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Complementary Health in the Public Service
Verified 01 January 2024 - Legal and Administrative Information Directorate (Prime Minister)
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The rate on the basis of which the calculation is made for the reimbursement of a medical act by the Health Insurance. Also called liability tariff.
Are you a civil servant, trainee or holder, or a contractor? Arrangements are gradually being put in place for employers' administrations to pay part of your contributions to a supplementary health insurance (mutual benefit scheme) in the public service.
What applies to you ?
State Civil Service (EPF)
Video: What you need to know
Vidéo - Complementary Health in the State Civil Service
Since 1er in january 2022, your employer administration reimburses you part of your contributions to your supplementary health (mutual).
The amount of such reimbursement shall be fixed at €15 per month regardless of your working time (full-time or non-full-time, full-time or part-time).
You can benefit from this lump sum reimbursement if you contribute to a mutual insurance scheme that covers medical expenses, caused by an illness, maternity or accident (health risk).
This lump-sum refund does not apply to any contributions you may have made to cover the risks of incapacity for work, invalidity, incapacity or death (pension).
Reminder
Before 1er in january 2022, administrations could contribute to the financing of health supplements to which their agents had individually subscribed. They could also enter into collective contracts to which agents could adhere. The implementation of these arrangements was optional.
Since 1er january 2022, the participation of administrations in the financing of the health of staff complement is obligatory.
If your administration has entered into a collective agreement that was in progress on 1er january 2022, this new flat-rate refund of your mutual contributions applies at the end of this contract. This collective agreement can be extended until December 31, 2024.
Who can benefit from this lump sum reimbursement?
You can benefit from this refund of €15 per month whether you are a civil servant (trainee or incumbent) or a contractor.
You can benefit from this refund if you are in one of the positions or the following:
- Activity
- Secondment or mobility leave
- Parental Leave
- Availability for health reasons or unpaid leave for health reasons
- Caregiver leave or parental leave or family solidarity leave
- Situation or leave of any kind giving rise to the payment of remuneration or salary
The payment is maintained until the end of the month in which you cease to be in one of these positions or situations.
When you resume your duties during a month, the payment is made for the entire month.
If you start or change employers in a month, the refund is paid by the new employer for the entire month.
You must report any changes in circumstances that may affect your refund entitlements.
Your administration can monitor your situation at any time.
How do I apply?
You must send a request to your employer administration.
You can use this request template to do this.
Model application for a flat-rate refund of supplementary social protection contributions for health
You must attach to your application a certificate from your supplementary protection organization.
This certificate shall specify whether you are an individual beneficiary or entitled a supplementary social protection contract which is responsible and jointly and severally liable to cover the costs incurred in connection with maternity, sickness or accident.
If you are entitled to a collective agreement concluded by an employer other than the State, the certificate indicates that you do not already benefit from the care of that employer.
From 1er In January 2025, state administrations will have to have signed collective health-related supplementary health contracts to cover the costs of maternity, sickness or accident (health risk).
Membership of these collective agreements will be compulsory except in special circumstances.
The employer authorities will 50% the amount of the staff members' contributions.
To whom will the membership obligation apply?
If you are employed and remunerated by a State administration, you must join the collective agreement signed by your employer administration if you are official or contractor.
No age requirement is required.
You will continue to benefit from the collective agreement during the following unpaid leave:
- Parental Leave
- Availability for health reasons or unpaid leave for health reasons
- Maternity leave
- Adoption leave
- Parental Leave
- Parental leave
- Paternity and childcare leave
- Caregiver leave
- Family Solidarity Leave
- Vocational training leave
You are exempted from the obligation to join the collective agreement entered into by your employer administration in the following cases:
- You benefit from the complementary health solidarity (C2S - ex CMU-C). This exemption is available until the date you cease to benefit from C2S.
- You are covered by an individual contract to cover the costs of maternity, sickness or accident, on the date of entry into force of 1er a collective agreement entered into by your employer's administration or on the date of your recruitment, whichever is later. This exemption is possible up to the expiry date of your individual contract, within the limit of 12 months.
