What is the employer's obligation in terms of complementary health?
Verified 20 January 2026 - Entreprendre Public Service / Directorate of Legal and Administrative Information (Prime Minister)
Every private sector employer (company and association) has the obligation to offer supplementary collective health coverage to its employees, except in exceptional cases. This coverage can be provided in particular by a mutual insurance company. An individual employing a home worker is not concerned. Some employees on short-term contracts may be exempted from joining the collective supplementary health insurance and benefit from a health payment by the employer. We present you the rules to know.
The rules differ depending on the employee's situation:
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General case
The employer must provide the benefit all its employees, irrespective of their length of service in the company, of complementary company health.
This coverage allows the employee to complete his reimbursements of health expenses in addition to the part reimbursed by the Social Security.
The coverage of the employees' beneficiaries is not compulsory, but the employer (or the social partners) may decide to cover them as well.
Example :
A person may apply for exemption from the health-care plan established in his or her company. For this, she must already be covered, including as a right holder.
This coverage is provided through a compulsory collective health plan (compulsory family plan for which the membership of family members, spouses, past members, children, is compulsory in the same way as that of the employee).
Employee with multiple employers
In the case of multiple employers, an employee already covered by a collective contract of one of his employers may refuse to subscribe to the other contracts.
He must justify this protection to other employers by means of an annual proof of membership.
Employee whose contract is suspended
The rules differ depending on the situation:
The employee is compensated by the employer or the Social Security
Coverage must be maintained when the employee's employment contract is suspended regardless of the cause (examples: occurrence of illness, maternity, accident or in case of partial activity or adoption leave).
The employee is not compensated
The employee must contact his employer to find out whether the mutual insurance is maintained or not.
Employee whose contract is broken
Employees whose contract is terminated for reasons other than gross negligence benefit from the maintaining this coverage for a period equal to the period of unemployment benefit up to the duration of the last employment contract.
Such maintenance of guarantees may not exceed 12 months (one year).
Compulsory group coverage must meet the following 3 conditions:
- The financial contribution of the employer must be at least equal to 50% of the contribution (the remainder to be paid by the employee)
- The contract must comply with a minimum set of guarantees (minimum care basket)
- The contract is mandatory for employees, except in cases where the employee can refuse the mutual.
If the company is subject to a collective agreement or to one branch agreement, it must respect what is provided for in those texts.
Indeed, minimum guarantee levels or a minimum contribution to be devoted to the financing of guarantees may be imposed on the company by industry agreement.
In any case, the employer and the employee representatives can negotiate an agreement within the company itself.
In the event of a branch agreement, the company agreement must provide for guarantees at least as favorable as that branch agreement.
If these negotiations do not succeed, it is a unilateral decision of the employer who sets up the supplementary health insurance.
Minimal care basket
Company supplementary health insurance must cover at least the following guarantees (care basket):
- Entire moderator ticket on consultations, acts and benefits reimbursable by the Health Insurance. However, exceptions may exist.
- The entire hospital daily fee in case of hospitalization
- Dental expenses (prostheses and orthodontics) up to 125% of conventional rate
- Optical fees in a flat rate per period of 2 years (annually for children or in case of vision change) with a minimum of care set at €100 for a simple correction, €150 (see €200) for a complex correction.
Guarantees of a so-called responsible contract
Complementary health insurance can be a so-called contract responsible.
The complementary health must respect the specifications of the contract said responsible.
In this case, the services of the contract are as follows.
What the contract supports is called “responsible”
Benefits | Support |
|---|---|
Routine care (consultations and medications to SMR: titleContent major reimbursed to 65%) | 100% of the Social Security reimbursement base |
Daily package | 100% without limitation of duration |
Common dental care (consultations and care such as scaling or treatment of cavities) | 100% of the Social Security reimbursement base |
Optical | 100% the Social Security reimbursement base. For optical costs that are beyond the conventional rate, the complementary health insurance may offer, cumulatively, limited coverage as follows: |
The contract must be joint and several: the insured cannot be subjected to a health questionnaire or be priced according to his state of health.
What is not covered by the so-called “responsible” contract
- The flat-rate contribution from €2 for each consultation performed by a city doctor, in an institution or hospital center, within the limit of €50 per year and per person
- The medical allowances left to the insured for medicines and medical transport. The amount of the deductible is capped at €50 per year and per person.
- The increase in the insured person's contribution for failure to appoint a treating physician or consult another physician without a prescription from the treating physician (“excluding care pathway »)
- Excess fees when the insured consults a specialist to whom the law does not allow direct access without going through a attending physician.
