A flat fee of one euro you is requested for all examinations and consultations covered by the social security system. There are few exceptions to this rule but ceilings exist when care cumulation.
Participation of 1 euro is requested you
- for each act or for each consultation covered by Medicare, performed by a general practitioner in an institution or a health center,
- as well as all acts of medical biology or radiology examination.
Read also: Repayment of a visit to the doctor
However, it is not levied for an act occurring during hospitalization.
Similarly, the participation of € 1 will not be recovered:
- when consulting a dentist,
- for the care charged by a paramedic,
- or as part of a surgical procedure,
- for acts performed in an organized screening of breast cancer.
We noted some strong cases of exemption from the flat fee:
- Children and adolescents under 18,
- pregnant women from the sixth month of pregnancy to the 12th day after delivery,
- beneficiaries of the complementary CMU.
As part of "responsible contracts", complementary health do not reimburse the participation of € 1.
Daily and annual limits
If several different doctors are consulted during the same day, a single act or consultation being carried out each time the flat fee of € 1 is selected for each consultation or act.
However, if the same doctor is consulted during the same day, or if the doctor performs several acts during the same session, the euro is chosen for each consultation or act, within the limit of € 4 per day for the same healthcare professional. Similarly, € 1 is retained by biology act realized in the limit of € 4 per day per laboratory.
The total amount of the flat fee is capped at € 50 per calendar year per person.
Participation is automatically deducted from refunds. It appears deducted on statements of reimbursement from the fund of health insurance.
Example. Consultation with a general doctor is reimbursed 70% of the base price, ie € 16.10. It is this amount that subtracts the flat fee of € 1. The sum reimbursed by Medicare therefore prepare to € 15.10.
If third-party payment
In the event that the insured has the third-party payer, Medicare can not take the lump euro since the insured did not advance money.
In this case, the participation of € 1 will be deducted from a subsequent repayment to the insured as to one of its beneficiaries. So we will see a lag between the date of the act and the time appear to deduct the fixed contribution on the statement.
If it is not possible to recover the amounts due on repayment, recovery is performed on daily allowances that are paid to the insured.