- You are recruited in CSD: titleContent and you receive individual coverage for the costs of maternity, sickness or accident
- You are covered, for expenses incurred as a result of maternity, sickness or accident, including as a beneficiary, by a supplementary company health or by a supplementary individual health taken out as an interim worker or by the supplementary sickness insurance scheme for the electricity and gas industries or by a supplementary territorial or hospital collective health.
You can waive your exemption at any time and apply to join your administration's collective agreement without any premium increase.
What other possible beneficiaries will there be?
If you are newly retired, you can apply to join the collective agreement signed by your last employer administration if you meet the following 2 conditions:
- You are employee and paid by your administration upon your retirement or you are entitled to any of the unpaid leave during which the benefit of the collective contract is retained (parental leave, availability for health reasons or unpaid leave for health reasons, maternity or adoption leave, parental leave, parental presence leave, paternity and childcare leave, caregiving leave, family solidarity leave, vocational training leave)
- You receive a pension from the State or State Pensions ServiceIrcantec: titleContent
You must apply for membership within one year of your retirement.
If you are retired on the date of enrollment by your last employer administration of its 1er for retired beneficiaries, you can apply to join this contract if you would have fulfilled the conditions required to join the collective contract as a retiree if this contract had been signed at the date of your retirement.
You must apply for membership within one year from the date on which you are informed of the entry into force of the collective agreement and the possibility of joining.
If you live as a couple with an active beneficiary or a retired beneficiary, you can apply to join, as a beneficiary, the collective contract of his employer administration or his last employer administration.
No age requirement is required.
You can also apply to join at any time, as the person entitled, the collective agreement of the employer authority or the last employer authority of an active beneficiary or a retired beneficiary if you meet the following 3 conditions:
- You are the child or grandchild of an active beneficiary or retired beneficiary
Or you are the child or grandchild of the person who living as a couple with an active beneficiary or a retired beneficiary
Or you have been assigned by court order to an active beneficiary or a retired beneficiary or to the person who lives in a cup with that active beneficiary or retired beneficiary - You do not have any other additional social protection
- You are under the age of 21
Or you are under the age of 25 and are a student or on an apprenticeship contract or a job seeker
Or you're recognized as disabled by the CDAPH: titleContent unconditional age
Surviving spouse or orphan child of a deceased active or retired beneficiary who receives a survivor's or orphan's pension, may apply to join the collective contract of the employer's administration or the last employer's administration of the deceased active or retired beneficiary.
The application for membership must be made within one year of death.
The spouse receiving a survivor's pension as a former retired official of the State on the date of entry into force of 1er a collective agreement concluded by the last employer authority of his deceased spouse may apply for membership of that agreement.
The application for membership must be made within one year from the date on which it is informed the possibility of joining.
What will be the minimum guarantees of the collective contract?
The collective contract for supplementary health care shall cover at least the following guarantees:
- Entire user fee on consultations, documents and benefits reimbursable by sickness insurance. However, there may be 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.
The collective agreement may provide for additional or additional guarantees to the minimum guarantees and/or optional guarantees.
They must apply in the same way to the different categories of beneficiaries (active, pensioners, beneficiaries).
Your contributions do not vary according to your health status.
Your contributions as an asset and those of your beneficiaries do not vary according to age.
Your contributions as a pensioner and those of your beneficiaries may change according to your age.
Territorial (FPT)
Your employer community must contribute to the financing of your health (mutual) supplement.
This participation may consist of a partial payment of your contributions to a mutual society to which you have individually subscribed.
It can also be a collective agreement proposed by your community and to which you must subscribe.
In order for participation to be possible, your mutual society organization must guarantee the implementation of solidarity arrangements between workers and pensioners and be labeled for this purpose.
The participation of your community concerns the coverage by a mutual society of medical expenses caused by a maternity, illness or accident (health risk).
It also covers the cost of incapacity for work, invalidity, incapacity or death from welfare.
FYI
If a collective agreement is offered to you, it can be a mutual agreement chosen by your community or a mutual agreement chosen by the management center and to which your community has signed up. If your employing community decides to join a collective agreement signed by the management center, it can join for one or more of the risks covered by the collective agreement.
