Nouvelle trame Résumé Garanties FS - VMware · 3/3/2020 · Hearing aids batteries and maintenance 1700 € - SSR (1 prosthetic by ear / 4 years) 2200 € - SSR (1 prosthetic by

M Y H E A L T H C A R E

B E N E F I T S

This guide summarises the benefits of the health insurance policy

taken out by your employer. It presents you the service you are

entitled to, applicable conditions, as well as the services

associated with them.

Your human ressources contacts can provide you with

information on how the schemes and their contributions work. All

the information related to your contract is available on your

Mercernet website.

2020, January

For all employees

M E R C E R S E R V I C E S 2 4 H O U R S A D A Y

Mercernet is the dedicated and secure online portal that allows

you to access in real time your Mercer services and all the

information related to your healthcare plan, in order to simplify

your process.

My insured space mercernet.fr

View

my benefits

How to create my account

in a few clicks?

1. Go to www.mercernet.fr, Personal Area, “First

visit” section;

2. select “I register”;

3. have your third party payment card;

4. follow the instructions and provide the requested

informations;

5. confirm your request to set up a Mercernet

account;

6. you will receive an email allowing you to create

your account and to personalise your password

for all your future logins.

Check my

reimbursements

Download my

Third-party payment

card

Attach a quote

or an invoice

Contact my

TPA centre

Update

my information

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Mes services associés

You wish to send us your documents online (invoices, quotes, rights certificates, etc.) but you do not have your login details?

Do not worry!

A secure contact form is available to enable you to forward your requests and any documents to your TPA centre and benefit from

complete processing and optimal follow-up.

To access it, follow the steps below and follow the instruction.

The contact form: easy, fast and no login needed

1 2 3

Click

at the bottom of the page

on “Contact us”

Select

“Contact an Advisor”

and complete the form

Visit us at

www.mercernet.fr,

Personal area section

2MERCER | MY HEALTHCARE BENEFITS

MERCER | MY HEALTHCARE BENEFITS 3

M Y H E A L T H C A R E B E N E F I T S C O N T R A C T

The insured.

The spouse, the civil partner (subject to providing

documentation to confirm this partnership) or the cohabiting

partner as defined by Article 515-8 of the French civil code

(Code civil).

The children and if they live at the participant’s home, the

children of the spouse, cohabiting partner or civil partner

subject:

A On the one hand :

- Under 21 years old,

- Under 28 years old if they are in full-time education,

including a paid internship in a company as part of their

studies,

- Under 28 years old if they are on a work-based

training program, on an apprenticeship or professional

development contract under the conditions defined by

the French employmeny code (Code du travail), or on a

qualification or guidance contract,

- Under 28 years old if they are looking for their first job

subject to providing proof that they are registered with

the French government employment agency - Pôle

Emploi - as a first-time jobseeker,

- Regardless of their age, if they receive any disabled

adult benefits levels (law of 30 June 1975), provided

that these benefits have been awarded to them before

their 21st birthday,

B On the other hand :

- they benefit from a social security plan because of the

affiliation of the insured, spouse, PACS partner,

concubine or personal affiliation;

AND

- whether they are tax-dependent on the insured, i.e.

taken into account for the application of the family

quotient or receive support that the insured deducts tax

from his or her overall income.

Who are the Beneficiaries of the policy ?

The portability of rights

In the event of employment contract termination (except for

dismissal for gross negligence) giving rise to entitlement to

unemployment insurance compensation, you can continue

benefiting from your rights under your company's compulsory

scheme. This maintenance of benefits will last for the duration of

your last employment contract, up to a maximum of 12 months,

provided that you send to your TPA centre the proof of payment

of unemployment benefits.

Extend your benefits

Contact your HR department in order to benefit from a possible

scheme in force in your company.

If your company does not provide a collective scheme, you can

contact our help service in order to get a personalised quote:

What to do if t my employment contract ends?

01 55 21 01 89 [email protected]

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My healthcare services

Do your health expenses often exceed your reimbursements?

Mercer Optimal, an additional top-up, complements the combined reimbursements of the Social Security and your Mercer

healthcare insurance scheme to allow you to be better reimbursed

5 options are available to optimise your benefits according to your healthcare needs!

Benefit from a maximum cover to avoid being out-of-pocket!

No waiting

period

No medical

questionnaire

Quick

reimbursements

Daily hopitalization

allowance Option

01 55 21 01 89 [email protected] a personalised quote

Participants covered by the QUATREM compulsory health

insurance policy have an option to take out the complementary

cover available under this policy:

Either on the policy’s start date, for existing employees, or on

their recruitment date if this is later than this policy’s start

date;

Or the first day of January;

Or in the event of a change in their family circumstances,

provided that they request this within three months of the

change. In this case, cover will be granted from the day of the

event.

