Third-party optical insurance
What is third-party payment? How and when can you benefit from it?
When a patient is not entitled to third-party payment, we know the procedure: they pay in advance for their consultation, nursing or dental care, pharmacy, X-ray or ultrasound examinations and new spectacle frames. His health insurance fund and his supplementary health insurance then reimburse him for the costs incurred, after deducting the co-payment.
If you benefit from the third-party payment system, you will not have to pay for your care to medical providers or to your referring doctor. The cost of a general practitioner's consultation will be fully or partially covered by the compulsory health insurance scheme, depending on the case.
The patient must always pay the co-payment.
Third-party payment is very simple for the policyholder, who no longer has to wait for reimbursement after having advanced the costs incurred.
opponents, on the other hand, point to the risk of disempowering patients by creating the false impression that medical treatment is free.
Third-party payment will not apply in pharmacies if you refuse generic drugs or have not declared a referring doctor. You will have to pay your bill and the consultation fees, and you will be reimbursed later.
However, not all supplementary health insurance providers offer third-party payment for all medical procedures. In pharmacies, all your supplementary health insurance contracts offer this service. This is not always the case for hospitalization, analyses, certain dental treatments or optical expenses.
Don't hesitate to ask the medical professional what will be covered in your case, after carefully reading the general conditions of your health insurance contract. A health bill had initially planned to generalize third-party payment to all insured persons by January 1, 2017, but this remains complicated to achieve given the complexity of the system.
How does third-party payment work at the optician's?
To qualify for third-party payment at your optician's, you need to meet a number of conditions.
First and foremost, you need a prescription less than 3 years old to qualify for reimbursement. Without a prescription, you won't be reimbursed. If you've mislaid your prescription less than 3 years old, and your eyesight hasn't changed, you can ask your ophthalmologist for a duplicate.
You'll need to bring your carte vitale and your optical supplementary health insurance card with you.
Once you've made your choice of glasses, your optician will contact your insurance company. Your supplementary health insurance will confirm that it will cover all or part of the cost of your purchase. If necessary, you'll have to pay the difference between the amount covered by your supplementary health insurance and the cost of your glasses, known as the "rest à charge".
Your optician will then be paid directly by your supplementary health insurance and your health insurance fund.
So, if the amount of your reimbursement is equal to the price of your prescription glasses, you won't have to pay anything, and you'll go home with your frames on your nose or your contact lenses in your pocket. As contact lenses are not reimbursed by French national health insurance, except in exceptional cases involving complex corrections, your supplementary health insurance will offer you a certain number per year, depending on the terms of your contract.
The third-party payment system through supplementary health insurance providers will pay your bill directly to the optician. But as you probably know, your health insurance fund reimburses a very small proportion of your glasses. If you opt for the third-party payment through French national health insurance scheme, it will pay your optician immediately. In general, opticians apply for third-party payment to both organizations at the same time.
Third-party payment soon to become widespread
Today, in optics, almost all healthcare professionals offer you third-party payment through French national health insurance and supplementary health insurance providers.
Adopted on December 1, 2015, one of the main measures of the bill for health, is to generalize third-party payment to all socially insured people from January 1, 2017.
Healthcare professionals will be guaranteed rapid compensation by accepting the generalization of third-party payment. Doctors are not convinced by this health law, which will add to their administrative workload.
The Mutualité Française believes that doctors' work will be made easier, since they will no longer have to manage cheques and deal with unpaid bills.
The government remains confident that, once the working tools are in place, practitioners will get used to them, as was the case for the electronic care sheet and the carte vitale. As of November 20, 2017, third-party payment will become a right for all French citizens.
By modernizing the health law, the government intends to guarantee all people on modest incomes access to healthcare as well as healthcare products at affordable prices such as eyeglasses or dental care.
Is third-party payment available at Mymonture?
Mymonture.com is the only online optician to offer the 0€ rac of basket A (100% healthcare) from mid-March 2020. You can simply order your glasses from a selection of at least 35 frames for adults and 20 class A frames for children
From January 1, 2020, the government has introduced the RAC 0€ Panier A 100% santé scheme. The aim of this RAC 0€ is to offer all adults and children quality optical equipment with a wide choice of frames and lenses for a wide range of corrections.
Who can benefit from the panier A?
All insured persons are covered by the "reste à charge zéro" (zero out-of-pocket expenses) and CMU/CSS. To qualify, you need to be covered by a health insurance scheme. This includes the general scheme, the agricultural scheme and special schemes (SNCF, EDF, GDF, RATP, etc.).Health insurance is not the only condition for benefiting from RAC 0€. You must also have subscribed to a mutual health insurance plan.
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