What are my health rights ?

Health insurance is a device that is responsible for insuring an individual against financial needs in the context of an illness, all in the respect of the rights of access to medical treatment. There are two types of health insurance: financial health insurance, which only provides full reimbursement of the insured individual’s care, and network health insurance, which provides the insured individual with a medical practitioner’s service for his or her treatment. The health insurance thus respects in both cases the health rights of the insured, even if there are other rights that must also be respected such as the right to social protection, the right to hospitalization, the right to prevention.

Your health rights with a health insurance

Health insurance is one of the branches of the Social Security system. Its mission is to ensure the coverage of costs related to the care of insured persons and the respect of their rights right to health of these. It is managed by a health insurance fund that aims to protect insured individuals from financial difficulties. Anyone can subscribe to this type of health insurance, just choose the plan related to your current situation.

The right to coverage of health care costs

First of all, it should be noted that the role of the health insurance fund is therefore to ensure that the rights of all insured persons are fully respected.

In order to be entitled to health care coverage, you need to meet a few conditions during your period of illness or discomfort. Your doctor must prescribe you a prescription sheet and a medical file that clearly details the health problems you have as well as the tests you need to do. Your file must show the care you are going to have and the related costs.

Once the file is processed by your health insurance, you will automatically benefit from the right of health as well as the coverage of all your health expenses. Thus, you will be entitled to:

• 100% reimbursement of medical acts and consultations
• 100% reimbursement of radiology and biology tests
• 100% reimbursement of nursing care with physiotherapy
• 100% reimbursement of medical transportation in case your condition justifies it

However, it should also be noted that the full reimbursement of your health care costs is calculated on the basis of the rates given by the Social Security. In case the cost of your care or prescribed medication exceeds the limit of the set rate, you will not be reimbursed by your insurance but rather by the complementary mutual insurance company.

Right to social protection

The social protection is also called the social security and it allows to insure the risks linked to the work accidents and the cases of serious diseases. For the implementation of the right to social protection, you must call upon the CODESC (the Committee of Economic, Social and Cultural Rights). This structure recalls the obligation of the state to assume responsibility and proper administration of care to the insured.

Its role is to support the insured so that they have their own income health law.

In fact, social protection has nine branches namely: sickness benefits, maternity benefits, health care, survivor’s family benefits, disability benefits, unemployment benefits, old age benefits, survivor’s benefits. Note also that, to have access to the right to social protection, the following criteria must be met

• The coverage
• Eligibility
• Affordability
• Physical access
• The participation and information

Note that all of this is only possible after completing the form s1104 available online or from your local health insurance office.

Assistance during a hospitalization or accident

In the case of a hospitalization or an accident, the health insurance covers 80% of your expenses that are unexpected during the hospitalization. However, the hospital package is often at the expense of the insured. In this case, it is necessary to have a modest income.

Medicare also offers to accompany you home once you’ve recovered.

Also, the rate of your coverage varies according to the care you will receive. You can also benefit from a full reimbursement except for expenses for your personal comfort.

In conclusion, all insured persons must have access to all health insurance rights, but it is important to respect the criteria of each insurance in order to benefit from the entirety of this right health law.