Third-party optical insurance

What is third-party payment? How and when can you take advantage of it?

When a patient is not eligible for third-party payment, they pay out of pocket for their medical visit, nursing or dental care, prescription medications, X-rays or ultrasounds, and new eyeglass frames. Afterward, their health insurance provider and supplementary health insurance provider reimburse them for the costs incurred, minus the copayment.

If you are eligible for third-party payment, you will not have to pay for your care directly to medical providers or your primary care physician. The cost of a general practitioner’s visit will be covered by mandatory health insurance, either in full or in part, depending on the circumstances.

Advantages and Limitations

Using the third-party payment system is very simple for the insured, who no longer has to wait for reimbursements after paying the costs out of pocket.

Conversely, opponents of this system highlight the risk that patients may become less responsible due to a false impression that medical services are free.

Third-party payment does not apply at pharmacies if you refuse generic medications or if you have not designated a primary care physician. You will need to pay your bill as well as any consultation fees, and you will be reimbursed later.

But be aware: not all supplementary health insurance providers offer third-party payment to their members for all medical services. At pharmacies, all supplementary health insurance providers offer this option. This is not always the case for hospital stays, lab tests, certain dental treatments, or vision care costs.

Don’t hesitate to ask your healthcare provider what will be covered in your specific case, after carefully reading the terms and conditions of your health insurance policy. A proposed healthcare bill had initially planned to extend third-party payment to all social security beneficiaries as of January 1, 2017, but this remains difficult to implement given the complexity of the system.

How does third-party payment work at the optician’s?

To be eligible for third-party payment at your optician’s, you must meet certain requirements.

1. A prescription less than 3 years old

   This is essential to qualify for coverage or reimbursement: without a prescription, there is no reimbursement or coverage. If you have lost your prescription issued within the last 3 years and your vision has not changed, you can request a duplicate from your ophthalmologist.

2. Your Vitale card and your supplementary health insurance provider card

   You’ll need to bring your Vitale card and your supplementary optical insurance card.

3. The optician contacts your supplementary health insurance provider

   Once you’ve chosen your glasses, your optician will contact your supplementary health insurance provider. Your supplementary health insurance provider will confirm whether they will cover all or part of the cost of your purchase.

4. You pay the out-of-pocket balance

   If applicable, you’ll pay the difference between your supplementary health insurance providers’ coverage and the price of your glasses: this is the “out-of-pocket cost.”

Who pays the optician?

Your optician is then paid directly by your supplementary health insurance provider and your health insurance fund.

As a result, if the amount covered is equal to the price of your eyeglasses, you won’t have to pay anything and you’ll walk out with your eyeglass frames on your nose or your contact lenses in your pocket. Since contact lenses aren’t reimbursed by French national health insurance—except in exceptional cases involving complex prescriptions—your supplementary health insurance provider provides you with a certain number each year, depending on the terms of your policy.

The supplemental health insurance provider's third-party payment option pays your bill directly to the optician. But as you probably know, your health insurance provider reimburses only a very small portion of the cost of your eyeglasses. If you choose the French national health insurance third-party payment option, it will pay your optician immediately. Generally, opticians submit the third-party payment request to both relevant organizations at the same time.

Third-party payment to Become Widespread Soon

Today, in the optical industry, virtually all healthcare professionals offer third-party payment through both private supplementary health insurance providers and French national health insurance.

Adopted on December 1, 2015, one of the main provisions of the health care bill is to make third-party payment available to all Social Security enrollees starting January 1, 2017.

Healthcare professionals will be assured of prompt reimbursement by accepting the expansion of third-party payment. Doctors are not convinced by this healthcare law, which imposes an additional administrative burden on them.

The Mutualité Française, however, believes that doctors’ work will be made easier since they will no longer have to handle checks or deal with unpaid bills.

The government remains confident: once the necessary systems are in place, practitioners will adapt to them, just as they did with the electronic healthcare reimbursement form and the Vitale card. Starting November 20, 2017, third-party payment will become a right for all French citizens.

By modernizing healthcare legislation, the government aims to ensure that all people with modest incomes have access to healthcare and health-related products at affordable prices, such as eyeglasses or dental care.

Can I use third-party payment at Mymonture?

Since January 1, 2020, the government has implemented the €0 out-of-pocket cost for Category A (the '100% Santé' scheme (full cover)). The goal of this €0 copayment is to provide all adults and children with high-quality eyewear, featuring a wide selection of frames and lenses for a variety of vision corrections.

Who is eligible for Basket A?

All insured individuals are eligible for the zero out-of-pocket cost, including those covered by health insurance. Two conditions must be met:

• be covered by health insurance: the general health insurance system, the agricultural health insurance system, or special health insurance plans (SNCF, EDF, GDF, RATP, etc.)
• you must have enrolled in a supplemental health insurance provider