Supplementary health insurance

• The PSC health system
• Exemptions for civilians
• Frequently asked questions for civilians

Following a public procurement procedure, the French Ministry of the Armed Forces selected Harmonie Mutuelle to cover the costs of civilian employees of the Ministry of the Armed Forces for a period of 6 years following maternity, illness or accident.

It will be implemented from January 1, 2025.

Yes, except in cases of exemption, membership is compulsory for both civilian and military personnel. The Ministry’s departments will organize the pre-registration of the Ministry’s civilian staff at the end of October 2024. Harmonie Mutuelle will contact policyholders directly (by e-mail or post) to finalize their enrolment in November 2024.

Healthcare referral will end on December 31, 2024. After the Ministry of the Armed Forces has pre-affiliated them, former Harmonie Mutuelle insured agents will receive information by mail or e-mail to finalize their affiliation as of November 2024.

Under the so-called “referencing” framework, since January 1, 2018, 4 organizations have been referenced by the Ministry of the Armed Forces to provide supplementary social cover for civilian and military personnel: UNEO, FORTEGO, INTERIALE and HARMONIE MUTUELLE. These mutual insurers have been selected for both military personnel and civilians.

Healthcare referencing (expenses incurred as a result of maternity, illness or accident) therefore ends on December 31, 2024, which marks the end of the healthcare contracts of the 4 mutual insurers mentioned above, including Harmonie Mutuelle.

Staff and military personnel who have not chosen a referenced mutual will not be penalized. They will join the new PSC santé scheme.

An interministerial agreement to improve benefits for civilians (incapacity, disability and death) was signed on October 20, 2023 by the General Directorate of Public Administration and Civil Service and the trade unions.

Since then, the DRHmd has been transposing this agreement to the military. In order to ensure that both civilians and military personnel who have subscribed to the current referencing agreement benefit from extended provident cover, it has been agreed to extend the referencing agreement by one year, insofar as it concerns the provisions relating to provident cover.

In accordance with article 3 of the aforementioned agreement, these provisions are extended for one year, i.e. until December 31, 2025.

Adopted on the basis of the August 6, 2019 law on the transformation of the civil service, the February 17, 2021 ordinance on supplementary social protection in the civil service aims to redefine the participation of public employers in the financing of supplementary social protection guarantees for their staff, as well as the conditions of membership for the latter, in order to promote their supplementary social coverage.

For civilians, the provisions of article L. 827-1 et seq. of the General Civil Service Code now allow public-sector employers, following collective bargaining with a majority agreement, to set up compulsory group health insurance contracts.

Negotiations with the trade unions were conducted by the General Directorate for Administration and the Civil Service (DGAFP). They resulted in an interministerial agreement signed unanimously on January 26, 2022 between the Minister for Transformation and the Civil Service and the trade unions.

This agreement establishes a new supplementary health insurance scheme for civil servants. It defines an interministerial base of guarantees designed to cover healthcare costs in addition to and in addition to reimbursements made by compulsory social security schemes, through compulsory enrolment of civil servants in collective contracts negotiated by their employer.

An agreement specific to the Ministry of the Armed Forces, dated October 5, 2023, sets out the supplementary “health” social protection scheme for civilian staff of the Ministry of the Armed Forces and public establishments under its supervision. In particular, it covers the beneficiaries of group health insurance contracts, the optional benefits available to them, the quality of contract management and services, solidarity mechanisms, the steering and monitoring commission (CPPS) and the ministerial agreement monitoring committee.

There are three categories of beneficiaries: active beneficiaries, entitled beneficiaries and retired beneficiaries.

Each category benefits from a separate group contract. For retired beneficiaries and eligible beneficiaries, membership remains optional.

The conditions for qualifying as eligible beneficiaries are set out in article 5 of decree no. 2022-633 of April 22, 2022.
In particular, the following may be entitled beneficiaries of active or retired beneficiaries:

• Spouses, civil union partners and cohabitants
• Children (subject to age);
• Widows and orphans

An employee in one of the following situations remains an active beneficiary:

1° Parental leave;
2° Leave of absence for health reasons, unpaid leave for health reasons or unpaid leave for health, maternity or parental reasons;
3° Caregiver leave, parental presence leave and family solidarity leave;
4° Professional training leave.

No, membership is optional for retired beneficiaries and their dependents. Please note that the employer’s financial contribution does not extend to these beneficiaries.

Retired employees may apply to join the group contract as “retired beneficiaries” if they meet the following conditions:

1° Be an active beneficiary on the date of his or her retirement;
2° Be entitled to a direct retirement pension under the Code des Pensions Civiles et Militaires de Retraite (Civil and Military Retirement Pensions Code), the scheme of the Institution de Retraite Complémentaire des Agents Non-Ten titulaires de l’Etat et des Collectivités Publiques (Supplementary Retirement Institution for Non-Tenured State and Local Authority Employees), the Fonds Spécial des Pensions des Ouvriers des Etablissements Industriels de l’Etat (Special Pension Fund for State Industrial Establishment Workers) or the AGIRC-ARRCO supplementary retirement scheme.
Application for membership must be made within one year of ceasing employment.
Retired beneficiaries who, following the liquidation of a retirement pension mentioned above, engage in remunerated activity enabling them to obtain a pension entitlement lose this status.

