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Company mutual (health supplement): employer's obligations

Verified 11 March 2020 - Directorate for Legal and Administrative Information (Prime Minister)

Every employer in the private sector (company and association) has the obligation to offer supplementary collective health coverage to its employees (except those who already have one). An individual who employs an employee at home is not concerned. Some employees on short-term contracts may be exempted from joining the collective mutual insurance scheme and may receive a health payment from the employer.

The employer must provide all employees who do not already have supplementary coverage, irrespective of their length of service in the undertaking, of a supplementary health reimbursement scheme.

The company freely chooses the insurer from whom it negotiates the insurance contract.

The employer must send a membership form to the employee who has no steps to take. He then receives a certificate of affiliation with the health supplement.

The social partners in the branch can recommend an organization. In this case, the recommendation must be made after a prior competition procedure.

Coverage of the rights holders (children or spouse) of the employee is not compulsory, but the employer (or social partners) may decide to cover them as well.

Mandatory group coverage must meet the following conditions:

  • the employer's financial contribution must be at least equal to 50% the contribution (the remainder to be paid by the employee);
  • the contract must respect a minimum guarantee base (minimum care basket);
  • the contract is compulsory for employees, except in cases in which the employee may refuse mutual assistance..

The employer's contribution must cover at least half of the financing of all the collective and compulsory health coverage of employees in respect of the supplementary reimbursement of health or maternity costs (even if it is higher than the minimum contribution).

In the case of multiple employers, an employee already covered by a collective contract of one of his employers may refuse to subscribe to the other contracts. He must justify this protection to other employers by means of an annual proof of membership.

FYI  

in the event of suspension of the employment contract, coverage must be maintained when the employee is in the process of being compensated (e.g. sick leave). On the other hand, the employer is not obliged to maintain the mutual trust when the suspension is not compensated (parental leave, for example). Employees whose contracts are terminated for other than gross negligence shall be entitled to the maintenance of such coverage for a period equal to the period of unemployment compensation.

The care basket must meet the specifications of the responsible contracts. The employer's health care coverage must therefore:

  • provide for floors and reimbursement ceilings for certain costs (optical);
  • and exclude the assumption of certain expenses.

The minimal care basket must offer the following guarantees:

  • full user fees for consultations, acts and benefits repayable by health insurance;
  • total daily hospital fee (€20 per day in hospital or clinic/ €15 per day in the psychiatric department of a health institution);
  • dental expenses (prostheses and orthodontics) up to 125% the conventional tariff;
  • flat-rate optical costs per 2-year period (annually for children or in case of changes in vision) with a minimum of care for €100 for single glasses and mounting/ €150 for complex glasses and mount).

Employees concerned

The employer must offer a mutual to all employees, including apprentices.

However, it may issue an exemption from membership of the company mutual to employees, in particular:

  • fixed-term employment (fixed-term contract) of less than 3 months;
  • on a mission contract of less than 3 months (acting);
  • part-time (up to 15 hours per week).

These employees may:

  • subscribe to the supplementary health coverage offered by their employer; or
  • or request to be exempted from this requirement for the health payment.

However, this possibility is not open if the compulsory collective coverage is at least 3 months, regardless of the duration of the contract.

The health payment may also be set up:

  • on the initiative of the social partners (by collective branch agreement or by company agreement);
  • by unilateral decision of the employer.

Other employees may be exempted, at their request, from the obligation to join:

  • employees who receive individual coverage when the compulsory collective scheme is introduced or when they are hired if it is later. The exemption shall apply until the expiry of the individual contract;
  • employees who are beneficiaries of CMUC: titleContent orACS: titleContent.. The exemption applies until the date on which the employee ceases to benefit from CMUC or GBA;
  • employees, including those entitled to benefits, receiving benefits in respect of another employment of one of these schemes: supplementary compulsory health insurance, local health insurance scheme in Alsace-Moselle, supplementary health insurance scheme for the electricity and gas industries (CAMIEG), and mutual insurance for state and local authorities, in particular.

In the event that the employee contracts 2 successive contracts of less than 3 months and the total duration of the 2 contracts exceeds 3 months, the health payment is due only under the first contract.

Where several DDCs are concluded with the same employee, without being successive, the health payment must be taken into account contract by contract.

Calculation of employer contribution

The health payment is financed by the employer.

The amount of the payments shall be calculated each month on the basis of a reference amount to which a coefficient is applied.

This reference amount corresponds to the employer's monthly contribution to the financing of the collective coverage of the category to which the employee belongs. It shall take into account, where necessary, the remuneration of the employee.

If the amount of the contribution cannot be determined for the category of the employee, the reference amount shall be €16.34 (or €5.45 for the local regime Alsace-Moselle).

The coefficient applied to the reference amount shall be:

  • 105% for permanent employees;
  • 125% for employees in CDD or in mission contracts.

For example, if an employer makes a lump sum contribution €60 for each of its employees in a certain category, for a permanent employee in that category who works 50 hours per month, the reference amount shall be calculated as follows: 60 x (50/151.67) = 19.78, to which the coefficient of 105%.. The monthly amount to be paid for this employee is €20.77 (19.78 x 105%).

The employer shall be exempt from social security contributions on such payments, except in respect of CSG-CRDS and social fortress in enterprises with at least 11 employees.

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