Reimbursement for a medical consultation

Verified 15 May 2024 - Directorate for Legal and Administrative Information (Prime Minister)

How much will you be reimbursed after going to the doctor? When you see a doctor, the amount of the reimbursement varies according to several criteria: coordinated care pathway, discipline (generalist or specialist) and doctor's agreement. We present you the regulations to know.

The rules are different for a child under 16 years.

FYI  

To find out the price charged by a healthcare professional, see the health directory on the Ameli website.

Respect of the route

All beneficiaries of Health Insurance are reimbursed partially for the costs of consulting a doctor.

Reimbursement rates for medical consultations differ depending on whether the doctor is a general practitioner or a specialist. In addition, some specialists benefit from special tariffs: psychiatrists, neuropsychiatrists, neurologists, pediatricians and cardiologists.

The correspondent doctor may be consulted for an ad hoc or regular opinion with the agreement of the treating physician. The doctor's rates are specific.

Reimbursement for the consultation varies also depending on type of agreement of the doctor. The contracted doctor of sector 1 applies the tariff fixed by agreement with the sickness insurance. The contracted doctor of sector 2 practices free fees.

You can consult some specialists directly without going through your doctor (examples: gynecologist, dental surgeon).

The situation varies depending on whether the doctor is adhering to Optam or not.

The Optam (controlled practical pricing option, formerly access to care contract) is an agreement between the contracted doctors and the health insurance. This agreement authorizes overcharging of regulated fees.

You can find out if your doctor has adhered by consulting the ameli.direct site.

Répondez aux questions successives et les réponses s’afficheront automatiquement

Attending physician

General Practitioner

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a consultation with a general practitioner

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€26.5

€26.5

€16.55

Sector 1 (complex consultation)

€47.5

€47.5

€31.25

Sector 1 (very complex consultation)

€60

€60

€40

Adhering to the contract for access to care

Fees with controlled overrun

€26.5

€16.55

Sector 2

Fees available

€23

€14.10

Specialist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a specialist consultation

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€26.5

€26.5

€16.55

Sector 1 (complex consultation)

€47.5

€47.5

€31.25

Sector 1 (very complex consultation)

€60

€60

€40

Adhering to the contract for access to care

Fees with controlled overrun

€26.5

€16.55

Sector 2

Fees available

€23

€14.10

Psychiatrist, neurologist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Fees and reimbursement of a consultation with a psychiatrist or neurologist

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€46.70

€46.70

€30.69

Sector 1 (very complex consultation)

€60

€60

€40

Adhering to the contract for access to care

Fees with controlled overrun

€46.70

€30.69

Sector 2

Fees available

€42.5

€27.75

Corresponding (regular) physician

General Practitioner

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a consultation with a general practitioner

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€31.5

€31.5

€20.05

Adhering to the contract for access to care

Fees with controlled overrun

€31.5

€20.05

Sector 2

Fees available

€23

€14.10

Specialist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a specialist consultation

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€31.5

€31.5

€20.05

Adhering to the contract for access to care

Fees with controlled overrun

€31.5

€20.05

Sector 2

Fees available

€23

€14.10

Corresponding physician (one-time)

Specialist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a consultation with a corresponding specialist on an ad hoc basis

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€56.5

€56.5

€37.55

Adhering to the contract for access to care

Fees with controlled overrun

€56.5

€37.55

Sector 2

Fees available

€56.5

€37.55

Psychiatrist, neurologist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Fees and reimbursement of a consultation with a psychiatrist or a corresponding neurologist on an ad hoc basis

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€64.00

€64.00

€42.80

Adhering to the contract for access to care

Fees with controlled overrun

€64.00

€42.80

Sector 2

Fees available

€64.00

€42.80

Specialist

Gynecologist and ophthalmologist

Reminder

These rates apply if you have reported a treating physician.

Tableau - Rates and reimbursement of a consultation with a gynecologist or an ophthalmologist

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€31.5

€31.5

€20.05

Sector 1 (very complex consultation)

€53

€53

€31.25

Adhering to the contract for access to care

Fees with controlled overrun

€31.5

€20.05

Sector 2

Fees available

€23

€14.10

Psychiatrist (16 to 25 years)

Reminder

These rates apply if you have reported a treating physician.

Tableau - Fees and reimbursement of a psychiatric consultation (patient aged 16 to 25)

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€51.70

€51.70

€34.19

Sector 1 (very complex consultation)

€60

€60

€40

Adhering to the contract for access to care

Fees with controlled overrun

€51.70

€34.19

Sector 2

Fees available

€42.5

€27.75

Please note

some complex public health consultations (such as 1)era consultation with a girl aged 15 to 18 who wishes to obtain contraception) are taken care of at 100%.

Off-course

All beneficiaries of Health Insurance are reimbursed partially for the costs of consulting a doctor.

Outside the care pathway the refund rate is 30% of the conventional tariff and the user fee is 70%.

The rates and the basis of reimbursement vary according to the specialty of the doctor consulted directly.

Répondez aux questions successives et les réponses s’afficheront automatiquement

General Practitioner

Tableau - Rates and reimbursement of a consultation with a general practitioner (outside the care pathway)

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€26.5

€26.5

€5.95

Adhering to the contract for access to care

Fees with controlled overrun

€26.5

€5.95

Sector 2

Fees available

€23

€4.90

Specialist

Tableau - Rates and reimbursement of a consultation with a specialist (outside the care pathway)

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€35 maximum

€26.5

€5.95

Adhering to the contract for access to care

Fees with controlled overrun

€26.5

€5.95

Sector 2

Fees available

€23

€4.90

Psychiatrist, neurologist

Tableau - Fees and reimbursement of a consultation with a psychiatrist or a neurologist (outside the care pathway)

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€58.99 maximum

€46.70

€12.01

Adhering to the contract for access to care

Fees with controlled overrun

€46.70

€12.01

Sector 2

Fees available

€42.5

€10.75

Cardiologist

Tableau - Rates and reimbursement of a consultation with a cardiologist (outside the care pathway)

Sector

Rate

Reimbursement Basis

Amount refunded (after deduction of the €2)

Sector 1

€60 maximum

€47.73

€12.32

Adhering to the contract for access to care

Fees with controlled overrun

€47.73

€12.32

Sector 2

Fees available

€47.73

€12.32

Who can help me?

Find who can answer your questions in your region