You can benefit from the participation in the financing of your mutual insurance company whether you are a public servant or a contract worker.
Until now, local authorities could already contribute to the financing of health supplements to which their staff had individually subscribed or subscribed to collective contracts.
The implementation of these arrangements was optional.
Now it becomes obligatory.
The contribution of your community must allow you to benefit from the following minimum guarantees from 1er january 2025 on and from 1er January 2026 on health risk.
From 1er in january 2025, your employer community will participate in the financing of your health supplement covering the costs occasioned by the risks of incapacity for work, disability, incapacity or death welfare.
The amount of such participation shall be at least €7 per month.
Your community can provide a higher level of participation.
If you report to the CNRACL: titleContent, your community pays you daily allowances in addition to your half-salary in the following cases:
- Sick leave (regular, long-term or long-term) with half-treatment
- Ex officio lay-off or maintenance of half treatment pending the opinion of the medical council
This is the case if you are a full-time civil servant or a full-time civil servant working at least 28 hours a week (at least 12 hours if you belong to the artistic teaching teacher's framework and at least 15 hours if you belong to the artistic teaching assistant's framework).
These additional daily allowances are intended to guarantee you a net remuneration equivalent to 90% your index treatment and the new index enhancement, and 40% your bonuses and allowances.
If you retire for disability before age 62, your employer community pays you an annuity that guarantees a remuneration equivalent to 90% of your net salary.
The amount of this annuity is revalued at 1er July of each year according to the evolution of the index plus 100 noted during the last 12 months and according to the rate defined by the mutual.
If you are covered by the general social security scheme, your community pays you daily allowances in addition to your half-salary and social security daily allowances.
This is the case if you are a full-time contract worker or public servant working less than 28 hours a week (less than 12 hours if you belong to the job cadre of arts teachers and less than 15 hours if you belong to the job cadre of arts teaching assistants).
Your community provides you with additional per diems in the following cases:
- Half-treatment sick or serious illness leave
- Automatic lay-off (if you are a non-full-time civil servant) or maintenance of half-salary pending the opinion of the medical council
These additional daily allowances are intended to guarantee you a net remuneration equivalent to 90% your index salary (and the new index increase if you are a full-time public servant) and 40% your bonuses and allowances.
If you are a contract worker, your community also pays you additional per diem before you are awarded part-time for therapeutic reasons.
These additional daily allowances are intended to guarantee you a net remuneration equivalent to 90% your index treatment.
If you are disabled before age 62, your employer community pays you an annuity that guarantees a remuneration equivalent to 90% of your net salary if you meet one of the following 2 conditions:
- Your ability to work or earn is reduced by at least 2/3
- You have a disability rate of at least 66% accident at work in the case of an occupational disease or
The amount of this annuity is revalued at 1er July of each year according to the evolution of the index plus 100 noted during the last 12 months and according to the rate defined by the mutual.
From 1er in january 2026, your employer community will contribute to the financing of your contributions to a health supplement covering the costs incurred by a maternity, an illness or an accident.
The participation of your community shall cover at least the following guarantees:
- Entire user fee on consultations, documents and benefits reimbursable by sickness insurance. However, there may be 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.
The amount of such participation shall be at least €15 per month.
Your community can provide a higher level of participation.
Hospital (FPH)
From 1er January 2026, you will be able to benefit from partial reimbursement of your contributions to a supplementary health (mutual) by your employer institution.
You will be able to benefit from this partial support whether you are a civil servant or a contractor.
Partial payment of contributions shall cover mutual insurance schemes to cover medical expenses incurred in connection with maternity, sickness or accident.
Your institution may also partially cover contributions to mutual societies intended to cover the risks of incapacity for work, invalidity, incapacity or death.
The mutual may be a mutual to which you have individually subscribed.
In this case, your employer institution will specify which supplementary health organizations are entitled to partial reimbursement of your contributions.
One collective agreement may also provide for the subscription by your employing establishment of a collective contract intended to cover all or part of the risks of maternity, sickness, accident, incapacity for work, invalidity, incapacity or death.
This collective agreement may provide for your compulsory subscription to all or part of the guarantees that this collective agreement contains.
Ministry of Public Service