Health Revolution: Everything You Need to Know About the Reform Care Basket 100% Health
offer a basket of treatments for which the remainder is zero
The “100% health” reform offers a basket of care for which the remaining cost is zero.
basket of care including prosthetic procedures,
It complements the existing regulations.
At the end of the “100% health” reform, there will be three baskets of prosthetic dental care:
- _ the “100% health” basket, fully reimbursed;
- _ a basket with controlled prices, via capped prices;
- _ a basket with free prices allowing you to freely choose the most sophisticated techniques and materials.
Prices for prostheses are capped and gradually reduced from 2019. The “100% health” basket came into force from January 1, 2020, for certain prosthetic dental treatments (crowns and bridges).
From January 1, 2022, for all other prostheses included in the care basket without any outlay (removable prostheses in particular).
Amelie sources: dental prosthesis reimbursements
The specifications for responsible contracts impose a minimum reimbursement guarantee.
Base contracts for the generalization of complementary health insurance As part of the generalization of complementary health coverage for employees, collective contracts must offer higher minimum guarantees than responsible contracts for prosthetic dental and facial orthopedic care.
They therefore cover, in addition to the co-payment, fee overruns of at least 25% of the reimbursement base.
The minimum reimbursement guarantee by the complementary organization amounts, for example, to:
59,13 euros (55% of the convention rate of 107,5 euros) for the installation of a metal-ceramic crown,
48,38 euros (25% of 193,50 euros) for one semester of orthodontic treatment started before the age of 16.
DRESS sources: Coverage for dental care and hearing aids
In which cases
Since January 1, 2020, all approved dentists must systematically mention in their quote a “100% Health” treatment plan when it exists (with the possibility of additional products and procedures in addition to traditional treatment).
After a medical examination, the dentist proposes a treatment plan. In a standard estimate where it describes the proposed treatment as well as the different materials used.
If it offers procedures or care that leaves an amount to be paid by the patient (remains payable) after reimbursements from Health Insurance and their mutual insurance company, the dentist must indicate in the “alternative therapeutic information” section of the estimate the actions that can be carried out without any charges (“100% Health” basket).
If there is no “100% Health” offer, it must indicate on the quote the procedures that can be carried out with a controlled out-of-pocket cost, when they exist.
The patient must have all the useful information on the amount of the different offers available for his situation.
Each patient is free to choose the therapeutic alternative that suits them. He must be able to find out about the reimbursement conditions provided for in his mutual health insurance contract for baskets at controlled and free prices.
Each dental prosthesis procedure belongs to a “basket of care” defined by the 100% Health reform.
There are three for dental prostheses:
- the 100% Health basket: dental prostheses are fully reimbursed if you have a complementary health or mutual insurance contract which provides for it (“responsible contract”);
- the basket with controlled prices: it includes crowns and bridges whose prices have been capped. According to the reimbursement conditions of your mutual insurance company, a moderate out-of-pocket payment may be requested from you;
- the basket with free prices: the prices are free and the rest payable may be greater. It depends on the reimbursement conditions provided by your mutual insurance company.
In the quote provided by your dentist, each proposed prosthetic procedure must correspond to one of these three baskets of care.
Your dentist is obliged to give you the choice between these three options and to offer you 100% covered treatment if it is technically possible.
A STANDARD QUOTE DEVELOPED WITH DENTISTS
The estimate must be established in writing and include in particular:
- the description of the treatment envisaged and the materials used;
- the place of manufacture of the prosthesis (in France or imported into France, which is becoming the most common);
- the amount of fees corresponding to the work of the practitioner;
- the amount reimbursed by Health Insurance;
- the basket of care to which each act belongs;
- an “alternative therapeutic information” section: for each procedure with an out-of-pocket cost, an alternative with no out-of-pocket cost must be offered to you (100% Health basket) or, failing that, with a moderate out-of-pocket cost.
You will then be free to choose the alternative that best suits your situation.
If the dentist is required to inform you of the treatments offered within the framework of 100% Health and/or at the prices controlled in his estimate, he is, however, not obliged to carry out these acts himself. He will have to inform you of this.
What does the law say about ethics?
The Dental Surgeon is a prescribing health professional, like all medical professionals.
In this respect, when he indicates to the patient that it is necessary to make a dental prosthesis, he must make a medical prescription so that the patient can have his prosthesis work carried out with coverage by Social Security and mutual insurance. for those who have them.
In the same way that the doctor prescribes medicines to the patient who buys them from the pharmacist.
The doctor does not have the right to trade in medicines, which is prohibited in ethics.
The Dental Surgeon is in the same situation where he is prohibited from selling dental prostheses and in this case he must detail the fees corresponding to the treatment for making said prosthesis in the dental office.
