irst euro A health insurance plan specifically designed for people not subject to a mandatory health insurance scheme (2013 Premiums)

Transcription

1 irst euro A health insurance plan specifically designed for people not subject to a mandatory health insurance scheme (2013 Premiums) Insurance isn t what it used to be.

2 First Euro The Health insurance plan for people not subject to a compulsory health insurance scheme You are not covered under a mandatory health insurance scheme* because you are a selfemployed foreigner living in France, or because you are employed, for instance, by an Embassy or a Consulate. You are seeking a health insurance plan under which you will get reimbursements equal to or greater than those applied by the French Social Security. APRIL provides you with a health insurance solution, under which you are covered right from the very first euro spent for your health care expenses. * It does not apply to French people residing in France, since they are inevitably affiliated to the French mandatory health insurance scheme. THE BENEFITS OF THE FIRST EURO POLICY A comprehensive coverage, tailored made to your needs 3 levels of coverage, ranging from 70% to 150% of the official rates set by the French Social Security, Intermediate care expenses coverage (pharmacists, opticians, dentists, doctors, ), A reimbursement ceiling for dental services doubled from the second year of the policy, Fourth and subsequent children are included free of charge. A clear-cut policy to put your mind at ease Possibility to take out the health insurance policy until the age of 65. Immediate life annuity If your health condition changes, your insurance policy remains unchanged* Get negotiated tariffs on optical services thanks to our network of privileged partners**. APRIL reimburses you within 24 hours (1) * Except in case of false statement, or default in payment of premiums. ** Check out our partners, listed on page 7. Log on to Check your reimbursements online anytime you like, by logging in to your Personal Policyholder Account. Thanks to the system of direct payment by insurers, no need to pay upfront in case of hospitalisation*. * Health institutions having an agreement with the French Social Security. (1) From the receipt of your reimbursement claim. 2

3 HOW TO GET REIMBURSED? 1. You should send your treatment forms and prescriptions directly to: APRIL Santé Prévoyance 114, boulevard Marius Vivier Merle LYON Cedex We proceed with your reimbursement within 24 hours. 3. You get reimbursed right from the very first euro spent, up to the coverage limit set under the insurance policy you have taken out. 3

4 First Euro A Comprehensive package Reimbursement expressed as a percentage of the official rates set by the French Social Security, within the limits of the expenses actually incurred. All fixed rates and coverage ceilings listed on the table below are only applicable once per policyholder and per policy year. * They cannot, therefore, be carried over from one year to another. COVERAGE TYPES Level 1 Economic Level 2 Comfort AGE LIMIT FOR APPLYING: 65 Level 3 Premium HOSPITAL CHARGES Medical and surgical hospitalisation, surgical fees 100 % 100 % 150 % Fixed hospital charge Actual costs Actual costs Actual costs ROUTINE HEALTH CARE GPs, specialists, radiology, paramedics, outpatient care, routine medical care 75 % 100 % 150 % MEDICAL ANALYSIS Medical analysis 75 % 100 % 100 % PHARMACY Medically prescribed pharmacy services 70 % 100 % 100 % MEDICAL DEVICES Orthopedy, hearing aids, small medical devices 75 % 100 % 150 % Transport Transport 75 % 100 % 150 % DENTAL CHARGES Dental care Accepted orthodontic services (1) Accepted dental prosthesis OPTICAL CHARGES Accepted glasses and lenses (1) Accepted spectacle frames (1) ACCEPTED THERMAL TREATMENT (1) Fixed rate excluding any other reimbursement 100 % Reimbursement ceiling per insured person: 1 st policy year*: e From the 2 nd policy year*: e % e maximum per policy year* e 6.51 per day 21 days maximum per policy year* and per insured person *Policy year: a one-year period between two anniversary dates. (1) By April, provided they are medically prescribed and covered by the French Social Security scheme. 100 % Reimbursement ceiling per insured person: 1 st policy year*: e From the 2 nd policy year*: e % e maximum per policy year* e12.37 per day 21 days maximum per policy year* and per insured person 150 % Reimbursement ceiling per insured person: 1 st policy year*: e From the 2 nd policy year*: e 1, % e maximum per policy year* e per day 21 days maximum per policy year* and per insured person IN A NUTSHELL - Only one level of coverage should be taken out for all members of the same family. - You are entitled to take out this policy until Dec 31 of your 65 th birthday. OUR SUGGESTION Coverage level:... Premium: _... /mois 4

