La loi du 14 juin 2013 a prévu la généralisation de la couverture santé complémentaire pour tous les salariés du secteur privé.
Depuis le 1er janvier 2016, l’employeur doit proposer une mutuelle collective, en complément des garanties de base de la Sécurité sociale.
Tous les employeurs, quelle que soit la taille de l’entreprise, et les associations, sont concernés par cette obligation. Seuls sont exclus les particuliers employeurs.
La couverture complémentaire proposée par l’employeur concerne les garanties suivantes :
-
L’intégralité du ticket modérateur sur les consultations, actes et prestations remboursables par l’assurance maladie (sous réserve d’exceptions)
-
La totalité du forfait journalier hospitalier en cas d’hospitalisation
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Les frais dentaires (prothèses et orthodontie) à hauteur de 125 % du tarif conventionnel,
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Les frais d’optique forfaitaire par période de 2 ans avec un minimum de prise en charge fixé à 100 € pour une correction simple
L’employeur doit participer au moins à la moitié du montant des cotisations, le reste étant à la charge du salarié.
La mutuelle concerne également les ayants droits du salarié.
Refus d’adhésion
Un salarié peut refuser la mutuelle d’entreprise dans certains cas. Une dispense d’adhésion doit être faite par écrit.
Exemples de cas de refus :
– Lorsque le salarié bénéficie déjà d’une couverture complémentaire (notamment bénéficiaire de la CMUC ou de l’ACS)
– Lorsqu’il dispose déjà d’une mutuelle en qualité d’ayant droit notamment
– Lorsqu’il est en CDD de moins d’1 an
– S’il est à temps partiel avec un petit nombre d’heures ou apprenti et que la cotisation à la mutuelle représente au moins 10% de son salaire
A condition que la possibilité de dispense soit précisée à chaque fois dans l’acte juridique qui a mis en place la complémentaire santé.
Plus d’informations sur les possibilités de refus ici
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