Allianz

Health

INFORMATION NOTICE

Thank you for your trust
Throughout your membership, the teams at Allianz will mobilize to meet your expectations.
Your membership consists of 2 documents:

• This Information Notice: it describes the content of your coverage (Care, services, and assistance) and specifies the conditions and modalities of your membership, necessarily composed of Allianz Health guarantees.
• Your Membership Certificate: it includes your personal declarations. It indicates the effective date of your coverage and specifies all the specifics or options you have chosen as well as your rate. It also integrates your benefits schedule. This last details the level of reimbursement of your Care guarantee in case of hospitalization, routine care, dental care, optical, and auditory care, according to the chosen level. In case of contradiction, your Membership Certificate always takes precedence over the Information Notice.

1. Your mobile application

You can download the “My Allianz mobile” application by going to the App Store or Google Play. Thanks to it, you have access on your phone or tablet to the essential services available in your client area.

2. Your third-party payment card always with you

Download it on your smartphone from My Allianz mobile (available on Apple Store and Google Play). You can also find it in your client area.

3. Practical services

• Your client area allianz.fr: you will find detailed information about your coverage and options.
• The e-mail service: we make certain documents available to you. As soon as a new document is available, you are notified by e-mail or SMS.
  Need more information about these services? Quickly refer to the chapter “Care guarantees,” paragraph VIII, and the chapter “The life of your membership,” paragraph VI.

To remember

To facilitate your reading, the following pictogram will help you identify useful information.

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Table of contents

• To contact us -------------------------------------------------------------------------------------------------------- 2
• How does the reimbursement system for care work?------------------ 3
• Summary table ------------------------------------------------------------------------------------------------------ 7
• Main definitions --------------------------------------------------------------------------------------------------- 8
• What are the membership conditions for Allianz Health?-------------------------------- 9
  • I. Allianz Health 9
  • II. Conditions related to the member or the insured 10
• Care guarantees --------------------------------------------------------------------------------------------------------- 13
  • I. Presentation of the ranges 13
  • II. Hospitalization 15
  • III. Routine care reimbursed by Social Security (excluding optical and dental) 17
  • IV. Optical 18
  • V. Hearing aids 20
  • VI. Dental 20
  • VII. Routine care not reimbursed by Social Security 22
  • VIII. Services you are entitled to 22
• The life of your membership ----------------------------------------------------------------------------------------------- 25
  • I. Your obligations 25
  • II. Your contribution 26
  • III. Modification of your guarantees 27
  • IV. Payment of your benefits 27
  • V. The end of your membership 31
  • VI. General information 33
• Assistance guarantees ----------------------------------------------------------------------------------------------- 40
  • I. Conditions for implementation 40
  • II. Summary of services and coverage 41
  • III. Detailed services 46
  • IV. Liability 54
  • V. Exclusions 55
  • VI. Claims examination procedures 56
  • VII. Personal data protection 56
  • VIII. Control authority 57
  • IX. Applicable law - language used 57
• Privacy statement ------------------------------------------------------------------------------------ 58
• Glossary -------------------------------------------------------------------------------------------------------------------------------- 61

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To contact us

A question, a request?

For your Care guarantees

• Via your member area: For all your procedures: management requests, reimbursement requests, health quotes… Accessible at www.allianz.fr

For your Assistance services (available in all our ranges except Eco)

For insured persons residing in metropolitan France:

• From metropolitan France: By phone 01 40 25 52 43 (non-premium call)
• From abroad: +33 1 40 25 52 43 (non-premium call)

For insured persons residing in Guadeloupe, Martinique, Guyana, Mayotte, or Reunion:

• From metropolitan France, Guadeloupe, Martinique, Guyana, Mayotte, Reunion: By phone 09 69 32 04 90 (non-premium call)
• From abroad: +33 1 42 99 03 11 (non-premium call)

Access for the deaf and hard of hearing: https://accessibilite.votreassistance.fr (24/7)
Protocol number, common to all ranges (except Eco) to communicate to your contact: 922.551
Information to provide for all requests:

• the name and membership number,
• the name and first name of the beneficiary,
• the exact address of the beneficiary,
• the phone number at which the beneficiary can be reached.

