100% health: key facts

The French healthcare system and the complementary healthcare landscape are constantly evolving. For HR managers, the "100% Santé" reform - formerly known as "reste à charge zéro" - is not just a technical measure, but has a direct impact on the company's social protection strategy, communication with employees and the compliance of group contracts.

But what exactly is "100% Health"? What impact does it have on companies and, above all, on employees?

What is 100% Health?

100% Health is a reform that will gradually come into force between 2019 and 2021. Its aim is to enable policyholders to benefit from essential care that is fully covered, at no additional cost to them (after reimbursement by Social Security and supplementary health insurance).

This system applies to three areas of care that are often costly for employees:

• Optics
• Dental
• Audiology

It is aimed at all people benefiting from a responsible complementary health plan or a complementary health plan based on solidarity (CSS), which has replaced the CMU-c and ACS.

Good to know: policyholders can still opt for equipment outside the 100% health basket, if they so wish.

What does 100% Health cover?

Optical :

There are 2 baskets: basket A, which offers equipment with no out-of-pocket expenses (100% Santé offer), and basket B, for which prices are free (excluding the 100% Santé offer).

For Basket A (100% Health), the optician must present :

• High-performance lenses: suitable for all visual corrections with anti-reflective, scratch-resistant and thinned coatings
• Adult frames: at least 17 different models available in 2 colors
• Children's frames: at least 10 models available in 2 different colors

Frames must comply with European standards, with price ceilings.

For Basket B :

• Rates are subject to change
• Coverage of frames is limited according to the conditions and limits of the contract's benefits and services.

Good to know: your optician is obliged to offer you a quotation including a 100% health offer. You can put together your own outfit by combining 100% health lenses with the frame of your choice at a free price, or vice versa.

Dental :

100% health basket :

Full reimbursement: crowns, bridges and prostheses from the 100% Santé range are fully reimbursed by the French Assurance maladie and Gerep.

Wide choice of prostheses: you have access to fixed or mobile prostheses with aesthetic materials adapted to visible and non-visible teeth.

Controlled-rate basket :

It includes crowns, bridges and dentures, all subject to price caps. Depending on your coverage, there may be a moderate out-of-pocket expense.

Composite or non-precious metal alloy inlay-onlays are the devices applicable in this basket that are impacted by the new reform.

Free-rate basket :

Tariffs set freely by the dental surgeon, with no price controls or compulsory coverage.

Good to know: all approved dentists must systematically include a "100% health" or "controlled basket" treatment plan in their estimate, where available.

Audiology:

Hearing aids are divided into two classes, enabling policyholders to choose the equipment of their choice: class I, which corresponds to the 100% Santé package, and class II, which comprises hearing aids not included in the 100% Santé basket, with prices freely defined by the hearing aid specialist.

Included in the 100% health care basket :

• All types of hearing aid: classic BTE, BTE with remote receiver and in-the-ear hearing aids
• 12 adjustment channels to adapt the device to the hearing problem
• At least 3 of the following options: anti-tinnitus system, wireless connectivity, wind noise reduction, binaural synchronization, adaptive microphone directionality, extended bandwidth, loudness learning, anti-reverberation device.

Good to know: audioprosthetists must offer you a solution with no out-of-pocket expenses, to ensure you have access to quality hearing equipment.

What are the implications for companies and group contracts?

Mandatory compliance

Responsible contracts must include 100% health baskets.

Not necessarily more expensive

Contrary to popular belief, 100% Healthcare has not necessarily led to a massive increase in premiums. In fact, the devices included in the 100% Health baskets are subject to price ceilings, which limit their cost. Thanks to this pricing framework, contracts have been able to be adapted without causing an explosion in expenditure for policyholders or supplementary health insurance providers.

The importance of transparency

Employees must be clearly informed of what they are entitled to. It is up to the company or its consulting broker to ensure clear, educational communication.

HR best practices: how to support your employees?

• Provide clear information on 100% health cover: booklet, summary sheet, internal FAQ.
• Organize discussion sessions (meetings, videoconferences, webinars) with your broker to answer questions.
• Provide visual comparisons: with/without 100% Healthcare, out-of-pocket expenses, equipment, etc.
• Listen to feedback from the field: glasses, hearing aids or dental care are often sensitive subjects for employees.

An employee who understands his or her rights is reassured and better supported. Our aim is to make life easier for policyholders, and at Gerep, we offer tailor-made support.

FAQ 100% santé :

Is 100 Santé compulsory?

Yes, for all responsible contracts. The insurer must offer benefits covered by the 100% Health basket, but the employee is free to choose options outside the basket.

Can my company offer better guarantees?

Yes, you can offer superior cover, with higher reimbursements, as long as the contract remains compliant.

How do we know if our contract is compliant?

An audit of your health plan, carried out with your broker, can help you check that your contract is compliant and identify any improvements you need to make.

What to do if an employee wants to refuse the 100% Health Plan?

This is not an imposed option; employees can choose benefits outside the basket. The most important thing is that they have a choice and clear information.

Need personalized support?

Call on our experts for a free audit of your group health contract.

We're here to help you simplify your company's social protection.