It will only be possible to return to the level of cover provided

exclusively under the QUATREM compulsory health insurance

policy. However, in the event of a change in your family

circumstances, this condition does not apply and the change is

made on the day of the event.

Any change of plan will concern all the beneficiaries.

Optional plan choice modalities


M Y B E N E F I T S ’ P L A N

Benefits paid in addition to the Social Security

reimbursements

BASE Plan BASE + Optionnal

DPTAM

Practitioners

Non DPTAM

Practitioners

DPTAM

Practitioners

Non DPTAM

Practitioners

HOSPITALIZATION (Surgical, Medical, Maternity)

Room & Board fees (sector 1) 400% RB 400% RB

Room & Board fees (sector 2)90% AC - SSB within the limit of 400%

reconstituted SSB

90% AC - SSB within the limit of 400%

reconstituted SSB

Doctor fees (sector 1) 400% RB MT + 100% RB 400% RB 420 % RB

Doctor fees (sector 2) - MT + 100% RB - 420% RB

Daily hospital fees not reimbursed by the S.S. 100% AC with no duration limit 100% AC with no duration limit

Moderating ticket for costly acts 100% AC 100% AC

Private room fees not reimbursed by the S.S. (included

ambulatory)3% SSMC per day 4% SSMC per day

Companion bed fees (child younger than 16 yo) not reimbursed

by the S.S.2% SSMC per day (max 30 days per year) 2% SSMC per day (max 30 days per year)

OUTPATIENT CARE

Consultations & home visits : General practitioners 300% SSB MT + 100% RB 300% SSB 330% RB

Consultations & home visits : Specialists 300% SSB MT + 100% RB 300% SSB 330% RB

Consultations & home visits : Minor surgery / Medical technique

procedures 300% SSB MT + 100% RB 300% SSB 330% RB

Consultations & home visits : X-Rays (including ultrasound) 300% SSB MT + 100% RB 300% SSB 330% RB

Paramedical Fees : Paramedical services 300% SSB 300% SSB

Laboratory tests 300% SSB 300% SSB

Medical Transportation MT MT

Drug Prescription : Pharmacy 2% SSMC per day and dependent 2% SSMC per day and dependent

Medical Prosthesis : Prosthesis and accessories 400% SSB 400% SSB

Medical Prosthesis : Orthopedics 400% SSB 400% SSB

HEARING AIDS

1 prosthetic by ear / 4 years

100% Health reimbursments :

Hearing aids (after 01/01/2021) 100% CC - SSR 100% CC - SSR

Hearing aids batteries and maintenance (after 01/01/2021) MT MT

Free Threshold reimbursments :

Hearing Aids (per ear) 1700 € - SSR (1 prosthetic by ear / 4 years) 2200 € - SSR (1 prosthetic by ear / 4 years)

Hearing aids batteries and maintenance 1700 € - SSR (1 prosthetic by ear / 4 years) 2200 € - SSR (1 prosthetic by ear / 4 years)

OPTICAL Network KALIVIA Network KALIVIA

1 pair of glasses every 2 years for adults except in case of visual impairing changes or illness specified by the legislator or for children under 16 yo


Frame, Glass & visual exam 100% CC - SSR 100% CC - SSR

Optical pairing, Special glasses or treatments in case of illness 100% CC - SSR 100% CC - SSR

Free Threshold reimbursments :

Frame 100 € - SSR 260 € - SSR

Glass See optical grid See optical grid

Special glasses or treatments in case of illness MT MT

Contact lenses covered or not by S.S. (disposable lenses

included)

8% SSMC per eye and dependent (all

contact lenses)

8% SSMC per eye and dependent (all

contact lenses)

Eye surgery 600 € per eye and dependent 600 € per eye and dependent


Please note that the above chart is informative and cannot

replace the insurer contractual documents.

Sector « non conventionné » is assimilated as non DPTAM

practictioners.

DPTAM : new name of CAS : Contrat d'Accès aux Soins (to

confirm that your practitioner is DPTAM please check

on http://annuairesante.ameli.fr/ ).

Actual Cost (AC) : Cost faced by the insured. It is displayed

on your care form or sheet, Social Security counts, bills...

Social Security Remboursement Base (RB) : official fees that

Social Security uses to calculate the amount of “secteur

conventionné” reimbursements.

Ticket Moderateur (MT) : Difference between Social Security

Reimbursement Base (RB) and its final reimbursement (SSR).

Monthly Social Security Ceiling (MSSC) : this amount is set

by decree and adjusted every 1st Januarys by decree (3428 €

in 2020).

PLV : Controled Costs – Maximum heatlh price.

HLF : Controled fees.

