What is Supplementary Health Insurance (AMC)?

What is the principle of AMC?

Complementing the services of the compulsory health insurance system is all organizations that provide supplemental health services. It exists in the form of individual and group contracts, combining both voluntary and compulsory schemes, depending on the social status of the beneficiaries.

AMC is offered by three types of organizations under two contract forms.

Three types of organizations that guarantee AMC coverage

These three types of insurers are distinguished by the specific rules that govern them.

  • The interrelationships managed by Codedela Mutualit√© are also known as interrelationships 45 (since the year this decree was created).
  • The provider is compliant with the Social Security Law.
  • Insurance companies are covered by the insurance code. They can take the form of commercial companies, but they can also take the form of mutual insurance companies.

AMC format

The type of contract depends on the quality of the subscriber.

The Group contract It is a group contract that is not the beneficiary of the guarantee itself, but a group (such as a union or specialized institution) or a company whose members comply with the group contract.

example : Since the ANI Act, employees have systematically benefited from group health contracts that employers must conclude.

The Individual contract If established and signed directly by the insured, the individual contract is intended for one individual with insured status and dependents from a family unit (spouse and children). They are mainly brought out by TNS (craftsmen, traders, farmers, liberal professions, etc.) and retirees who do not benefit from the provisions of ANI law.

Be careful: Collective contracts were originally offered only by the provider. Although individual contract subscriptions were offered only by mutual insurers and insurers.

However, the implementation of the ANI Act obligations that require employers to enter into group contracts for the benefit of all employees allows mutual organizations and insurance companies to now offer collective contracts. Provident authorities whose status has changed by creating a structure whose management corresponds to the reciprocity code.

Is supplementary health insurance required?

Complementary health insurance except for those covered by the employee system (the company covers 50% or more of the contribution) that must be contributed by joining a group contract set by the employer under the ANI Act. There is no obligation to join. insurance.

Why buy complementary health insurance?

Enrolling in supplemental health insurance is interesting because the compulsory health insurance scheme allows the insurance to cover all or part of the cost of care entrusted to the social insurer’s responsibilities. This also allows you to benefit from third-party payments, eliminating the need to prepaid treatment costs. Through the Carte Vitale, medical professionals will be credited with social security repayments based on traditional fees and supplementary health insurance out-of-pocket costs.

Good to know: Employees who believe the warranty is inadequate can individually enroll in a supplementary care contract by acting as a third level as an additional supplement after the intervention of social security or group health supplements.

How to get a refund?

In addition to the use of third-party payments to avoid paying medical expenses directly paid by compulsory schemes and complementary health insurance, beneficiaries of complementary health contracts will be refunded under the guarantees set forth in. Actually what happened in the case of his contract regarding the supply of a statement of expenses issued by social security to the insurance company or mutual insurance company, or in the case of a care service that is not subject to the compulsory scheme if the contract provides reimbursement. Billing for high-end formulas from the perspective of natural medicine).