Top-up health insurance (France)
A contract added on top of a supplementary health policy, often the employer's mandatory group plan, to cover what it leaves to the insured, notably the excess fees the responsible contract caps.
Since the generalization of employer health cover, most private-sector employees have a group plan whose level is set by the employer or the industry sector and which meets the responsible contract specifications. This plan may leave substantial out-of-pocket costs: capped excess fees, private hospital rooms, alternative medicine, glasses or dental work outside the no-out-of-pocket basket. Top-up health insurance reinforces it. It may be offered as an optional extra by the employer, paid by the employee, or bought individually. It pays after social security and the base supplementary plan, on the remaining share only. It is generally not a responsible contract, since its very purpose is to reimburse what the specifications forbid or cap, which subjects it to higher taxation. For insurers, it is a supplementary market with strong adverse selection: those who buy it expect spending, planned surgery, heavy dental work, and cancel once treatment is done. Hence waiting periods and annual caps. The product illustrates a second-order effect of regulation: by capping certain reimbursements, the responsible contract gave rise to an extra layer of insurance.
Hypothetical case: an employee needing two dental implants finds that his company plan reimburses only 40 percent of the 4,000 euro bill. He buys the optional top-up offered by his employer, but a six-month waiting period applies to dental care.
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