Mutual health, complementary and other forms of insurance are an integral part of health insurance. The confusion is frequent because these two terms have the same objective. A person who subscribes to a mutual health insurance does it for the same purpose as a person who opts for health insurance. Nevertheless, there are some parameters that can differentiate. Discover in this article what differentiates a mutual health insurance.
What is the purpose of health insurance and mutual health?
Social security offers the advantage to anyone who is affiliated to benefit from a partial coverage of health costs. It is indeed through health insurance that social security covers these. Depending on the expenses of the insured, expenses are reimbursed at a given height and the rest is the responsibility of the individual.
The amount of expenses borne by the insured will be important depending on certain aspects such as drugs, vaccinations, consultations, whether the service received was made by a licensed practitioner or not and according to the category of drugs (white label or blue). It should also be noted that expenses related to optics, dental care or excess medical fees remain the responsibility of the insured when it comes to health insurance.
The mutual health insurance intervenes when the insured, because of the insufficiency of the coverage of the social security decides to take another measure in complement of the health insurance. And it is the subscription to a complementary health or mutual health. This allows him to benefit from better care and cope appropriately with his health problems.
What is the difference between the two terms?
The mutual health as well as the health insurance allow to benefit from an adequate health cover in addition to that of the social security but, their statutes are different.
What you need to know about a mutual health insurance?
The mutual is a non-profit organization that operates on the Mutuality Code. The most promoted value in this context is solidarity. Mutual members join together to pay medical expenses. The mutual is governed by a board of directors whose members are chosen by the members.
To join a mutual like Viahealth, you just have to go to the authorized structures, sign a membership form and then start paying the contribution that will entitle you to the guarantees.
Indeed, the members are the people who are within the association and who are an integral part of the management of the mutual. They are informed of the slightest details related to the management of the mutual, especially in the financial area. They have the opportunity and the power to participate in making important decisions that engage the mutual.
The primary goal of a mutual is not to make profit. Nevertheless, when profits are made, the board of directors undertakes to repay some of these profits to members of the mutual society or to keep them in reserve in order to cope with certain periods during which requests exceed the funds collected.
As for health insurance, it is a form of company that is commercial in nature and operates on the provisions of the Commercial Code. It offers commercial claims through complementary health insurance contracts for which it sets an amount according to the needs of the insured.
Unlike mutuals, members of an insurance company are all considered clients and have no decision-making power over the management or administration of the insurance company. They are for profit and generate profits paid directly to shareholders and not to members as in the case of mutuals. .
To join, you must subscribe to a complementary health through a health insurance contract with an insurance company. The duty of the insured is to pay an insurance premium in order to benefit in return for a health cover according to the guarantees chosen.
Refunds and contractual conditions
In addition to the differences in the status of mutuals and health insurances, they work in much the same way as they both provide the insured with good health coverage. Sometimes, one and the same client can subscribe to both types of health insurance.
In a health insurance contract, the insurance company may require the insured to complete a medical questionnaire while the mutual can not impose such requirements on the member. It is required to accept any adherent regardless of health status or medical history. This is a very important aspect in choosing a complementary health. That is why it is advisable to use insurance comparators online to choose the best possible health supplement.