Pregnant women: 100% care (Health insurance)

Verified 24 April 2024 - Directorate for Legal and Administrative Information (Prime Minister)

Are you expecting a baby? Be aware that the mandatory medical examinations as part of the follow-up of your pregnancy (maternity) are taken care of at 100% the sickness insurance rate. This includes tests from the start of pregnancy until 12 days after delivery. You can also benefit, under certain conditions, from a non-medical temporary accommodation benefit. This is calledhospital hotel. We're giving you the regulations to know.

FYI  

You must declare your pregnancy before the end of 3e month pregnancy in order to benefit as soon as possible from the care of the sickness insurance.

Please note

You can declare a midwife referrer before the end of 5e month pregnancy.

Pregnancy-related consultations

The Health Insurance covers 100% with waiver of advance payment of fees (paying third party) mandatory medical examinations as part of your pregnancy follow-up.

For example:

  • Mandatory prenatal consultations (one before the end of 3e month of pregnancy, then one per month from 4e months of pregnancy)
  • Birth and parenting preparation sessions, including early prenatal examination
  • Laboratory tests (including those for the father-to-be).

The first 2 ultrasound scans done before the end of 5e months of pregnancy are managed at 70%.

In case of pathological pregnancy or fetal pathology (fetal malformations, infectious or genetic context...), other ultrasound scans can be prescribed and taken care of.

Dentist

You can benefit, from 4e months of pregnancy, a dental prevention examination.

This preventive examination is fully supported by Health Insurance. You don't have to advance any fees.

Upon receipt of your declaration of pregnancy, your health insurance fund will send you a letter of invitation accompanied by the form for taking charge of your oral examination.

You then make an appointment with your dentist. You go there with:

  • Your support print
  • And your vital card.

Other consultation

Non-pregnancy consultations and medical expenses are reimbursed at the usual rates.

General case

All your reimbursable medical expenses are covered at 100%. You do not have to make an advance payment (paying third party).

This support applies to all your expenses whether or not they are related to your pregnancy.

Example :

Pharmaceutical, analytical, laboratory, hospitalization costs

The 3e Ultrasonography is supported by 100%.

In case of pathological pregnancy or fetal pathology (fetal malformations, infectious or genetic context...), other ultrasound scans can be prescribed and taken care of under the same conditions.

Please note

These supports at 100% are based on and within the limits of the sickness insurance rates.

Excess fees are not covered by the Health Insurance. They may be supported by your health complementary if the contract so provides. You can check with your health supplement.

You also benefit from the advance fee waiver (paying third party) on the part covered by social security (excluding overpayment of fees) for healthcare professionals working in town for the following examinations and care:

  • Mandatory Pregnancy Tests
  • Mandatory examinations for children under 6 years of age
  • Care, whether or not related to maternity, provider of 1er day of 6e months until 12 days after delivery.

Dentist

You may benefit from an oral prevention examination.

This preventive examination is fully supported by Health Insurance. You don't have to advance any fees.

Upon receipt of your declaration of pregnancy, your health insurance fund will send you an invitation letter accompanied by the printed copy of your oral examination.

You then make an appointment with your dentist. You go there with:

  • Your support print
  • And your vital card.

Hospitable hotel

Health care facilities can set up a non-medical accommodation.

This accommodation can be offered to you if you live in a commune whose center is at more than 45 minutes by car the closest hotel.

This temporary accommodation is for a period of 5 consecutive nights at most before the expected date of delivery.

FYI  

Other durations may apply:

  • In Guyana
  • Or in case of a risky pregnancy.

Medicare pays for these accommodation costs if you are in any of the following:

  • Social Insurance
  • Recipient of State medical assistance (AME)
  • Social Security Recipient in Mayotte
  • Member of a social security scheme of a Member State of the European Economic Area (EEA), Switzerland or any other country pursuant to an agreement.

Delivery costs

Delivery costs and care vary depending on the facility you choose.

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Conventional hospital or clinic

Delivery costs and subsistence costs, up to a maximum of 12 days, shall be borne at 100%.

They are reimbursed directly to the establishment by your health insurance fund.

You pay only for the portion corresponding to the excess of fees and the costs for personal comfort (examples: private room, television), these costs are not covered by the Health Insurance. 

The hospital package is fully supported on 1er day of 6e months of pregnancy until 12e day after delivery.

The transport costs at the hospital or clinic, by ambulance or other means of transport, can be taken care of on medical prescription.

You can get closer to your mutual to know how to cover overpayment of fees and expenses related to personal comfort.

Unconventional clinic

Delivery and subsistence costs, up to 12 days, shall be reimbursed to 100% on the basis of and within the limits of the sickness insurance rates.

If you choose to give birth in an unlicensed private clinic, be aware that the prices charged are generally higher there.

The remaining costs may be very high and you will have to pay in advance (examples: extra fees, costs for personal comfort such as a television or private room).

You can get closer to your mutual to know how to cover overpayment of fees and expenses related to personal comfort.

Full support

You continue to be supported at 100% and to benefit from the advance exemption of fees (third-party paying) for all your medical expenses, whether or not they are related to your pregnancy.

Followed by a midwife

You can enjoy at your home a followed by a midwife for you and your child. This follow-up takes place within one week of discharge from the maternity ward.

To ensure follow-up, it is recommended that a community midwife be contacted from the maternity ward the day after delivery.

If a midwife is already monitoring your pregnancy, you can tell her shortly before birth that you are counting on her to follow up at home until the 12th day of your child’s pregnancy.

The midwife, after her first visit, will tell you what follow-up is needed.

This monitoring is supported at 100% by Health Insurance, until 12e day after your baby is born.

Dentist

You may benefit from an oral prevention examination.

This preventive examination is fully supported by Health Insurance. You don't have to advance any fees.

Upon receipt of your declaration of pregnancy, your health insurance fund will send you an invitation letter accompanied by the printed copy of your oral examination.

You then make an appointment with your dentist. You go there with:

  • Your support print
  • And your vital card.

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