G L O S S A R Y

M Y B E N E F I T S ’ P L A N

Benefits paid in addition to the Social Security

reimbursements

BASE Plan BASE + Optionnal

DPTAM

Practitioners

Non DPTAM

Practitioners

DPTAM

Practitioners

Non DPTAM

Practitioners

DENTAL


Dental Cares and prosthesis 100% CF - RSS 100% CF - RSS

Free and Moderated Thresholds reimbursments :

Dental Cares (including periodontics) 300% RB 100% RB

Inlays-Onlays400% RB capped at 100% of CFF* - SSR in

the moderated threshold

450% RB - SSR capped at 100% of CFF* -

SSR in the moderated threshold

Dental prosthesis with bridges over damaged tooth, temporary

crown

400% RB capped at 100% of CFF* - SSR in

the moderated threshold

600% RB - SSR capped at 100% of CFF* -

SSR in the moderated threshold

Bridges over healthy tooth 300 € per year and dependent 400 € per year and dependent

Orthodontic (exam, semester, treatment) 400% RB 450% RB

Orthodontic not reimbursed by the S.S. 387 € per semester 774 € per semester

Periodontics reimbursed or not by the S.S. 6% SSMC per year and per dependent 10% SSMC per year and per dependent

Dental implant not reimbursed by the S.S. : implant (root)516 € per implant root and per dependent

(Max 3 per year)

516 € per implant root and per dependent

(Max 3 per year)

Dental implant not reimbursed by the S.S. : inlay core (pilar)172 € per implant pilar and per dependent

(Max 3 per year)

172 € per implant pilar and per dependent

(Max 3 per year)

NON CONVENTIONNAL MEDICINE by a practitioner with an ADELI or FINESS number, not reimbursed by the S.S.

Osteopath, acupuncturist, chiropractor, tobaccoologist46 € per year and dependent (max 3 per

year)

46 € per year and dependent (max 4 per

year)

Well-being (dietitian) 30 € per year and dependent 60 € per year and dependent

OTHER CARES

Thermal Care : Transportation and Onboarding fees reimbursed

by the S.S.25% SSMC 25% SSMC

Thermal Care : Fees reimbursed by the S.S. See OUTPATIENT CARE See OUTPATIENT CARE

Maternity or adoptionPackage 22% SSMC (no doubled if multiple

birth)

Package 22% SSMC (no doubled if multiple

birth)

PREVENTIVE CARE

Vaccines prescribed but not reimbursed 6% SSMC per year and per dependent 6% SSMC per year and dependent

Smoking cessation - 50 € per year and dependent

Test for hepatitis B 300% BR 300% BR

Prescribed osteodensitometry - 50 € per year and dependent

ADDITIONAL SERVICES

Daily Assistance Phone number 01 44 85 49 64 - Convention number : 230 011 - Assistance

Care Network : KALIVIAServices and Prices negociated with opticians, dentists and hearing prostethists partners.

List of partners available via geolocalization on your MERCERNET personnal web space.


M Y O P T I C A L G R I D

Sous-titre 1

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Sous-titre 1

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Medical consultation

Garantie exprimée y compris la

Sécurité socialeVERRE UNIFOCAL VERRE PROGRESSIF / MULTIFOCAL

PUISSANCE (sphère ou somme S)

Classe

responsable

Panier LIBRE

BASE

Panier LIBRE

BASE +

OPTION

Classe

responsable

Panier LIBRE

BASE

Panier LIBRE

BASE +

OPTION

VE

RR

E

SP

HE

RIQ

UE

0,25 à 2,00 simple 160 € 210 € complexe 300 € 350 €


4,25 à 6,00 simple 160 € 210 € très complexe 350 € 400 €

6,25 à 8,00 complexe 300 € 350 € très complexe 350 € 400 €


> 12,00 complexe 300 € 350 € très complexe 350 € 400 €

VE

RR

E

SP

HE

RO

-

CY

LIN

DR

IQU

E

(+)

[0,2

5 à

4,0

0]




6,25 à 8,00 complexe 300 € 350 € complexe 300 € 350 €



VE

RR

E

SP

HE

RO

-

CY

LIN

DR

IQU

E

(+)

> 4

,00







Many healthcare professionals

(more than 5,000 for optical care)

Attractive rates

Systematic third-party payment

Geolocation system

Optical care: rate reductions

Network advantages

NEGOTIATED

PRICES

CERTIFIED

LEVEL OF

QUALITY

FREEDOM

OF CHOICE

SYSTEMATIC

THIRD-PARTY

PAYMENT

Contact my TPA centre

By mail:

164 - 174, rue Victor Hugo

92536 LEVALLOIS-PERRET

My Mercernet insured space:

www.mercernet.fr , Personal area,

"Contact Us" section

By phone, Monday to Friday from

8:30am to 6pm, and Saturday from

8:30am to 12:30pm

Claim phone number : 03 20 89 10 88

Je n’ai rien à régler. La téléconsultation est prise en charge à

100% par ma complémentaire santé Malakoff Médéric Humanis et

toutes les personnes affiliées sur mon contrat bénéficient aussi de

ce service (5 téléconsultations par an et par bénéficiaire).

