even cover the cost of certain drugs not covered by French national health insurance, but which have been prescribed by a doctor.
For your reimbursements, several healthcare professionals are paid directly by your health insurance and supplementary health insurance providers. These include pharmacists and opticians. To ensure that healthcare professionals receive reimbursements from your funds, a teletransmission system has been set up between French national health insurance funds and supplementary health insurance providers. This enables the professionals concerned to obtain reimbursement within a few days.
What are the different types of supplementary health insurance providers?
There are three types of supplementary health insurance providers: management centers, closed mutual networks based on calls for tender, and partner or approved mutuals. Here's a brief description of the differences.
Management centers
In order to offer their members better benefits at affordable prices, many supplementary optical insurance providers call on the services of healthcare platforms. These include Henner, CGRM and others, all of which are independent and work with a number of complementary health insurance companies. The aim is to establish partnerships with opticians in order to negotiate advantageous rates and obtain discounts on spectacle lenses, frames and contact lenses. They can obtain discounts of up to 40% on lenses and 20% on contact lenses and frames. In return, patients can see the price of their optical equipment reduced by up to €100 for single vision lenses, or even €200 for progressive lenses. The great advantage of subscribing to this type of supplementary health insurance provider is that you get a cheaper, better-covered contract.
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Supplementary health insurance providers networks closed to competitive bidding
There are two types of healthcare platform for supplementary health insurance providers: closed networks and open networks. Closed networks are made up of approved opticians who offer strict but highly advantageous pricing conditions. These networks accept all opticians who agree to sell their products up to a certain ceiling. This means that all opticians who sign up to these agreements have access to these networks. To benefit from these advantages, policyholders must visit one of the approved opticians on the list provided. Open networks welcome opticians who agree not to exceed a certain price ceiling. They also commit to a number of best practices (welcome, precision, aesthetics, etc.). To join these networks, opticians must apply to platforms such as Sévéane, Kalixia, Itelis, Santé Clair, Carte blanche, etc
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Approved or partner supplementary health insurance providers (all other supplementary health insurance providers)
In the case of supplementary health insurance providers, it is the health platforms that select their opticians. Opticians are selected according to strict criteria. They are obliged to commit to the quality of their services and, above all, to keep their prices under control. Partner opticians such as MGEN, ALLIANZ, AXA and MMA offer low-priced frames for under €50, as well as preferential rates on contact lenses. We also offer a range of other services, such as free maintenance or repair of glasses, trial lenses or progressive lenses, replacement of broken frames..
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Supplementary health insurance providers and optician networks partnering with Mymonture
MyMonture is approved by all supplementary health insurance providers thanks to its Finess number 622608339. This is a reference number assigned to certain healthcare professionals, including opticians. We are accredited with all supplementary health insurance providers (over 500 in France) and are the only platform accredited with the closed supplementary health insurance providers networks: TP+, Sévéane, Kalixia, Itelis and Carte Blanche. We're also the first optician on the web to offer online third-party payment. With MyMonture, you don't have to do a thing. Our team will take care of requesting reimbursement of your optical expenses directly from your insurance companies.
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