The establishment of a mutual company follows a specific procedure. Find out how to implement or revise supplementary health insurance.
Health insurance does not cover all of the insured’s health costs.
Supplementary health is necessary to reduce their out-of-pocket expenses. Since 1 st January 2016, private sector employers are required to take out mutual business since the company has one or more employees. How to set up a company mutual? Explanations.
Preparatory steps for the establishment of the company mutual
The first step is to study the contractual obligations of the company. Indeed, the mutual insurance company must comply with the minima provided for by the inter-professional agreement and/or the branch agreement. The employer will also have to determine the budget he wishes to allocate to supplementary health, knowing that he will have to finance at least half of the contributions.
The identification of the needs of employees in health expenditure coverage is a must. This assessment, which can be carried out by consultation, is not compulsory but strongly recommended.
It should be remembered that complementary health insurance must meet the minimum level of guarantees imposed by law: the entire user fee payable by employees for acts and services covered by health insurance; the daily hospital rate; dental expenses up to 125% of the conventional rate; optical expenses based on a flat rate per period of 2 years.
Choice of the formalism of the establishment of the mutual company
The choice of formalism for the establishment of mutual insurance in the company represents an important step. The company mutual can be set up by unilateral decision of the employer(DUE). Most companies prefer this mode of installation because it is the simplest procedure. In this case, the employer alone decides on the mutual health insurance chosen before sending a copy of the founding act, the notice, and the general conditions of the chosen contract with signature.
The founding act is different from the insurance contract since its drafting is free. This document must mention certain elements and in particular the collective and compulsory nature of the mutual, the date, the terms of revision and termination of the contract, the cases of exemption.
A founding act that is too brief can be sanctioned by URSSAF.
Conversely, a founding act that is too complete will have to be reviewed at each evolution of an inscribed element. It is therefore necessary for the entrepreneur to find the right balance.
The manager can also decide to adopt the company mutual by referendum. In this case, he asks each employee to comment. Organized by the employer, the referendum must be ratified by a majority of employees.
As a first step, the manager must draft the project which will be submitted to the vote, ensuring that it complies with the contractual obligations of the branch agreements or, failing that, with the minimum basket of care defined in the law of job security. He must, secondly, inform the works council if there is one as well as the employees of the project and the date of the vote. This is done under the voting conditions for the elections of staff representatives. Note that electronic voting is authorized for the adoption of a company health mutual.
Finally, your company’s mutual insurance company can be set up by branch agreements. A branch agreement makes it possible to define a legal framework negotiated between the social partners and adapted to the professional branch. Thus, when a company depends on a branch of activity that has signed a branch agreement, compulsory mutual insurance must be established under the conditions set by this agreement. While certain branches may suggest one or more insurers to the company, the employer remains the decision-maker.
The choice of the insurer
In principle, the company is free to choose the insurer with which it wishes to subscribe to its compulsory mutual. Indeed, the branch agreements providing for a designation clause intended to impose on the companies covered by this agreement the management of their collective complementary health insurance to the same insurer was declared unconstitutional by the Constitutional Council in 2013.
As specified above. , a branch agreement can now only suggest one or more insurers.
Do not hesitate to take the time to compare the mutual companies according to the needs of your employees. For this, you can use a free online comparator with no obligation. The choice of your mutual will be different depending on the characteristics of the category for which this cover is intended: average age, dependants, level of income, length of service, type of activity, etc.
To effectively meet the expectations of your employees, It may be wise to opt for a contract with optional options and providing additional services such as assistance or access to new health technologies. It should be noted that complementary health insurance must cover all employees as well as their beneficiaries, on an optional or compulsory basis. To be sure to make the right choice, the employer can seek professional advice.
The timeframe for setting up the mutual company
Private-sector employers must offer their employees complimentary group health since 1 st January 2016. The company has already implemented a mandatory mutual collective agreement for its employees and wants to revise or change is not free to choose its implementation procedure unless the mutual has been adopted by DUE.
Thus, if the previous founding act was a referendum, the next one will also have to follow this path unless it is the subject of a company agreement. If the mutual insurance company was set up by company agreement, the employer will have no choice: a new agreement will have to be signed.
It is therefore important to know the procedure to follow to set up a mutual insurance company within your company.