For your Santéclair services (Santéclair partners, services, quotes...)

• By phone: 0 970 809 815 (non-premium call)
• Via your member area: Accessible at www.allianz.fr

For ADPS assistance

• Find all the information on the website: https://adps-sante.fr/votre-association-vous-aide/.
• For any questions: adps@allianz.fr.

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HOW DOES THE CARE REIMBURSEMENT SYSTEM WORK?

The reimbursement for care is based on a combined intervention of:

• Social Security, which covers part of your health expenses,
• your complementary health insurance, which fully or partially complements the coverage provided by Social Security.

How is the reimbursement amount from Social Security calculated?

For each medical act or medication, Social Security sets:

• a reimbursement base (BR), which is a reference price.
• a reimbursement rate applied to this BR to determine the actual reimbursement amount. It is expressed as a percentage.

The portion of the reimbursement base not covered by Social Security is called the co-payment. Without complementary health insurance, it remains entirely your responsibility.
The reimbursement bases and reimbursement rates differ from one act or medication to another. For more information, visit the health insurance website www.ameli.fr.

At the time of reimbursement, Social Security always deducts an additional amount that remains your responsibility:

• €2 flat-rate participation (for adult insured persons) on all consultations or acts performed by a doctor, on radiological examinations, and medical biology analyses.
• a medical franchise on boxes of medication (€1/box), paramedical acts (€1/act), and health transport (€4/transport).

Let’s take the example of a consultation with a specialist (free fees) costing €57:

• The BR is set at €23 (rate as of January 1, 2024) and the reimbursement rate at 70%. Social Security therefore reimburses only 70% of €23 (i.e., €16.10 - €2 non-reimbursable flat-rate participation). The co-payment represents 30% of the BR (i.e., €6.90).

Reimbursement from Social Security
(€16.10 - €2 flat-rate participation at your expense)
€14.10

Fee exceeding
(amount exceeding the BR: €57 - €23)
€34

Co-payment
€6.90

Out-of-pocket expense without complementary health insurance
€6.90 + €34 + €2 = €42.90

HOW DOES THE CARE REIMBURSEMENT SYSTEM WORK?

What is the purpose of complementary health insurance?

Complementary health insurance allows for a better level of reimbursement for routine care, hospitalization, and particularly for optical, dental, and auditory prosthetics. It intervenes:

• as a complement to Social Security depending on the level of guarantee you have chosen:
  • the Eco range (100% of the BR guarantee) allows reimbursement of the co-payment, but not the fee overruns,
  • the Comfort range (for example, with level 3 where the guarantee is at 150% of the BR) or Premium (for example, with level 5 where the guarantee is at 200% of the BR) covers the co-payment and the fee overruns fully or partially depending on their extent. The reimbursement base is multiplied by 1.5 or 2,
• to reimburse partially or fully certain expenses not reimbursed by Social Security (example: daily hospital fee, osteopath act, dental implant...).

Beware of fee overruns

The reimbursement base of Social Security is often lower than your actual expenses, especially in the case of prices set freely by health professionals (dental prosthetics, optical equipment, hearing aids, or specialist fees). What remains your responsibility can then amount to several tens or hundreds of euros if you do not have complementary health insurance.

Example of reimbursement for a specialist consultation (free fees) at €57:

Range	Out-of-pocket expense	Fee overruns	Reimbursement from complementary health insurance	Reimbursement from Social Security
Eco (100% of the BR)	€36	€6.90	€14.10	€16.10 - €2 flat-rate participation
Comfort level 3 (150% of the BR)	€24.50	€6.90	€14.10	€16.10 - €2 flat-rate participation
Premium level 5 (200% of the BR)	€13	€6.90	€14.10	€16.10 - €2 flat-rate participation

And how does 100% Health work?