As soon as Harmonie Mutuelle receives the agent’s retirement notice, the agent is offered a fully paperless, online affiliation process for the retiree scheme(being rolled out in 2024).

Harmonie mutuelle also provides a membership kit, including a full information guide on the new scheme and how to subscribe. This kit can be handed out by the employer, available on the dematerialized space or on request from Harmonie mutuelle advisors.

On receipt ofall the necessary supporting documents (any document proving that he/she has not resumed salaried employment),membership of the retiree plan is finalized by Harmonie Mutuelle’s management services, in accordance with the contract’s pricing conditions. Confirmation of enrolment is then sent out, and thecall for contributions and the Tiers Payant card are available in the Personal space, together with the tables of benefits. If the former employee has not opted for paperless enrolment, he or she will receive his or her documents by post.

Spouses and children may be affiliated to the employee’s mutual insurance company. However, the employer’s financial contribution does not extend to dependents.

As the affiliation of beneficiaries is optional, the agent can request the addition of a beneficiary directly via his or her Personal Area, thus benefiting from a 100% online process. This process enables Harmonie Mutuelle to carry out all the necessary checks and validations.

The new Tiers Payant card is available in the Personal Area once the modification has been registered.

The 2 levels of options offered under the future PSC santé plan have been negotiated by the trade unions in addition to the guarantees set out in appendix 1 of the decree of May 30, 2022 on supplementary social protection covering expenses incurred as a result of maternity, illness or accident in the French civil service. They are detailed in appendix 1 of the collective agreement of October 5, 2023 on supplementary social protection to cover expenses incurred as a result of maternity, illness or accident in the Ministry of the Armed Forces.

Civilian employees of the Ministry may apply for exemption from the group contracts taken out by the Ministry of the Armed Forces if they meet the conditions for exemption set out in the regulations. For civilian personnel, these cases are listed in article 3 of decree no. 2022-633.

It should be noted that requests for exemption are intended to cover situations where policyholders are already covered by schemes other than the Ministry of the Armed Forces’ group contracts. These policyholders will in any case have a mutual insurance company. If they are exempted, these employees will no longer benefit from the employer’s contribution, and will no longer be entitled to the €15 lump-sum payment as of December 31, 2024.

Employees who do not wish to join the new scheme may apply for an exemption if they meet the conditions.

Pursuant to the provisions of article 3 of the decree of April 22, 2022, employees are exempt from joining the compulsory group contract taken out by their employer:

1° Beneficiary of the complementary health insurance scheme
2° Beneficiary of an individual supplementary health insurance contract on the date of entry into force of the first group contract taken out by his/her employer, or on the date on which he/she takes up his/her new post. This exemption is valid up to the expiry date of the contract, up to a maximum of twelve months.
3° Employed under a fixed-term contract when benefiting from an individual supplementary health insurance contract.
4a° Beneficiary of a compulsory or optional group contract as a beneficiary.
4b° Beneficiary, as a beneficiary, of a complementary social health protection contract eligible for the “health payment” paid by the contract holder’s employer.
4c° Beneficiary of a complementary health insurance scheme for the electricity and gas industries
4d° Beneficiary of collective coverage in the territorial or hospital civil service in application of article L. 827-2 of the CGFP (French Civil Service Code)

Requesting an exemption is an individual process. The employee makes his or her request to his or her local manager, using the form provided.
The relevant departments within the armed forces are responsible for entering the information.
An agent who has been exempted from the obligation to join may, at any time, waive his or her exemption and apply to join the group contract.

This is a case of exemption provided for in article 3, 2° of decree no. 2022-633. Between now and January 1, 2025, an agent covered by an individual contract may keep it until the expiry date of the individual contract, up to a limit of 12 months. After that, they must join/be affiliated to Harmonie Mutuelle. If I wish to be exempted, I must inform my local manager and provide proof of coverage after completing the exemption form.

This is a case of exemption under a) 4° of article 3 of decree no. 2022-633. If I wish to be exempted, I must inform my local manager and provide proof of coverage after completing the exemption form.

It will still be possible to subscribe to two contracts. However, the insured will only benefit from the employer’s contribution in respect of the compulsory group contract taken out by the Ministry of the Armed Forces. The second contract will therefore be entirely at the policyholder’s expense. It can therefore be anticipated that few employees will make this choice, especially if the two contracts cover the same risks.

The data will be made available at the end of June 2024, following selection of the additional services by the Joint Steering and Monitoring Committee.

Yes, this information is set out in appendices 1 and 2 of the collective agreement of October 5, 2023 on supplementary social protection covering expenses incurred as a result of maternity, illness or accident in the French armed forces.

