What is the difference between the 5 levels of cover offered by AMARIZ ?
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. The daily hospital benefit and personal accident cover are also included.
This ‘Complémentaire’ or ‘Mutuelle’ provides supplementary reimbursement for people who already have basic medical insurance cover, with the choice of three levels of cover:
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.
Bronze Temporary Insurance
Short-term medical insurance providing essential cover in the event of illness, accident or hospitalisation for a period of 1 to 6 months.
If I take out Gold or Silver Health Insurance, do I need Top-Up Insurance ?
Not necessarily. These two solutions provide cover at 100% of the French Social Security’s ‘Base de Remboursement’ and therefore include basic top-up cover. However, if you find you need a higher level of cover for optical and dental expenses or if you consult a medical practitioner who charges over and above the ‘Base de Remboursement’, you can add CLASSIC, COMFORT or LUXURY Top-Up cover.
For Top-Up cover, what does 150% or 250% of the 'Base de Remboursement' mean ?
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
Who can take out cover ?
Cover can be taken out by persons of any nationality who are resident in the European Economic Area.
Is cover valid outside the European Economic Area ?
Yes, cover is valid worldwide excluding Iran, Democratic Peoples’ Republic of Korea, Russia, Syrian Arab Republic and Ukraine for any stay of up to 3 months. Medical expenses incurred abroad will be reimbursed in Euro in accordance with the French Social Security’s ‘Base de Remboursement’.
If my circumstances change, can I upgrade or downgrade the level of my cover ?
Yes, if you need GOLD Health Insurance initially on arrival in France, 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.
Do premiums go up with age ?
No, you will retain the same age bracket as when you took out your policy for as long as you remain insured. If you join when you are 55 for example, you will still pay the same rate as someone aged 55 even when you are 65. Please note that premiums go up on 1st January each year by a modest percentage determined by inflation and the claims experience of all the persons insured by the Amariz Santé policy.
Does cover cease when I reach the age of 80 ?
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.
If I become seriously ill, can you cancel my policy ?
No, the Insurer cannot cancel your policy if your state of health deteriorates, regardless of the amount, the duration and the frequency of your claims.
What documentation do I need to send you in order for my medical expenses to be reimbursed ?
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.
How are reimbursements made to me ?
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 drawn on a French bank.
If I have to go to the hospital I will not be able to pay the bill - what happens ?
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.
How do I request direct settlement ?
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 medical information required. 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.
I am interested in your products, where can I get further information ?
Details of benefits, the policy wording and the Insurance Product Information Document 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.