To facilitate access to care, the government has implemented the 100% health reform. Thanks to 100% health, you can benefit from care fully covered in 3 areas:

• dental (prosthetics),
• optical (eyeglasses),
• hearing aids.

To do this, you must first have complementary health insurance (excluding Allianz Health Eco). In these 3 areas, a set of care (basket of care), including a choice of equipment, is fully reimbursed by Social Security and your Allianz complementary health insurance (except Allianz Health Eco). If you choose the equipment from the care baskets, you will therefore have nothing to pay (provided that the health professional respects the maximum regulatory price). This system is accessible to everyone, regardless of income. You just need to request it from the dentist, optician, or audioprothesist you consult. If you wish to benefit from other equipment not included in these baskets, reimbursements will be made according to the level of guarantees you have chosen.

For more information, visit the 100% health website.

What happens when you have a Long-Term Condition (ALD)?

When you have a Long-Term Condition (ALD), you are covered 100% by Social Security, only for care related to your pathology. Complementary health insurance remains essential for your other expenses:

• non-reimbursed expenses (notably the daily hospital fee, fee overruns ...),
• partially reimbursed expenses (for example, the co-payment and any overruns remaining your responsibility if the care is unrelated to an ALD).

Have the right reflexes for all your health needs

Obtaining a reimbursement

You have no steps to take to obtain a reimbursement. We are automatically informed of all the care that is provided to you and reimbursed by Social Security. For those not covered by Social Security (example: osteopath session), you just need to upload your invoices to your Client Area.

Need glasses, a hearing aid, dental care, to find a general practitioner or specialist, or to consult quickly?

Via your Allianz Client Area and thanks to Santéclair services (also accessible by phone, refer to the “To contact us” page), you can:

• request a reimbursement simulation or a quote analysis,
• search for an ophthalmology center, an optician, an audioprothesist, a dentist, a doctor (and benefit from negotiated prices on major brand lenses, dental care, and hearing aids),
• quickly consult a general practitioner or specialist online.

A hospitalization?

From your Allianz Client Area and thanks to your Santéclair services (also accessible by phone, refer to the “To contact us” page), you can:

• request an analysis of your surgery, obstetrics, or anesthesia quotes,
• consult the ranking of hospital establishments to guide your choice towards the best establishments and anticipate your out-of-pocket expenses in case of surgical intervention,
• obtain a second medical opinion regarding a serious health problem from the second opinion service,
• search for a home nurse to provide necessary care after hospitalization.

To know and plan the services you can benefit from before, during, or after your hospitalization (for example: home help, meal delivery), contact Allianz assistance (refer to the “To contact us” page). Always mention protocol number 922.551). Services not included in your contract if you have subscribed to the Eco range.

Present your Allianz Third-Party Payment card upon your admission to the hospital so that they can request a coverage agreement from us and avoid you having to advance the costs that we cover (example: daily fee).

A symptom that concerns you?

Via your Allianz Client Area and thanks to the Santéclair tool, access the Symptom Analysis and Health Orientation Service. With this tool, you can evaluate the symptoms that worry you in just a few clicks and be guided in their management.

Summary table

Allianz health insurance is:

Ranges	Eco	Comfort	Premium
Hospitalization	Optional	Included
Routine care
Optical/Auditory aids	Optional	Optional
Dental	Optional	Optional

Services

• Santéclair services (partner health professionals)
• Health and wellness
• Client area on www.allianz.fr
• My Allianz Mobile
• ADPS
• Assistance
• General information
• Housekeeping
• In case of hospitalization or immobilization
• In case of travel in France or abroad

Legend: Guarantees and services

Main definitions

• We: Refers to Allianz, AP Solutions GmbH French branch, hereinafter Allianz Assistance, for the implementation of assistance guarantees, or Santéclair for our partner networks.
• You: Refers to you as a member.
• BR: Corresponds to the Reimbursement Base of Social Security (example: the price of a consultation with a specialist (free fees) is €23 as of January 1, 2025). It is on this basis that Social Security calculates its reimbursement.
• Mandatory scheme: It is the social organization (generally the...

