GENERAL QUESTIONS ON AMARIZ SANTE HEALTH INSURANCE
GOLD HEALTH INSURANCE
This solution provides comprehensive medical insurance covering a wide range of medical expenses at 100% of the French Social Security’s ‘Base de Remboursement’ or ‘Tarif de Convention’ and therefore includes basic top-up cover. It also comprises a daily hospital benefit and personal accident cover.
SILVER HEALTH INSURANCE
This solution provides for reimbursement of the same types of treatment as Gold Health Insurance, with the exception of all consultations and visits with a general practitioner or specialist, unless they are carried out during the course of a covered in-patient hospitalisation. The daily hospital benefit and personal accident cover are not included in this level of cover.
This solution covers hospitalisation expenses only (at least one night in hospital) and reimburses of 100% of actual expenses for accommodation costs and up to 300% of the ‘Base de Remboursement’ for medical and surgical fees. Also insured are the daily hospital benefit and personal accident cover.
This ‘Complémentaire’ or ‘Mutuelle’ provides supplementary reimbursement for people who already have basic medical insurance cover, with the choice of three levels:
CLASSIC: Reimbursement of up to 150% of the ‘Base de Remboursement’ with no medical questionnaire and no waiting period
COMFORT: Reimbursement of up to 275% of the ‘Base de Remboursement’
LUXURY: Reimbursement of up to 400% of the ‘Base de Remboursement’ including personal accident cover
IMPORTANT : Please note that any reimbursements received from another health insurance scheme will be deducted from the amount payable under the Top-Up option.
Some healthcare providers charge over-and-above the ‘Base de Remboursement’. If you were charged € 90.00 for a consultation with a GP, the French Social Security would reimburse 70% of the ‘Base de Remboursement’ (€ 25.00) less the €1.00 excess, i.e. € 16.50.
If you had CLASSIC top-up cover, we would reimburse the difference up to 150% of the ‘Base de Remboursement’, after deducting the Social Security’s payment, i.e. € 21.00
If you had COMFORT top-up cover, we would reimburse the difference up to 250% of the ‘Base de Remboursement’, after deducting the Social Security’s payment, i.e. € 46.00
If you had LUXURY top-up cover, we would reimburse the difference up to 350% of the ‘Base de Remboursement’, after deducting the Social Security’s payment, i.e. € 71.00
Yes, if you need GOLD Health Insurance initially on arrival in France because you are affected by the 2007 change in legislation for expatriates, you can ‘downgrade’ this to Top-Up insurance when you become entitled to cover under the French state scheme. A decrease in cover will take effect on the date the next premium is due (the first of a month).
Conversely, if you have taken out Top-Up insurance in conjunction with your S1 form on moving to France, you can ‘upgrade’ this to GOLD Health Insurance when this document expires if you find that you need more comprehensive insurance. Please note that you will need to complete a satisfactory proposal form in order to do this as an increase in cover is subject to the same rules and conditions as a new application for cover.
No, cover is lifelong and your premium will be calculated as indicated in the previous paragraph. 80 is the maximum age at which you can join the AMARIZ SANTE plan.
No, you will remain insured irrespective of your state of health or the number of claims that you make.
You should send us your original treatment forms and invoices, along with the corresponding prescriptions etc. We provide pre-paid envelopes. For Top-Up cover, you should send us the original of the breakdown of your reimbursement by the French Social Security or other basic scheme so that we can reimburse the difference. Most claims are processed within one week of receipt of the relevant documents. Please ensure that you send us a completed claim form with each request for reimbursement, indicating the nature of the illness and the date of diagnosis.
We prefer to make an electronic transfer of funds into your bank account – this transfer is almost immediate and cost-free to you. Alternatively, we can mail you a cheque.
You can use your direct settlement card for hospitalisation, outpatient and day case treatment, radiology, medicines and medical tests. This means that instead of you having to pay for treatment up-front and then be reimbursed, we will pay the healthcare provider directly.
You will be able to request direct settlement of your medical expenses by filling in the reverse of your claim form (demande de prise en charge hospitalisation) and providing the requisite medical information. For non-emergency hospitalisations, please send your request to us at least 10 days before you are due to be admitted. Once your request has been processed, the acceptance will be sent directly to the hospital or clinic. For emergency admissions, the hospital can contact us directly.
Details of benefits, the policy wording and the policy summary are available on each of the product pages of our website. If you have difficulty downloading or printing these documents, please contact us and we will send you a hard copy by post – Freephone from France 0800 900 258.