5 By choosing First Euro today, how much can you get reimbursed tomorrow? Here are some examples of reimbursement of the most common intermediate care services covered by First Euro. The actual cost April s reimbursement = for which you remain responsible, according to the level of coverage chosen when you took out the policy. - REIMBURSEMENT EXAMPLES Level 1 Economic Level 2 Comfort Level 3 Premium Type of expenses Actual cost Reimbursement rate set by the French Social Security Reimbursement by the French Social Security April s reimbursement Remaining amount for which April s reimbursement your are responsible Remaining amount for which April s reimbursement your are responsible Remaining amount for which your are responsible HOSPITALISATION Appendectomy surgery ROUTINE HEALTH CARE GP consultation Specialist consultation MEDICALLY PRESCRIBED PHARMACY SERVICES Medicines MEDICAL ANALYSIS Medical Analysis/ Blood tests DENTAL CARE Dental scaling SC Dentures SPR Orthodoncy (set price for the first semester for a child under 16) REMINDER Because of your status, you are not eligible for reimbursement by the French Social Security. Instead, get reimbursed by April and benefit from an additional reimbursement, according to the level of coverage chosen when you took out the policy. 5

6 2013 Premiums Monthly premiums for the year 2013 are listed in Euros, all taxes included. Premiums are calculated based on the age of the insured at the time the policy was taken out. PREMIUMS Level 1 Economic Level 2 Comfort Level 3 Premium < 35 (1) Eligible beneficiary child < 21 (2) (1) The Under 35 insured rate applies to the insured child from January 1st of the child 21st birthday (date from which the child is no longer included free of charge). (2) Fourth and subsequent children are included free of charge: are considered as eligible beneficiaries of this policy, children dependant of the policyholder for tax purposes and not affiliated to any mandatory health insurance scheme. Children can be included until December 31 of their 25 th birthday. *IN A NUTSHELL Your current age is your age on December 31 of the year the policy became effective. Example: Effective date: 01/01/2013 Birth date: 25/10/1963, that is 50 years of age. 6

7 Learn about Services that make your life easier and help you save money! My Personnel Policyholder Account...on Check your reimbursements online 24/7 Ask for the coverage of hospital costs, not to mention optical or dental quotes Contact us by or directly using our live chat Subscribe to the Reimbursement Alert to be informed in real time of the amount of each reimbursement Update your personal data: statement of account information, address, phone number, Access to our tips, thematic files and updates on our website Prévention Santé, accessible from the section My services and benefits. MY OPTICAL BENEFIT (1) Over 2,500 opticians in France Negotiated tariffs: your glasses equipped with progressive lenses from 165 (2) Quality advice and products OPTICIENS MY PHONE APPS My APRIL account: Have access to the main functionalities of your Personnel Policyholder Account, and follow in real time all the information relating to your policy directly on your Smartphone by downloading the free APRIL app, giving you access to your Personnel Policyholder Account, either via the App store or Google play. MY WINNING PURCHASES (3) Buy online through your cash back portal and build your own nest egg! Each time you place an order online in one of our 300 partner brands: Marionnaud, Virgin, Décathlon, Conforama, a percentage of the amount of your purchases is credited to a nest egg. My O 2 BENEFIT APRIL Santé Prévoyance partners with 0 2, the leader in home services. As a customer of APRIL and for any policy taken out, get your first 2 hours of service for free (4), among the following ones: Domestic cleaning Ironing Childcare Gardening (1) An exclusive offer available only to our customers in Metropolitan France (excluding Reunion Island and Caribbean Islands). (2) Offer valid for adult glasses equipped with 1.5 organic, progressive toughened glass lenses. (3) The General terms and conditions of use of the service Winning purchases are available on (4) For any policy contract signed out prior to 31/12/2012. It cannot be used in conjunction with any other offer. The offer can be used only once per household. 7

8 APRIL, committed to changing the image of insurance When it was created in 1988, APRIL committed itself to changing the image of insurance by putting the customer at the centre of its activities. Today, over 6 million insured people have entrusted the protection of their family and goods to the 3, 830 employees of the Group. April has managed to gain their confidence by providing them with a range of policies that offer a fair balance between the price, the coverage limit and the corresponding service, and thereby by proving insurance has evolved. APRIL s commitments You benefit from a service at your fingerprints You know exactly what you are buying CONTACT YOUR INSURANCE CONSULTANT You are covered at the fairest price You get rewarded for your loyalty The Association of APRIL s policyholders is here to help you on a daily basis, providing you with: Support and assistance in case of hospitalisation, Legal support services in case of legal issues, Financial support, from reserve funds, to bear the cost of any expensive medical care or equipment exceeding your financial resources. For further information, please visit SOFICAS 4 RUE FRANCIS MARTIN BORDEAUX Tél : info@soficas.fr 10/2012 All the brands, logos, graphic elements and sales arguments of both APRIL Santé Prévoyance and its commercial partners included in this document are the exclusive property of APRIL Santé Prévoyance SA. Any reproduction, either partial or total, of the above-mentioned elements and of any kind of text is strictly prohibited and will result in appropriate legal proceedings. f Immeuble Aprilium 114 boulevard Marius Vivier Merle LYON Cedex 03 Tél. : Fax : S.A. au capital de RCS Lyon Intermédiaire en assurances - immatriculée à l ORIAS sous le n ( Autorité de Contrôle Prudentiel - 61 rue Taitbout Paris cedex 09. Produit conçu et géré par APRIL Santé Prévoyance et assuré par Axéria Prévoyance Insurance isn t what it used to be.