CPAM

The CPAM, to which everyone is mandatorily affiliated, reimburses most of your health expenses.

Third-party payment

Refers to the payment system that prevents you from advancing all or part of the health expenses to the care providers. They are paid directly by the mandatory and/or complementary health insurances for the care or products they have provided to you.

Find other definitions in the glossary at the end of the document.

MAIN DEFINITIONS

What are the membership conditions for Allianz Health?

I. Allianz Health

Allianz Health corresponds to 3 group insurance contracts with optional membership, subscribed to Allianz IARD by the Health Prevention Association (ADPS), for the benefit of its members hereinafter referred to as “the contract, Allianz Health.” These contracts are governed by the Insurance Code and French law.

• Contract no. 3 is subscribed within the framework of the scheme exclusively reserved for Non-Salaried Non-Agricultural Workers (TNSNA - article L144-1 of the Insurance Code), called “Madelin Law.”
• Contract no. 4 is subscribed for all member members of the Association wishing to benefit from solidarity and responsible guarantees.
• Contract no. 5 is subscribed for all persons wishing to choose guarantees that do not meet the characteristics of the responsible contract.

1. The subscriber

The Health Prevention Association (ADPS) is the subscribing association of the contracts. It is an independent non-profit association governed by the law of July 1, 1901, registered at the Hauts de Seine prefecture under number W922002348. Its headquarters is located at Tour Neptune - CC 2242 20 place de Seine - La Défense 1 - 92400 Courbevoie.

When you join Allianz Health, you also join the ADPS and benefit from the collective expertise of the Association, engaged in health information and prevention actions, as well as in the development of social assistance accessible to members.

The ADPS is a nationally oriented association, created for over 50 years, which brings together nearly 500,000 members and more than one million insured beneficiaries in health and prevention with Allianz. The Association is managed and administered by volunteer members. With its 20 regional delegations, it carries out its actions and missions on the ground as close as possible to its members.

a. A local association focused on its members

The ADPS promotes health & prevention insurance and represents its members in relation to Allianz by:

• The subscription of group insurance contracts, as well as the contribution to the development and evolution of these contracts, aim to better meet the coverage needs and expectations of members. Anyone wishing to join a group contract subscribed by the ADPS with Allianz must first be a member of the association, which implies the payment of an annual statutory contribution. Members automatically become members of the ADPS and have voting rights at the General Assembly, thus actively participating in the life of the association.
• As active members, members influence the orientations and decisions taken by the ADPS during the General Assembly.

The ADPS assists its members:

• By providing support and occasional assistance in case of life’s unforeseen events: insufficient medical or social coverage, assistance with mobility or the purchase of medical equipment, the consequences of a death… Support is granted at the discretion of the ADPS Social Commission after reviewing the submitted file. The Social Commission is composed of ADPS volunteers.
• On happy occasions: the ADPS offers a “birth box” containing textile articles and toys, and a digital prevention offer, on the occasion of a birth. The newborn must be registered on the individual Allianz health contract of the insured parent.

The ADPS mobilizes, in addition to “insurance solutions,” on the development of information and health prevention practices:

• It promotes well-being and health, encourages good behaviors, informs its members, particularly through its website https://adps-sante.fr, its magazine “Echos Santé,” and its digital communication.
• It offers health prevention programs for employees of member companies.

b. An association committed to social action and solidarity and support for medical research

The ADPS carries out numerous social and solidarity actions:

It provides financial and local support to associations engaged in supporting disability and illness, promoting intergenerational links, and social integration and preservation.

The ADPS plays an active role in supporting medical research to participate in the emergence of innovative therapeutic applications around the theme “Living well to age well” or “How to age in good health?”:

• It encourages a dynamic of openness to research actions on aging prevention in collaboration with scientific organizations and researchers.
• It supports medical research work that allows for the rapid valorization of a scientific discovery into concrete and rapid application through the implementation of treatments for the benefit and proximity of patients.

c. For any information, you can:

• Contact the permanent secretariat of the ADPS by email (adps@allianz.fr).
• Consult all information and news about the association on its website https://adps-sante.fr or on its Facebook page https://fr-fr.facebook.com/adps.allianz/.

