Reimbursement of a medical consultation for a child under 16 years of age
Verified 22 December 2024 - Directorate for Legal and Administrative Information (Prime Minister)
What is the reimbursement for a medical consultation for a child under 16? Reimbursement is subject to specific rules. Depending on whether the doctor consulted is a general practitioner, a pediatrician or a specialist, the amount and reimbursement of the consultation is different. Here we present you the regulations to know.
To find out how much a healthcare professional can charge, see the health directory on the Ameli website.
In the metropolis
The reimbursement rate (70% of the conventional tariff) is identical for any child under 16 years of age, with or without attending physician identified.
Reimbursement rules may vary depending on whether the child is seeing a general practitioner, a pediatrician or a specialist.
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General Practitioner
General practitioner consulted | Age of the child | Rate | Refund Basis | Amount Refunded |
|---|---|---|---|---|
Sector 1 | Under 6 years | €35 | €35 | €24.50 |
From 6 to 16 years | €30 | €30 | €16.10 | |
Complex consultation | €47.50 | €47.50 | €33.25 | |
Very complex consultation | €60 | €60 | €42 | |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Under 6 years | Fees with controlled overruns | €35 | €24.50 |
From 6 to 16 years | €30 | €16.10 | ||
Sector 2 | Under 6 years | Fees available | €28 | €19.60 |
From 6 to 16 years | €23 | €16.10 |
Please note
The mandatory consultations (8e day, 9e and 24e months) are at €54 and refunded to 100%.
Pediatric patient
Consulted physician | Age of the child | Rate | Refund Basis | Amount Refunded |
|---|---|---|---|---|
0-2 years | €39 | €39 | €27.30 | |
Pediatrician Sector 1 | 2 to 6 years | €35 | €35 | €24.50 |
From 6 to 16 years | €31.50 | €31.50 | €22.05 | |
Complex consultation (child) | €47.50 | €47.50 | €33.25 | |
Very complex consultation (child) | €60 | €60 | €42 | |
Pediatrician adhering to the controlled pricing practice option (OPTAM) Sector 2 | 0-2 years | Fees with controlled overruns | €39 | €27.30 |
2 to 6 years | €35 | €24.50 | ||
From 6 to 16 years | €31.50 | €22.05 | ||
Pediatrician Sector 2 | Less than 2 years | Fees available | €34.50 | €24.15 |
2 to 16 years | €23 | €16.10 |
Please note
The mandatory consultations (8e day, 9e and 24e months) are at €54 and refunded to 100%.
Specialist
Consulted physician | Rate | Refund Basis | Amount Refunded |
|---|---|---|---|
Sector 1 Specialist | €31.50 | €31.50 | €22.05 |
Specialist adhering to the controlled pricing practice option (OPTAM) Sector 2 | Fees with controlled overruns | €31.50 | €22.05 |
Sector 2 Specialist | Fees available | €23 | €16.10 |
Psychiatrist, Neuropsychiatrist, Neurologist Sector 1 | €67 | €67 | €46.90 |
Neuropsychiatrist, neurologist adhering to the controlled pricing option (OPTAM) Sector 2 | Fees with controlled overruns | €67 | €46.90 |
Psychiatrist, neuropsychiatrist, neurologist sector 2 | Fees available | €42.50 | €29.75 |
Sector 1 Cardiologist | €52.50 | €52.50 | €36.75 |
Cardiologistadhering to the controlled pricing practice option (OPTAM) Sector 2 | Fees with controlled overruns | €52.50 | €36.75 |
Sector 2 cardiologist | Fees available | €47.73 | €33.41 |
Please note
In some cases, the consultation may be reimbursed to 100% the conventional rate (for example, child followed for a long-term disorder).
Overseas
The rate of reimbursement by the Health Insurance for consultations for a child under 16 years of age is 70% the conventional tariff.
Depending on the child's situation (example: he or she receives complementary health solidarity), visits to the doctor can be managed by 100%.
Please note
The refund rate is identical for any child under 16 years of age, with or without attending physician identified.
For the reimbursement rates for consultations or teleconsultations with children under 16 years of age, see the information listed on theHealth insurance.
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