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L'assurance complémentaire santé
| Publié le 7 septembre 2020 à 5:55 |
Une assurance complémentaire santé est un contrat qui a pour objet de prendre en charge tout ou partie des dépenses de santé non couvertes par l’Assurance maladie obligatoire en cas de maladie, d’accident et de maternité.
La complémentaire santé peut être souscrite soit à titre individuel en s’adressant directement à un organisme complémentaire santé (mutuelles, entreprises ou sociétés d’assurance, institutions de prévoyance…;), soit en adhérant à un contrat collectif (ou contrat groupe) par l’intermédiaire de l’employeur ou d’une association.
Elle intervient en complément de l’Assurance maladie obligatoire, en prenant notamment en charge : Le ticket modérateur.
Il correspond à la partie des frais remboursables (base de remboursement) que l’Assurance maladie obligatoire ne prend pas en charge.
Le ticket modérateur s’applique aux prestations suivantes :
consultation médicale, analyses de biologie médicale, examen de radiologie, soins dentaires, achat de médicaments prescrits, etc. Les dépassements.
Ils correspondent aux frais de santé non pris en charge par l’Assurance maladie obligatoire.
Les dépassements ne sont pas systématiques et sont à la discrétion du praticien qui doit les appliquer « avec tact et mesure ».
Il peut s’agir d’une partie des honoraires de professionnels de santé, L’Assurance maladie obligatoire ne rembourse qu’une partie de vos dépenses de santé. Les frais restants sont théoriquement à votre charge.
C’est ici qu’intervient votre complémentaire santé : elle vous rembourse tout ou partie de ces frais, en fonction des garanties prévues à votre contrat. de dépassements pour des soins prothétiques en dentaire ou orthodontiques, pour des lunettes ou des aides auditives...
La complémentaire peut aussi rembourser partiellement ou intégralement (selon vos garanties) des soins non couverts par l’Assurance maladie obligatoire : Certains frais d’hospitalisation : chambre particulière, forfait journalier hospitalier…
Des prestations de médecine dite « douce » ou « alternative » : ostéopathie, acupuncture, diététique…
Certains achats en pharmacie : vaccins et médicaments non remboursables…
Divers frais optiques : opération de la myopie, achat de lentilles de contact...
Comment intervient ma complémentaire santé ?
Remboursement de la complémentaire santé ticket modérateur dépassements (éventuels)
En plus du remboursement des frais de santé, votre complémentaire peut donner accès à des services tels que les réseaux de soins ou le tiers payant complémentaire.
Catégories : PREVOYANCE et SANTE
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