The statutes are available upon simple request from the ADPS and on the association's website in the “our media library” / “documentation” section.

2. The insurer

All guarantees and options of the Allianz Health contract are insured by Allianz IARD (branches 1 “accident” and 2 “illness”), a company governed by the Insurance Code, a public limited company with a capital of €991,967,200, whose headquarters is located at 1 cours Michelet - CS 30051 - 92076 Paris La Défense Cedex - 542 110 291 RCS Nanterre.

The ADPS has not received any power from Allianz IARD to act in its name in any matter concerning distribution, membership, management, or any other area regarding these contracts.

3. Modification or termination of the group insurance contract

The Allianz Health contract came into effect on October 10, 2019, for an initial period ending December 31, 2019. It renews annually, each January 1 by tacit renewal. It can be terminated each year on December 31 by Allianz IARD or the ADPS with a notice period of 6 months.

• In case of modification of the contract affecting your rights and obligations, you will be informed in writing in accordance with article L141-4 of the Insurance Code, by the ADPS at least three months before the scheduled date of their entry into force. Following these modifications, you may terminate your membership if you wish.
• In case of termination of the contract, you will be informed at least 3 months before the effective date of the termination and will continue to benefit from the guarantees and options subscribed until the date of cessation of your membership, subject to the payment of contributions. The management of ongoing memberships at the date of termination will continue with Allianz IARD in accordance with the latest provisions in force. This termination results in the loss of your status as a member of the ADPS.

Your membership thus maintained in force is excluded, where applicable, from the scope of the scheme reserved for Non-Salaried Non-Agricultural Workers (article L144-).

Membership conditions for Allianz Health

I. Conditions related to the member or the insured

When you join the contract, you become a member of the ADPS association and have voting rights at the General Assembly, thus participating in the life of the association. The contract is reserved for members of the ADPS association who are up to date with their annual statutory contribution. This contribution:

• may be revised each year by the association in accordance with its statutes,
• is automatically deducted with the first contribution of your membership.

Failure to pay this contribution results in the loss of membership status with the ADPS. This loss simultaneously results in the cessation of ADPS social assistance for both you as the insured and for your family members (your dependents affiliated with the contract) from the date of the event, even if they started or were granted before this date.

As a member of the association, you declare that you fully accept the statutes of the ADPS with the commitment to respect all its provisions.

To join Allianz Health, you must also meet the following conditions:

• be a natural person,
• reside in metropolitan France, Guadeloupe, Martinique, Guyana, Mayotte, or Reunion,
• be affiliated with a mandatory French Social Security health insurance scheme. Therefore, membership in Allianz Health is impossible if you benefit from the Caisse des Français de l’Étranger (CFE), as Allianz is not one of the managing organizations, and the Allianz Health offer is not intended for beneficiaries of the Complementary Health Solidarity (C2S).
• be at least 18 years old,
• not benefiting from complementary health insurance or wishing to change.

If you are self-employed, a craftsman, a merchant, or a liberal profession, wishing to benefit from the tax system of article 154 bis of the General Tax Code reserved for Non-Salaried Non-Agricultural Workers (TNS), your membership occurs within the framework of group insurance contract no. 3. To benefit from this tax system, you must be up to date with the payment of your contributions under the mandatory health and old-age insurance schemes. Furthermore, this deductibility is only possible for contributions concerning you and those of your dependents as defined by the contract.

Outside of this framework, your membership occurs under group insurance contract no. 4 or 5.

1. Who can benefit from your membership?

• The member, that is to say you,
• the dependents, that is to say the persons you have declared as covered by your membership under the Allianz Health guarantee.

