User ticket, package and deductibles (Social security)

Definition

The user fee represents the part of the expenses that remains at your expense after reimbursement of the sickness insurance and before deduction of the lump sum contributions.

User fees apply to all benefits covered by the Health Insurance.

Exempt persons

In certain situations (for example long-term affliction - ALD or if you are enclosure), you are exempt from paying user fees. The Health Insurance takes care of it at 100% within conventional tariffs.

Amount 

The amount of the user fee varies according to the services (care, medicines, equipment...).

For example, for a consultation with your GP, it is equal to €7.95. Calculation detail:

• Conventional rate : €26.5
• Support at 70% by Health Insurance: €18.55
• User Fee Amount: €7.95

Surcharge

The user fee can be increased if you are seeing a healthcare professional outside of the home coordinated care pathway.

For example, for consultation with a primary care physician outside the coordinated care pathway, it is equal to €18.6. Calculation detail:

• Conventional fare: €26.5
• Support at 30% by health insurance: €7.95
• User Fee Amount: €18.6

Payment

The user fee is automatically deducted the amount of your refunds. It is deducted from the refund statements.

If you have a health supplement, it can take charge of the user fee according to the contract you have signed. Check with your complementary organization.

Benefits concerned

User fees are replaced by a flat-rate fee for certain major medical procedures (procedures that cost at least €120).

However, the following costs shall be borne at 100% and are not affected by the package:

• Emergency transport
• X-ray diagnostic procedures
• Magnetic resonance imaging (MRI) procedures
• Scan

Amount

The package is €24.

The same is true if several heavy acts are performed during the same consultation or hospitalization.

Exempt persons

The package does not apply to persons who are in the care of 100% because of their situation or health.

These include:

• Person with a long-term assignment (ALD)
• Pregnant woman (of 1^er day of 6^e months of pregnancy and up to 12^e day after delivery)
• Newborn hospitalized
• Accident at work Person who is in receipt of an annuity for
• Person receiving a disability pension
• Person benefiting from complementary health solidarity
• Child and adolescent victims of sexual abuse.

Payment

You must pay directly to the healthcare professional or health facility for the package you owe.

If you have a health supplement, it can take charge of the package according to the contract you have signed. Check with your complementary organization.

Data subjects

This flat-rate contribution is due following a visit to the emergency department which is not followed by hospitalization in the medical, surgical, obstetric or dental departments of the institution.

The package does not apply irrespective of the reason for the passage for the following persons:

• Pregnant woman as of 6^e months for all care
• Newborns less than one month old
• A person who receives an annuity or an allowance paid under the legislation on occupational accidents and diseases (AT-MP) with a disability of at least 2/3
• Military or disability pensioner

Finally, this package does not apply for the following people when their emergency department visit is related to their specific situation:

• Organ donor
• Victim of an act of terrorism
• Victim of a serious and exceptional health risk
• Child victim of sexual abuse

Amount

The amount of the package is €19.61.

This package shall be reduced irrespective of the reason for the change to €8.49 for the following insured persons:

• In long-term illness (ALD)
• Attached to the system of occupational accidents and diseases (ATMP) with a disability of less than 2/3

Benefits concerned

A flat-rate contribution is payable at each consultation or medical procedure, except in particular in the context of a full hospitalization of one or more days.

This participation also applies to any act of radiology or medical biology.

Amount

The flat-rate contribution is €1 up to €50 per year per person.

If during the same day you consult the same doctor several times or if you benefit from several actions performed by the same professional, the package is applied within the limit of €4 per day per doctor.

Exempt persons

The flat-rate participation of €1 does not apply to the following persons:

• Children and young people under 18 years of age
• Pregnant woman (of 1^er day of 6^e months of pregnancy and up to 12^e day after delivery)
• Person benefiting from the complementary health solidarity
• Recipient of the AME

Payment

The flat-rate contributions are automatically deducted the amount of your refunds. They are deducted from refund statements.

The flat-rate participation of €1 is not reimbursed by health supplements as part of a responsible contract. Check with your complementary organization.

Benefits concerned

A medical deductible remains at your expense for the following costs:

• Medicines
• Paramedical procedures
• Sanitary transport

Amount

The amount of the deductible is:

• €1.00 per pack of medicines (or any other unit pack, e.g. vial),
• €1 by paramedical act up to €4 per day,
• €4 by sanitary transport up to €8 per day.

The amount of the deductible shall not exceed €50 per year per person.

Exempt persons

Franchise does not apply to the following persons:

• Children and young people under 18 years of age
• Pregnant woman (of 1^er day of 6^e months of pregnancy and up to 12^e day after delivery)
• Recipient of the complementary health solidarity
• Recipient of the AME
• Minor for emergency contraception
• Victims of terrorism.

Payment

Medical deductibles are automatically deducted the amount of your refunds. They are deducted from refund statements.

Medical deductibles are not reimbursed by health supplements as part of a responsible contract. Check with your complementary organization.