Health insurance is an essential pillar of your social protection. It guarantees that your health expenses will be covered in the event of illness, accident or maternity. Yet many people are still unaware of how it actually works, what it covers, and why it’s crucial to supplement it with appropriate health insurance.

At Insurcap7, we help our customers to better understand how health insurance works, and to choose the solutions best suited to their situation.

In this article, you’ll find out everything you need to know to be well covered, with no surprises.

1. Compulsory health insurance: what Social Security covers

Everyone who works or resides on a stable and regular basis is covered by compulsory health insurance, via the Social Security system. It covers a portion of medical expenses relating to :

Medical consultations (general practitioner or specialist)

Prescription drugs

Hospitalization

Laboratory tests and analyses

Dental and optical care (in part)

💡 Important : Social Security does not reimburse 100% of your expenses. The rest is your responsibility… unless you have a complementary health plan.

2. The indispensable role of complementary health insurance

For the best protection, it’s essential to take out supplementary health insurance. It covers all or part of the costs not covered by compulsory health insurance.

Here’s what a good complementary health insurance plan can cover:

Co-payments for consultations and medication

Extra fees

Hospitalization costs (single room, daily rate)

Expensive dental care (prostheses, implants)

Optical equipment (glasses, contact lenses)

Alternative medicine (osteopathy, acupuncture, etc.)

Care not reimbursed by Social Security

👉 At Insurcap7, we offer tailor-made health contracts, adapted to your age, family situation and budget.

3. Understanding reimbursement levels

A health insurance contract offers different levels of reimbursement, often expressed as a percentage of the Social Security reimbursement base (SSRB).

For example :

A 100% SSRB plan reimburses only the co-payment.

A 200% SSRB plan covers excess fees.

A package of 300% SSRB or more can offer almost complete reimbursement of your expenses.

💡 Concrete example: If Social Security reimburses €70 on a €100 consultation with a specialist, and you have a 200% complementary plan, you can recover the remaining €30.

4. Which cover for whom? Employees, self-employed, pensioners…

👨‍💼 Private-sector employees
Employers are required to offer a group health insurance plan. It is often attractive because it is co-financed by the employer.

🧑‍💻 Self-employed workers and auto-entrepreneurs
They must take out their own contract. It is essential to opt for good coverage, particularly in the event of sick leave or hospitalization.

👨‍👩‍👧‍👦 Families
A family health contract covers all members of the household. There are formulas with enhanced cover for children (orthodontics, optics, etc.).

👴 Retired and senior citizens
Health needs increase with age. A good senior mutuelle includes appropriate cover for dental care, hearing aids, optical care, long-term hospitalization, etc.

👉 Our advice: Don’t take out a standard mutual. Let us help you choose coverage that meets your real health needs.

5. Focus on poorly reimbursed or non-reimbursed treatments

Some treatments are poorly or not at all reimbursed by Social Security, which can lead to significant expenses if you don’t have the right complementary health insurance:

Optical: glasses, progressive lenses, contact lenses

Dental: implants, high-end prostheses

Hearing: hearing aids

Alternative medicine: osteopathy, chiropractic, hypnosis, etc.

Cosmetic surgery (excluding medical cases)

A quality complementary health insurance plan can help you limit these costs, thanks to annual reimbursement packages or specific cover.

6. Services that make all the difference

Good health insurance isn’t just about reimbursements. It’s also about human support and useful day-to-day services:

24-hour access to medical teleconsultation

A network of partner healthcare professionals

Coverage in the event of hospitalization

Third-party payment service (you don’t have to pay in advance)

Mobile application to track your reimbursements

At Insurcap7, we do our utmost to ensure that you are well protected… and well supported.

7. Good to know: your rights if you are in a precarious situation

Certain people can benefit from enhanced coverage:

Supplementary health insurance (SHI): free or at very low cost, for people on modest incomes

Medical assistance of government (MAG): for illegal immigrants.

These schemes provide access to essential healthcare without advance payment. We can help you check your eligibility and assist you with the necessary formalities.

✔️ To sum up: key points to remember

What you need to know	Why it matters
Social security doesn’t reimburse everything	Hence the need for a complementary
There are different warranty levels	Tailored to your health needs
Some treatments are very expensive	Optical, dental, hearing, alternative medicine
Each profile has specific needs	Employees, self-employed, senior citizens, families…
Useful services are included	Third-party payment, teleconsultation, online follow-up
There is help for the most modest	SHI, AMG, administrative support

📞 Need help choosing your health insurance?
At Insurcap7, our team will guide you step by step to:

Analyze your needs

Choose the most advantageous plan

Manage your subscription and cancellation procedures

Request your personalized quote today. Protect your health, your family’s health and your budget with complete peace of mind.

👉 Contact us now | 📍 Book an appointment | 💬 Chat with an advisor online