The following can qualify as dependents:

• your spouse or the person with whom you have entered into a contract under the legal regime of the Civil Solidarity Pact (PACS), or the person with whom you maintain a notable and constant cohabitation, able to justify a common principal residence during this period,
• your children, those of your spouse, your PACS partner, or your cohabitant,
• generally, any person who is effectively and permanently dependent on you, living under the same roof as you.

2. What are the conditions and formalities for membership?

You fill out a membership application on which you mention the persons to be covered as well as the guarantees chosen for each of them. It allows you to join:

• the Health Prevention Association (ADPS),
• the “Allianz Health” contract and optionally the Hospital Packages guarantee.

No medical formalities are required, regardless of the offer selected.

To join the contract, you must provide us with:

• the duly completed and signed membership application (we advise you to keep a copy),
• a photocopy of your valid identity document (example: national identity card),
• a bank account statement (RIB) from an account of which you are the holder, and the completed SEPA direct debit mandate if you opt for the direct debit of contributions. You commit to sending your bank institution, upon conclusion of the contract, a regularized and signed SEPA mandate. This document will be communicated to you either by email or by mail.

If you are TNS and wish for contributions to be deducted from your company's bank account, you must comply with applicable regulations to avoid being suspected of misappropriation of corporate assets (or embezzlement). The RIB used must correspond to the company in which you carry out your activity. You must complete and sign the document “Certificate of legal entity paying contributions.”

• a second RIB for the payment of your benefits if you wish for the account, of which you must also be the holder, to be different from that used for the payment of your contributions,
• the photocopy of your vital card certificate (provided by your mandatory scheme and also downloadable from your AMELI account at www.ameli.fr), as well as those of your dependents to be attached to your membership,
• the SIRET certificate (or the number) if you are a self-employed worker (TNS).

3. When does your membership take effect and what is its duration?

Your membership takes effect on the date specified on your Membership Certificate. However, your care guarantees do not systematically intervene or may be limited if necessary. They may be subject to exclusions and/or limitations of guarantees. To know these, you just need to refer to the paragraphs “Exclusions” and “Limitations of guarantees” corresponding to each care guarantee.

Your membership is concluded for a duration of one year and renews by tacit renewal each year at the main due date. It is concluded between you and us as soon as you have signed the membership application (electronically or manually). From that date, and in the absence of teletransmission to another complementary health organization, teletransmission between your health insurance fund and us is mandatory. Membership can be terminated by you or by us according to the terms and conditions provided in the chapter “The life of your membership,” paragraph V.

4. What documents are provided to you and how is your membership materialized?

The acceptance of your membership is materialized by the sending of a Membership Certificate, the delivery of this Information Notice, and a third-party payment certificate mentioning in particular the identity of the insured persons. The table describing your guarantees is included in your Membership Certificate.

II. Care guarantees

1. What are the possible ranges?

To best meet your needs, Allianz offers you a range of health guarantees tailored to your needs:

• the Eco range to cover the essentials of your needs at a minimum,
• the Comfort range, declined in 4 base levels and complemented by 3 optional enhancements:
  • an enhancement dedicated to hospitalization called Serenity enhancement,
  • an enhancement dedicated to optical and auditory aids,
  • an enhancement dedicated to dental care.

In case of membership, the chosen enhancement(s) replace the corresponding guarantee(s) defined in the base.

Levels of service

Level	1	2	3	4
Bases	Hospitalization/routine care	H1	H2	H3
Optical	O1	O2	O3	O4
Auditory aids	O1	O2	O3	O4
Dental	D1	D2	D3	D4

Serenity (hospitalization)

Type of guarantee	Yes/No	Yes/No	Yes/No	Yes/No
Optical/Auditory aids	Yes/No	Yes/No	Yes/No	No
Dental	Yes/No	Yes/No	Yes/No	No

If an enhancement is chosen by one person, it applies only to that person.

The Premium range

Composed of 3 base levels and complemented by 2 optional enhancements:

• an enhancement dedicated to optical and auditory aids,
• an enhancement dedicated to dental care.

In case of membership, the chosen enhancement(s) replace the corresponding guarantee(s) defined in the base.

