Benefits workshops

The transition period is over: time to move on to 3rd tier plans!

Posted on 21 November 2017

Whilst lots of companies are just sitting back and waiting for the end of the transition period on 31 December 2017 before making their complementary (2nd tier) healthcare plan compliant, the responsible policy model has already changed the shape of complementary cover for millions of insureds. 

The transition period is over: time to move on to 3rd tier plans!

This should push employers who are lagging behind to start educating staff and offering them optional covers or even “non-responsible”, 3rd tier plans to shield them from unpleasant surprises with medical expense reimbursements. 

Watch out for in-patient care under responsible policies!

The law now obliges complementary healthcare plans to comply with a series of new limits and rules. Reimbursements of fee overruns for general practitioners and specialists are now capped. For certain practitioners this will result in a few extra copay Euros. This is something that will push insureds into asking themselves the thorny question: is my doctor CAS or non-CAS, is he/she Optam or non-Optam? For optical care, these new limits leave enough room for the right lenses and a good choice of frames. Careful though: cover is restricted to one single pair of glasses every two years. 

Nevertheless, it is hospitalisation where the responsible policy model produces the most untoward effects. In some cases, the patient copay can indeed easily rise by several hundred Euros. It is not unusual for insureds, once they are home again, to telephone complaining of a delay in their reimbursement only to find, to their dismay, that certain items of their complementary insurance plan had been deleted when transferring to a responsible policy. 

The non-responsible, 3rd tier solution

In the face of such difficult situations, the prime responsibility of employers is to inform their staff as to any gaps in cover that they run the risk of finding after their complementary healthcare plan is brought into compliance. However, making an effort to communicate is often not enough. A stay in hospital is a rare event and very often not envisaged. Patients are not accustomed to comparing fees for this and negotiating reductions so as to reduce their copay. Before entering the operating theatre, their main concern is their state of health.

In order to compensate for the dilution of cover under the responsible policy model, insurers have developed some 3rd tier, non-responsible products. Premiums are graded depending on the level of cover and range from a few Euros to tens of Euros a month, entirely for the staff member’s account. However, putting in place such a plan is not a simple matter for the employer: premiums need to be negotiated, new individual policies handled, and payroll software configured, among other things. Plus, there is the need to educate staff and the social partners, at the risk of otherwise spoiling relations with HR management for some time to come. So, what is the result of all this? Quite simply, the status quo on staff healthcare insurance. Spending so much energy to find that nothing has changed may seem ludicrous, but rest assured, it is indispensable.

>>> Our advice

> Choose a solution with integrated scheme management and so avoid complicating the lives of employees by having several contact persons, thus limiting areas of friction.

> Don't skimp on explanations so as to reach a target of over 50% take-up (the average rate seen is around 30%). Strive for added value by warding off those rude awakenings when misfortune arrives.

> Take advantage of your communication campaign to highlight the fact that using a practitioner from the network of healthcare professionals, especially for optical care, can mean a saving of up to 20% and can easily result in100% cover.

Damien Vieillard-Baron