This is help to pay for health-related expenses. The resource conditions have been updated.
In order to ensure access to care for all, complementary health insurance helps people or households with modest incomes to pay for their health-related expenses (general practitioner, dentist, nurse, physiotherapist, hospital, medications, etc.) and this, without advance costs. This aid replaces the CMU and the ACS since November 1, 2019.
What are we not actually paying for?
With Supplementary Solidarity Health, you do not pay:
- The doctor, the dentist, the nurse, the physiotherapist, the hospital…
- Your medicines in pharmacy
- Your medical devices, such as dressings, canes or wheelchairs
- Most glasses, dentures or hearing aids.
Your medical expenses are paid by the compulsory health insurance organizations and the organization you have chosen to manage the Supplementary Solidarity Health Insurance. The Solidarity Supplementary Health Insurance can cover your entire household. In certain cases, the doctor may ask you for additional fees if you have special requests, such as consultations outside of usual hours or unjustified home visits.
Who has the right to complementary solidarity health insurance?
To apply for Supplementary Solidarity Health, you must:
- benefit from Health Insurance due to your professional activity or your stable and regular residence in France
- and not exceed the maximum resource limit which depends on the composition of your household (the resources that you and the members of your household received during the 12 calendar months preceding the penultimate month of your request are taken into account) .
The Solidarity Health Supplement is automatic for people who receive the RSA unless they object and those who have already had the Solidarity Health Supplement (they must be up to date with the payment of their financial contributions (or in the process of being regularized)). The application must be renewed each year. It is the same as for the initial application and must be filed no earlier than 4 months and no later than two months before the right expires. The renewal takes effect on the first day of the month following the expiration of the previous right. Insured persons benefiting from automatic renewal (RSA or ASPA holders) receive a letter at least three months before the end of their entitlement which will inform them of the amount of the contribution due for their household. They are invited to reaffirm their wish to continue to benefit from their right and to express their possible desire to change manager within one month. After this period, without a response from them, the right is renewed with the same managing body, which will be informed.
How much does it cost to benefit from it?
Depending on your resources:
- the Solidarity Health Supplement costs you nothing (CSS without financial participation). Your right is open on the 1st day of the month following the date of the positive decision which will have been notified to you
- or the Solidarity Health Supplement costs you less than 1 euro per day per person (CSS with financial participation). You will receive a membership form to complete and return, accompanied by the means of payment for entitlement on the 1st day of the month following the date of receipt of these elements.
What ceiling this year?
The resources are equivalent to all amounts received by the household during the 12 calendar months preceding the penultimate month of your request (for example, for a request made in July 2024, the reference period runs from June 1, 2023 to May 31 2024): income (salaries, retirement pensions), alimony, regular financial aid (allowances, money donations), gambling winnings, etc. The applicable resource ceilings since April 1, 2024 in mainland France are:
| Number of people in the household | Annual ceiling allowing you to benefit from CSS without financial participation | Annual ceiling allowing you to benefit from CSS with financial participation |
|---|---|---|
| 1 person | 10,166 euros | 13,724 euros |
| 2 people | 15,249 euros | 20,586 euros |
| 3 people | 18,298 euros | 24,703 euros |
| 4 people | 21,348 euros | 28,820 euros |
| 5 people and more | + 4066 euros per additional person | + 5,490 euros per additional person |
To avoid having to pay, it is necessary to:
► Respect the coordinated care pathway: that is to say, you must choose your treating doctor and declare it to your health insurance fund. Except for emergencies, you cannot consult another doctor (in particular a specialist – e.g. cardiologist, neurologist, etc.) without having a prescription from your treating doctor.
► Contact approved health professionals, this means that they have signed an agreement with Health Insurance. To ensure this, simply enter the name of the healthcare professional in the Health Directory.
► Present your up-to-date Vitale card or, failing that, your certificate of entitlement to Supplementary Solidarity Health.
At the doctor: the beneficiary of complementary health solidarity does not have to pay anything, whether it is a general practitioner or a specialist
At the pharmacy: There is nothing to pay for medications for which a prescription has been issued and within the limit of the amount reimbursed by Health Insurance; as well as for medical devices (dressings, blood glucose meters, wheelchairs, etc.) prescribed by a health professional if they are reimbursed by Health Insurance, within the limits of the products and prices provided for complementary solidarity health insurance .
At the dentist : there is nothing to pay for check-ups, cavities, scaling as well as for dental prostheses and dento-facial orthopedics within the limits of the procedures and prices provided for the Supplementary Solidarity Health Insurance.
At the midwife, nurse, physiotherapist, speech therapist or orthoptist : there is nothing to pay as long as the prescribed care is reimbursable
At the medical analysis laboratory : there is nothing to pay from the moment the requested analyzes are prescribed by a healthcare professional and they are reimbursed by Health Insurance.
At the hospital: Hospitalization costs, the flat rate of 24 euros and the daily flat rate during hospitalization, whatever the duration and whether there is surgical intervention or not, do not have to pay.
The application form can be found in the “My procedures” section. To apply for Supplementary Solidarity Health, you must:
- enter your CAF beneficiary number
- confirm or modify the composition of your household
- scan the necessary supporting documents and attach them to the request
- choose the organization managing the Solidarity Supplementary Health Fund
- validate the form.
At the end of the request, an electronic acknowledgment of receipt is sent to the Ameli account messaging system. If necessary, the health insurance fund contacts the insured for additional information.
