Complementary company health (Mutual health)

Verified 01 January 2022 - Directorate for Legal and Administrative Information (Prime Minister)

In addition to the basic guarantees of social security, an employee may receive supplementary health benefits from his company (or the association which employs him). It is the employer who negotiates the contract and follows up with the insurer. The complementary company health must take care of a minimum of guarantees.

Health Insurance (Social Security) does not fully reimburse your health expenses. The company health supplement completes these refunds, in whole or in part.

In addition to the supplementary health, the collective company system may offer other guarantees (death guarantees, dependency guarantees, etc.).

Please note

only companies are concerned. The individual who employs a homeworker is not concerned.

The employer must provide all its employees with additional health cover, regardless of their length of service in the company.

However, you can be exempt from membership in certain situations.

FYI  

if your employer has not contracted a health supplement, you can to refer the matter to the labor council.

You don't have to take any steps. It is your company that negotiates the contract and follows up with the insurer.

FYI  

if you and your spouse or Civil partnership partner both have a mandatory mutual, it is sometimes possible to terminate one of them. It is recommended to get in touch with your mutual.

Minimal care basket

The supplementary company health must cover at least the following guarantees (care basket):

  • Entire user fee on consultations, documents and benefits reimbursable by sickness insurance, subject to certain exceptions
  • Entire daily hospital fee in case of hospitalization
  • Dental expenses (prostheses and orthodontics) up to 125% of the conventional tariff
  • Optics costs on a flat-rate basis per 2-year period (annually for children or in the event of changes in vision) with a minimum of care fixed at €100 for a simple correction, €150 (or €200) for a complex correction

Guarantees of a contract called responsible

The health supplement may be a so-called contract responsible in your company. In this case, health expenditure shall be covered as follows:

Tableau - Main services of a responsible contract signed or renewed from April 1, 2015

Benefits

Compulsory care

Excluded support

Optional support

Doctor's fees

Moderator Ticket

  • Exceedances of fees and increase in the user fee related to non-compliance with the care pathway
  • Flat-rate participation of €1
  • No limit if the doctor is adhering to the contract of access to care
  • Limited support if not

Medicines

TO SMR.: titleContent major (refunded to 65%)

Moderator Ticket

Franchise (fixed fee)

TO SMR.: titleContent moderate and low (refunded to 30% and 15%)

No obligation to take charge

Homeopathy

No obligation to take charge

Hospitalization

Daily package in full, without limitation of duration

Moderator Ticket

  • No limit if the doctor is adhering to the contract of access to care
  • Limited support if not

Optical

Moderator Ticket

Limited as follows:

  • A pair of glasses every 2 years or less (annually for children or in case of vision changes)
  • Frame at the height of €100 maximum (for contracts entered into or renewed from 1er January 2020)
  • Minimum and maximum limits depending on the complexity of the equipment (e.g. for a single lens, between €100 and €420 for contracts entered into or renewed on or after 1er January 2020)

    • Dental

    Moderator Ticket

    Thermal cure

    No obligation to take charge

    FYI  

    since 1er january 2022, the responsible contracts provide for the acceptance by the complements of the practice of paying third party (waiver in advance of fees) on the equipment and care of the basket 100% health (optics, dentistry and audiology).

    Additional benefits

    The health supplement may offer additional benefits, for example:

    • Third-party payer
    • Assistance service (housekeeping, childcare, etc.)
    • Prevention and support (e.g. screening)

    The rate depends on the contract signed by your employer.

    Your employer may participate in the payment of contributions in whole or in part. Its participation must be at least equal to 50% of the contribution.

    At the end of your employment contract (retirement, dismissal...), you can keep your company's mutual health, under conditions.

    Who can help me?

    Find who can answer your questions in your region

    FAQ