In recent years, the supplementary health insurance market has undergone increasing regulation, leading to significant changes in its composition. The reform of the Supplementary social protection comes to conclude a cycle leading to a definitive shift to a market predominantly driven by collective contracts.
While the 2013 National Interprofessional Agreement (ANI) mandated the generalization of supplementary health coverage through collective agreements in the private sector, public sector employees are still operating under a voluntary individual contract model.
Public servants today have the choice of contributing, or not, to a complementary organization’insurance disease (OCAM). Furthermore, if ministries reference OCAs and finance part of the contribution if an employee joins, they always benefit from the free choice of their supplementary health insurance.
The reform of supplementary social protection for civil servants, decided in 2022 and currently being implemented, aims to align the public sector's protection model with that of the private sector.
Cet alignement fait suite au constat de nombreuses inégalités vécues entre secteur privé et secteur public, tant sur le nombre de personnes couvertes que sur la participation de l’employeur au financement de la cotisation. 83% des fonctionnaires font appel à une complémentaire santé à adhésion individuelle, 13% bénéficient d’une complémentaire en contrat collectif (en particulier par le biais des conjoints), 2% sont couverts par la CSS et 2% restent non couverts.
The reform of the supplementary health insurance aims to guarantee a collective complementary health insurance, financed at 50% % by the public employer, which will reduce the out-of-pocket expenses for civil servants and improve their access to quality care, particularly concerning optical, dental, and hospital care. By making complementary health insurance mandatory, the State wishes to improve the efficiency of the system, with a minimum base of accessible care, especially for the most vulnerable. Emphasis is also placed on the need for prevention, through guarantees covering routine and preventive care, with the aim of reducing the need for complex treatment in the long term.
This reform is part of a broader effort to modernize social protection for agents by adapting it to their needs.
A PSC That Challenges the Positions of Historical Actors
Beyond the evolution for public sector employees, this reform risks profoundly transforming the supplementary health market by challenging the positions of historical players. Our projections allow us to identify a risk of losing nearly 750,000 contracts spread among these mutual insurance companies, leading to significant reductions in portfolios and associated revenue.
However, the impact is not the same for all the mutual insurance companies concerned. Indeed, for these mutual insurance companies, 3 scenarios emerge. Scenarios that must now challenge the mutual insurance companies concerned in order to identify short and long-term solutions to remain in the supplementary health market. Several options are possible in this regard.