Reimbursement levels for civil servants are the same as for the French civil service. There is no choice to be made concerning basic coverage. However, they can choose between 2 levels of options. These levels and the basic benefits are detailed in Appendix 1 of the collective agreement of October 5, 2023 on supplementary social protection to cover expenses incurred as a result of maternity, illness or accident at the Ministry of the Armed Forces.

By means of an amendment, the Ministry of the Armed Forces has extended the provident insurance component of the referencing agreement for a further year. Civilian employees of the Ministry of the Armed Forces are therefore covered by the provident scheme if they have subscribed to the 4 referenced mutual insurers until December 31, 2025. A new optional provident scheme will be set up by the Ministry of the Armed Forces from January 1, 2026.

No. Coverage of the waiting day cannot be provided for in any healthcare PSC contract. Nor can it be included in any future PSC contract or provident scheme to be introduced on January 1, 2026.

In addition to the basic benefits, it is possible to take out optional benefits of the employee’s choice. These levels of options and basic cover are detailed in Appendix 1 to the collective agreement of October 5, 2023 on supplementary social protection to cover expenses incurred as a result of maternity, illness or accident at the Ministry of the Armed Forces.

For your information, if you choose optional cover, this also applies to your dependants. These optional benefits are financed by the employer, i.e. the Ministry of the Armed Forces, up to 50% of the employee’s contribution, limited to €5.

Former military personnel who are now civil servants are covered by the civil servant regime.

Under article 2 of decree no. 2023-605 of July 15, 2023 on supplementary social protection for members of the armed forces, former members of the armed forces and their dependants in respect of expenses incurred as a result of maternity, illness or accident, the military scheme applies only to active members of the armed forces.

Retired military personnel may apply to join the group contract as “retired beneficiaries” if they meet 3 conditions:

• 1° Be an active beneficiary on the date of his or her removal from the ranks or controls, or his or her placement in the second section of general officers;
• 2° Be entitled to a direct military retirement pension or reserve pay under the Code des pensions civiles et militaires de retraite.
• 3° Not, subsequent to the liquidation of a retirement pension or reserve pay mentioned in I above, be engaged in a remunerated activity giving entitlement to a pension. The preceding provisions do not apply to remunerated activities in the military operational reserve.

Civilian/military couples can either each be covered by their own schemes, or apply for exemption from the other scheme. However, it should be remembered that only the member of the armed forces could benefit from the exemption.

On the other hand, regulations do not currently allow civilian spouses of military personnel to benefit from an exemption. In the event of exemption, the member loses the benefit of the employer’s contribution. It is therefore advisable for couples comprising a civilian and a military member to remain active beneficiaries of their own plan.

In accordance with article 13 of decree no. 2022-633, contributions for active beneficiaries do not vary with age.

The employer’s contribution is 50% of the contributions for active employees. There is no financial coverage for beneficiaries (children and spouses) or retirees of the Ministry of the Armed Forces .

The Ministry will be responsible for the pre-registration of the Ministry’s civilian and military personnel from the end of October 2024. Harmonie Mutuelle will contact policyholders directly (by e-mail or post) to finalize their enrolment in the contract in November 2024.

The contribution for an active beneficiary breaks down into three parts:

• A portion paid by the employer, corresponding to 50% of the equilibrium contribution;
• An individual flat-rate contribution paid by the active beneficiary, set at 20% of the equilibrium contribution;
• An individual contribution paid by the active beneficiary, calculated for each group contract by applying a coefficient to the gross monthly remuneration of the active beneficiary, within the limit of the monthly social security ceiling (PMSS) set in application of article L. 241-3 of the Social Security Code.

Contributions for beneficiaries entitled to benefits are calculated on the basis of an equilibrium contribution.

Active beneficiaries pay 2 additional contributions:

• social support contribution

A social support fund for group contract beneficiaries has been set up within the joint steering and monitoring committee, based on the provisions of article 27 of the decree of April 22, 2022. It can finance benefits based on the health and resources of beneficiaries.

They are financed by an additional contribution paid by all group contract beneficiaries, at a rate equal to 0.75% of contributions paid, excluding tax, as stipulated in the collective agreement of the Ministry of the Armed Forces. These benefits, the conditions under which they are granted and the conditions under which beneficiaries may avail themselves of them are defined by the joint steering and monitoring commission, so as to complement the social actions proposed by the administration. The members of the commission are informed of the number and type of benefits granted and their beneficiaries.

• contribution to the fund to support the resources of retired beneficiaries

An assistance fund for retired beneficiaries is set up by the joint steering and monitoring committee referred to in article 28. This commission proposes to the Minister of Defense a scale for covering a portion of the contributions of retired beneficiaries, taking into account the resources of these beneficiaries. The fund is replenished by an additional contribution based on the contributions, excluding tax, paid by all group contract beneficiaries. The rate of this 2% contribution is set by the collective agreement of October 5, 2023 on supplementary social protection to cover expenses incurred as a result of maternity, illness or accident in the French armed forces.

The portion of the contribution to be paid by each employee is deducted directly from his or her pay. This portion, as well as the portion paid by the employer, will appear on the employee’s pay slip.