Social Security health reimbursements are calculated on the basis of a basic rate, known as the

Social security reimbursements are calculated on the basis of a basic tariff, known as the "tarif de convention", set by various players in the healthcare sector (healthcare professionals, health insurance, the French government).


Health insurance applies a reimbursement rate to this basic tariff. This rate varies according to the nature of the medical service or compliance with the coordinated care pathway.


For example, when you go to see your GP for a simple consultation, if you have declared him or her to be your preferred doctor, Social Security will reimburse 70% of the cost of the consultation, and between 15% and 70% of the cost of the drugs prescribed.


In the end, Social Security does not reimburse all your medical expenses, and you may have to pay some of them yourself:


- the "ticket modérateur" (i.e. the portion remaining between the Social Security reimbursement and the "tarif de convention"), the remaining 30% of the cost of the consultation in the previous example.

- excess fees, e.g. if the doctor you are consulting charges more than the agreed fee (link to "Secteur 1, 2, 3: what are the differences").

- medical deductibles, which are lump-sum amounts deducted from Social Security reimbursements (set by decree: e.g. €1 for GP consultations; €0.50 for paramedical acts and medicines; €2 for transport, etc.).


If you are covered by the Alsace Moselle health insurance scheme, which covers 3 départements (57, 67 and 68), social security reimburses you at an average rate of 90%.


In some cases, however, you may be left with very high out-of-pocket expenses: dental prostheses, hospitalization, etc. And a mutual insurance company is essential!