FYI
Since 1er january 2022, the responsible contracts provide for the acceptance by the complementary companies of the practice of third-party payer (advance fee waiver) on equipment and cart care 100% health (optics, dentistry and audiology).
Additional benefits
Supplementary health insurance may offer additional services, for example:
- Third-party payment
- Assistance service (housekeeping, childcare, etc.)
- Prevention and support (e.g. screening).
No, some employees may be exempt from membership at their request, in particular:
- Fixed-term employment contract (CDD) of less than 3 months
- Assignment contract of less than 3 months (temporary)
- Part-time (up to 15 hours per week).
One agreement The branch may also provide that the obligation to cover health care costs is ensured for those employees through the health payment.
This scheme consists of the employer's participation in the financing of the supplementary cover.
In the absence of, or where permitted by, a branch agreement, a company agreement may also provide for this alternative hedging arrangement.
Please note
To benefit from this health payment, the employee must justify being covered by a responsible contract. It produces a certificate from the organization with which they have subscribed to a supplementary health contract.
In the case where the employee contracts two successive contracts of less than 3 months and the overall duration of the two contracts exceeds 3 months, the health payment is due only under the 1er contract.
When several fixed-term contracts are concluded with the same employee, without being successive, the health payment must be taken into account contract by contract.
Example :
A 3-month fixed-term employee benefits from the health payment.
If his contract is renewed, he is not entitled to this payment for renewal.
Except in the case of exemption, he must therefore be affiliated to the health insurance plan at the end of the 1ster FIXED-TERM CONTRACT.
Others employees may be exempted, at their request, of the obligation to accede:
- Employees with individual coverage when the compulsory collective scheme is implemented or when they are hired, if later. The exemption applies until the expiry of the individual contract.
- Employees benefiting from the complementary health solidarity. The exemption applies until the date on which the employee ceases to benefit from the supplementary solidarity health insurance.
- Employees, including as beneficiaries, who are beneficiaries of benefits provided under another job of one of these schemes: compulsory supplementary collective health insurance, Alsace-Moselle local health insurance scheme, supplementary health insurance scheme for the electrical and gas industries (Camieg), mutual insurance schemes for public officials and local authorities, among others.
FYI
Since April 2024, employees covered as rights holders by another collective and compulsory contract can waive the obligation to join at their initiative, whether this coverage as rights holders is optional or mandatory.
The employer's contribution to the health benefit is calculated differently depending on the area concerned:
General case
The health benefit is funded by the employer.
The amount of the health benefit corresponds to the sums that the employer would have been obliged to pay if the employee had benefited from group coverage.
If it is not possible to determine the amount that the employer should have paid, the reference amount is set at €22.27 for 2026.
The coefficient applied to the reference amount shall be:
- 105% for permanent employees,
- 125% for employees on fixed-term or mission contracts.
Example :
The employer's contribution is a lump sum and equal to €20.
The employee works 35 hours a week. He is on a fixed-term contract of less than 3 months. The compulsory collective contract does not guarantee him supplementary health coverage of at least 3 months.
- Since the employee is a full-time employee, his or her proratization coefficient is 1 (151.67/151.67)
- This coefficient applied to the flat-rate contribution (€20), the reference amount remains €20
- Since the employee is on a fixed-term contract, the increase coefficient is 125%.
Thus, the amount paid to the employee is €25 (€20*125%).
The employer is exempt from social security contributions on these payments.
However, these payments are subject in full to the CSG-CRDS and at social package in companies with at least 11 employees.
Alsace-Moselle
The health benefit is funded by the employer.
The amount of the health benefit corresponds to the sums that the employer would have been required to pay if the employee had benefited from group coverage
If it is not possible to determine the amount that the employer should have paid, the reference amount is set at €7.44for 2026.
The coefficient applied to the reference amount shall be:
- 105% for employees on permanent contracts
- 125% for employees on fixed-term or mission contracts.
Example :
An employer pays a lump sum contribution of €60 for each of its employees of a certain category.
For a permanent employee in this category, who works 50 hours per month, the reference amount is calculated as follows: 60 x (50/151,67) =19,78, to which is applied the coefficient of 105%, the employee being on a permanent contract.
The monthly amount to be paid for this employee is €20.77 (19.78 x 105%).
The employer is exempt from social security contributions on these payments, .
However, there is no exemption for the CSG-CRDS and the social package in companies with at least 11 employees.
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