Mutual insurance waiver: conditions and procedures
Written by Estelle BALDERESCHI | Posted on 29/11/2024
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Mutual health insurance: an employer's obligation to provide coverage
Before talking about mutual dispensation, it's worth mentioning the obligations surrounding collective complementary health insurance. Since January 1, 2016, companies in the private sector have been required to offer their employees compulsory collective complementary health insurance, in accordance with the law on the generalization of complementary health insurance.
The aim: to guarantee minimum health cover for all employees. If, like 95% of companies, you offer your employees a responsible contract, your benefits will have to comply with a certain level of coverage and respect reimbursement ceilings. Your collective bargaining agreement may also provide for higher levels of cover. However, some employees may refuse this compulsory affiliation by requesting an exemption from mutual insurance. These exemptions are provided for in the regulations and must comply with precise formalities. In this article, find out when an employee can request an exemption, the steps to follow and your obligations as an employer.
What is the mutual insurance waiver?
An employee can opt out of his or her company's group health insurance scheme. However, this option is only available under certain conditions. A distinction must be made between "de jure" and "optional" exemptions. The former are automatically applicable, irrespective of the legal instrument setting up the health costs scheme (collective agreement, unilateral employer decision - DUE), while the latter must be expressly provided for in that instrument. This system is designed to respect employees' individual situations, while avoiding the payment of double contributions in certain cases.
What are the conditions for exemption from company mutual insurance?
Employees are therefore entitled to an exemption in cases clearly defined by legislation and according to the cases provided for by the collective agreement or the DUE.
Legal exemptions
The following cases of exemption from rights are applicable without the need to formalize them in the DUE or collective agreement:
- Employees benefiting from complementary coverage under the CSS (Complémentaire santé solidaire, formerly CMU-C and ACS). This exemption applies only until the date on which employees cease to benefit from this coverage or assistance;
- Employees on fixed-term contracts (or assignment contracts) for less than 3 months. These employees must also be covered by a contract that complies with the specifications for responsible contracts;
- Employees covered by an individual health insurance policy. This exemption applies only until the individual contract expires. In the case of a tacitly renewable individual contract, the waiver applies only until the tacit renewal date;
- Employees covered by one of the following contracts, including as dependents:
- Compulsory group contract (multiple-employer employees or compulsory beneficiaries). The French Supreme Court has specified that coverage for dependents need not be compulsory;
- Régime local d'assurance maladie du Haut-Rhin, du Bas-Rhin et de la Moselle ;
- Madelin law " group insurance contract;
- Supplementary health insurance scheme for the electricity and gas industries (CAMIEG) ;
- Mutuelle des agents de l'Etat et des collectivités territoriales, for at least the same level of cover.
For all the cases of exemption listed above, the employee must provide the personnel department with a sworn statement, which, at Gerep, is issued automatically at the end of the affiliation process if the employee opts for an exemption.
Optional exemptions
To be applicable, these cases must be expressly provided for in the deed of installation:
- Employees and apprentices on fixed-term or temporary contracts of 12 months or more. These employees must also be covered by a contract that complies with the specifications for responsible contracts;
- Employees and apprentices benefiting from a fixed-term contract or an assignment contract of less than 12 months, even if they do not benefit from individual cover taken out elsewhere;
- Part-time employees and apprentices who would have to pay a contribution equal to at least 10% of their gross remuneration if they joined the scheme.
How does an employee apply for a mutual insurance waiver?
To be exempted, the employee must follow a strict procedure:
- Make a written request: the employee must provide his employer with a certificate specifying the applicable exemption and its possible expiry date. The employer may stipulate that the employee must provide proof of entitlement on an annual basis.
- Respecting deadlines: The request must be made at the time of hiring or when the employee's benefits take effect (e.g.: the spouse joins a new company, in which case the spouse's benefits take effect for the employee).
- The employer must keep the application and supporting documents for use in the event of an audit.
At Gerep, we have set up a digitalized process so that you don't have to worry about this procedure:
- During the employee's online course, Gerep offers them the option of joining or opting out;
- Exemptions are configured according to legislation (legal exemptions) and your company's agreements (optional exemptions);
- The employee then downloads the declaration in PDF format. You can also access the mutual exemption declarations in your company area.
Thanks to our online course , your URSSAF compliance is guaranteed. To find out more about our digital workflow, watch our video:
How do I modify my DUE?
Modifying the Unilateral Employer Decision (DUE) to include or remove cases of exemption requires a methodical approach in order to comply with legal obligations and avoid any disputes. Here are the key steps for incorporating optional exemptions:
- Analyze regulations and your needs
Look at the impact this change will have on your employees (fixed-term contracts, part-timers, expatriates, etc.) and on your payroll management.
- Have the DUE validated by a legal expert.
Make sure that changes comply with the legal framework by calling in a lawyer specialized in labor law or a legal expert. At Gerep, we have a team on hand to assist our customers with compliance.
- Informing your CSE of the signing of a new DUE
This is an essential and compulsory stage in the CSE's work.
- Communicating the evolution of the DUE
This DUE must be given to each employee individually.
The mutual insurance waiver is a way of reconciling the employer's obligation to provide coverage with the specific needs of employees. For the employer, it is essential to be rigorous in drafting the DUE and managing supporting documents. For employees, it is essential to understand the procedures and their rights before requesting an exemption. By applying these rules, employers and employees can comply with the law, while adapting their health cover to their individual circumstances.
FAQ: Answers to frequently asked questions
What supporting documents do I need to obtain a mutual insurance waiver?
Supporting documents depend on the situation:
- Declaration of honour
- Certificate of compulsory coverage under another contract (e.g. spouse's mutual insurance company)
- Employment contract for a fixed-term contract of less than 12 months
- Proof of complementary health insurance.
Can an employee cancel an exemption request?
Yes, an employee can revoke his or her waiver at any time if his or her situation changes (end of coverage under another contract, change in family status, etc.).
Can the employer refuse a request for exemption?
No, if the application complies with the regulations and the supporting documents are supplied.
Post written by
Estelle Baldereschi
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