However, in a note published before the final arbitrations, the consulting firm Mercer France considered that the reform would have a financial impact for companies through their collective mutual agreements. He predicted an increase in their contributions from 5.6% to 8.9% for “entry-level” contracts and 1.6% for “high-end” contracts.
For hearing aids
It is on the audioprosthesis that the reform makes the most sense since it is the medical equipment on which the rest of the patient is the highest: 57%, against 35% for the dentures and 24% for the glasses. The average cost is currently 1,500 euros per ear including 850 euros to the patient.
Some 6 million French people have difficulty hearing and about half can be paired. But only 35% of them are equipped with an audioprosthesis. The goal is to get closer to a hearing impaired person on two paired.
The implementation of the remainder at zero charge will be progressive: in 2019 there will be on average for the insured 200 euros fee less per device “100% health”, then 250 euros less in 2020. Finally in 2021, there will be no more costs to the patient. Insureds will have the choice between models placed in or behind the ear, with 12 channels of adjustment, a sound amplification of at least 30 decibels and several comfort options (tinnitus, wind noise, wireless connection …)
It will still be possible to choose more expensive hearing aids, but the amount paid by the social security and complementary can not exceed 1,700 euros per device.
From 1 January 2020, policyholders will have at their disposal mounts without a charge of up to 30 euros. Opticians must offer at least 17 models of frames for adults and 10 for children, in 2 colors. The glasses without any remaining dependents are “quality equipment, as much by their aesthetics (thinning) as by their technical performance (anti-scratch and anti-reflection)”. Their maximum price will depend on the type of correction.
The insured may also variegate the offer by choosing lenses without any reliance but with a frame more to his taste, or vice versa. The amount reimbursed will then depend on the policy of the insured, knowing that the participation of additional will be capped at 100 euros for a mount (against 150 euros today).
The reform will come into effect on 1 January 2020.
For dental prostheses
The reform plans to cap prices for the majority of dental prostheses, in return for a revaluation of “conservative care” (caries treatment, descaling, for example) and the creation of new preventive measures. Ceilings will come into effect on April 1, 2019, then “the remainder at zero charge” will apply in 2020 to crowns and bridges, in 2021 to removable dentures (dentures). Ultimately, almost half (46%) of dental prostheses will be reimbursed in full. A quarter of prostheses will benefit from a “moderate dependent rest” with capped prices. The other acts (29%) will remain at free rates.
“This is not a return of metal crowns,” said Nicolas Revel, the director of health insurance, because “the remainder at zero charge” will concern “all materials, including ceramic crowns . ” According to him, the reform was necessary because the rate of recourse to dental care in France is “about 40%” , compared with “more than 70%, 80%” among our European neighbors.