24h/24,7j/7, en vacances,

même à l’étranger, accédez à un médecin

par téléphone ou vidéo.

Avec la Téléconsultation médicale,

c’est immédiat !

http://www.mercernet.fr/

*2021 for hearing aids

1 0 0 % H E A L T H C A R E

R E F O R M A N A L Y Z E D

B Y M E R C E R

Y O U R H E A L T H C A R E P L A N C H A N G E S

Quick and simplified reimbursements: Noemie

The NOEMIE link allows the automatic electronic transmission of

your healthcare data concerning you and your beneficiaries between

your Social Security fund and Mercer. To benefit from it, you must send

Mercer your updated Social Security rights certificate and that of any of

your beneficiaries.

Without noemie remote transmission

Send Mercer the Social Security statements (or statements downloaded

from your dedicated space on www.ameli.fr) along with supporting

documents (see table below). Please note that these documents must

be sent within 2 years of the date of treatment.

how to be reimbursed for your healthcare expenses?

The supporting documents requested by Mercer (in addition to the remote transfer or S.S. statement)

Healthcare expenses type Supporting documents How to send

OPTICAL EQUIPMENT* without third-party

payment

Lenses- frames- contact lenses covered

by the Social Security

Copy of the paid and detailed invoice (price, brand and

reference),for the lenses and contact lenses with the

optician's stamp and a copy of the prescription.

DENTAL CARE* without third-party

payment

Dental prostheses covered by the Social

Security

Copy of the paid and detailed invoice

(codification of procedures and tooth numbers).

PAYMENT OF THE TICKET

MODÉRATEUR1 ONLY all types of

expenses

Copy of the receipt for the payment of the additional part

(ticket modérateur, portion of cost paid by patients) or copy

of the paid invoice.

For fees exceeding 6 times the Social

Security reimbursement basis

Paid invoice or Notice of amounts to be paid and proof of

payment (public hospitals) or billing slip (clinics) for

outpatient care.

HOSPITALIZATION CARE* (excluding

Maternity)

Accommodation costs, hospital daily fees,

private room

Surgeon, anaesthetist fees, etc.

Invoice slip from the healthcare facility (clinics) or notice of

amounts to be paid and proof of payment (hospitals).

Invoice slip and copy

of the paid invoice of the healthcare facility.

*Get an estimate of your reimbursements for your medical procedures by sending us a quote

This document is only a summary of the group insurance contract taken out by your company and can in no way replace the warranty notice provided by the insurer. Only the provisions of this contract are

binding on the parties. For more information on these benefits, please refer to the insurer's notice. In accordance with the provisions of Articles R 871-1 and R 871-2 of the French Social Security Code, this

contract does not cover flat-rate contributions, the reduction of Social Security reimbursements and authorised fee overruns in case of non-compliance with the care process and for refusing to give access to

the medical file. Procedures not reimbursed by the Social Security are covered under this contract only if they appear in the General Classification of Professional Procedures (NGAP) or in the Common

Classification of Medical Procedures (CCAM). Benefits are calculated on a procedure by procedure basis and are, in any case, limited to the difference between the costs incurred and the corresponding

reimbursements from the Social Security and any other organisation. You have a maximum of 2 years to request reimbursement of your expenses. Beyond this period, “Healthcare” organisations (the Social

Security and Complementary health insurance companies) apply the foreclosure period and will no longer be able to access the necessary information to make any payments.

By post

Find the contact

details of your TPA

centre on this

information sheet.

By form

www.mercernet.fr

Personal area,

section: Contact us

Avoid avoid advancing any fees (Social Security +

supplementary part) by presenting your carte vitale and your

third-party payment card to health professionals.

If you have paid the Mercer supplementary part, send us a

copy of the paid invoice or payment receipt.

Third-Party Payment

U S E F U L I N F O R M A T I O N

Prefer generic medication

Do not communicate the level of your benefits to your

dentist or optician.

For important treatments, get 2 quotes from different

healthcare professionals.

Encourage your spouse's healthcare reimbursements

through his or her own healthcare plan.

Check http://annuairesante.ameli.fr to find out more

about fee overruns (charges exceeding statutory fees).

The right reflexes


Documents

Nouvelle trame Résumé Garanties FS - VMware · 3/3/2020 · Hearing aids batteries and maintenance 1700 € - SSR (1 prosthetic by ear / 4 years) 2200 € - SSR (1 prosthetic by