In France, the “régime général” (standard public health insurance system) sets official prices for every medical service. When you get care, The Sécurité Sociale (the public system) reimburses you a percentage of this official rate, not the actual price you pay.
Here’s how it works in practice:
Doctor visits and medical care
General practitioner (GP) or specialist:
Official rate for a GP: €30
The Sécurité Sociale usually reimburses 70% of the official rate
Example: For a €30 visit, you get €21 back (minus a €2 “participation forfaitaire” you always pay yourself), so €19 reimbursed
Specialists may have slightly different rates, but the 70% rule is standard
Medicines
Most prescribed medicines: 65% of the official price reimbursed
Some medicines are reimbursed at 30% or even 15%, depending on their usefulness
Laboratory tests and medical imaging
Usually 60% or 70% reimbursed, depending on the test
Hospitalization
In general, the Sécurité Sociale reimburses 80% of the official price of a hospital stay (including surgery)
You pay the remaining 20% (“ticket modérateur”) and a fixed daily hospital fee (“forfait journalier,” currently €20 per day in hospital and €15 in psychiatric hospitals)
Your mutuelle can cover the 20% and most or all of the daily fee
Dental care
Routine dental work (check-ups, basic fillings): reimbursed at 70% of the official rate.
Crowns, bridges, and prostheses: the official rates are much lower than the real prices, so the Sécurité Sociale refund is usually small. Your mutuelle can cover an extra amount depending on your plan.
Dental implants: Implants are not covered by the Sécurité Sociale at all (“hors nomenclature”). Only your mutuelle may reimburse part of the cost, usually a fixed amount per implant (for example, €300). The remaining cost is still your responsibility, and implants can be expensive (often €1,500–€3,000 each).
Glasses and optical care
The public system reimburses a very small amount for glasses—typically only about €30 for a pair
For “100% Santé” (fully covered) glasses and lenses, the public system and your mutuelle together cover the full price
For most other glasses, your mutuelle fills the gap between the low public refund and the actual cost
In summary
Sécurité Sociale pays back a percentage of the official rate for each service, not what you actually pay
You are left with the “ticket modérateur” and other fees—the mutuelle is what fills this gap
The exact percentage depends on the type of care, but for most doctor visits and standard treatments, 70% is the norm
For more details, you can check the official reimbursement table here and for dental or optical care here, and hospitalization here.
How does the mutuelle top up your reimbursements?
After the Sécurité Sociale reimburses its share (for example, 70% of the official rate for a GP visit), the mutuelle steps in to cover all or part of what’s left. This leftover part is called the “ticket modérateur.”
How much does the mutuelle reimburse?
It depends on your plan. Mutuelle coverage is often expressed as a percentage of the official Sécurité Sociale rate, not the real price you pay.
Example: Doctor visit
Official rate: €30
Sécurité Sociale reimburses 70% (€21), minus €2 participation forfaitaire, so you get €19 back
If your mutuelle covers 100% of the official rate, it pays the remaining €9 (the “ticket modérateur”)
You pay only the €2 participation forfaitaire yourself
If your mutuelle covers more than 100% (for example, 200% or 300% for certain specialists), you may get extra reimbursement, especially if the doctor charges above the official rate (“dépassements d’honoraires”).
Example: Dental prosthesis
Official rate for a crown: €120
Real price charged by the dentist: €600
Sécurité Sociale reimburses 70% of €120 = €84
If your mutuelle covers 100% of the official rate, you get €36 from your mutuelle
You pay the remaining €480 yourself
If your mutuelle covers, for example, 250% of the official rate, you get €216 from the mutuelle (70% + 180%), so your out-of-pocket cost drops to €300
For items “hors nomenclature” (like dental implants):
Sécurité Sociale pays nothing. Your mutuelle may reimburse a fixed amount (such as €300 per implant), but the rest is up to you.
What about “100% Santé” items?
For some glasses, dental, and hearing aids under the “100% Santé” scheme, the combination of Sécurité Sociale and mutuelle will cover the full price, with no out-of-pocket cost.
In summary
The mutuelle fills the gap left after the Sécurité Sociale’s share.
The percentage your mutuelle covers is based on the official rate, not the real bill.
For some treatments, especially with extra fees or items not listed by Sécurité Sociale, you may still have out-of-pocket costs.