Levels of service

Type of guarantee	5	6	7
Bases
Hospitalization/routine care	H5	H6	H7
Optical	O5	O6	O7
Auditory aids	O5	O6	O7
Dental	D5	D6	D7
Enhancements
Optical/Auditory aids	Yes/No	No	No
Dental	Yes/No	No	No

If an enhancement is chosen by one person, it applies only to that person.

All insured persons under the same membership can join different ranges if they are of a similar type (responsible or non-responsible). For example, you can choose a guarantee from the Comfort range and your spouse prefers a guarantee from the Premium range. Conversely, your spouse cannot choose an Eco range if you want them to be on your membership.

Moreover, concerning children, they must have the same guarantees among themselves, including optional enhancement(s).

Care guarantees

2. What is the purpose of your guarantees?

They aim to reimburse you, in whole or in part, for health expenses remaining your responsibility after the intervention of your French Social Security, unless otherwise stated in your integrated benefits schedule in the Membership Certificate.

Our benefits are paid within the limits of actual expenses and are expressed:

• either as a percentage of the Reimbursement Base of Social Security (BR) and include the portion covered by health insurance,
• or in euros. In this case, they are added to any portion covered by health insurance.

The reimbursed health expenses must correspond to care received after the effective date of your membership, regardless of the date of onset of the illness.

Thanks to your membership, you also benefit from assistance services and guarantees. To know the details of these, quickly consult this chapter, paragraph VIII, and the chapter “Assistance guarantees” in this notice.

Allianz Health is a complementary health insurance offer. It is unsuitable for complementing the guarantees of a first complementary health insurance on certain care items (on complementary) or for intervening as a second complementary health insurance on all care.

3. What is the profile of your membership?

a. Responsible guarantees

Your membership meets the requirements of the responsible contract if you have joined the Comfort or Premium offer. This means that it complies with articles L871-1, R871-1, and R871-2 of the Social Security Code and includes the 100% health system.

Your guarantees and reimbursement levels will automatically follow any legislative and regulatory developments related to the responsible contract system that may occur subsequently.

As your membership is responsible, you can benefit from the advantages of the “Madelin Law” if you are a non-salaried non-agricultural worker.

b. A non-responsible guarantee

Your membership is non-responsible if you have joined the Eco range. You cannot therefore benefit from the advantages of the “Madelin Law” if you are a non-salaried non-agricultural worker. In this case, your membership does not include the 100% health system.

4. What is the territorial scope of your guarantees?

Your guarantees apply in metropolitan France as well as in Guadeloupe, Martinique, Guyana, Mayotte, and Reunion.

Outside of these territories:

• for care usually reimbursed by your Social Security, it must continue to cover them during your stay. We reimburse you according to the Medical Expenses incurred abroad and reimbursed by French Social Security indicated in your benefits schedule. Our reimbursements are always calculated based on the reimbursement base of French Social Security.
• for routine care not usually covered by your French mandatory scheme (example: implants, alternative medicine…), they are reimbursed as if they had been provided in metropolitan France, Guadeloupe, Martinique, Guyana, Mayotte, or Reunion. Note: their coverage is limited to the corresponding caps mentioned in your schedule.

In all cases, you must provide us with the detailed paid invoice. This must be translated into French, mention the acts performed, the amount of expenses incurred, and the portion remaining your responsibility.

For all scheduled acts abroad, you must send us a copy of the agreement from your French Social Security along with the elements allowing us to know the planned acts in order to calculate the amount of our reimbursement.

To be reimbursed by your Social Security for your health expenses for care abroad, simply log into your Ameli account online (tab “My procedures,” then select “Request a reimbursement for care abroad”).

II. Hospitalization

1. Your guarantees

To know your level of guarantee in hospitalization, you just need to consult the benefits schedule in your Membership Certificate referring to the “hospitalization” section.

2. Exclusions

Depending on the chosen range, the exclusions that apply are different.

a. The Eco range

Your membership does not cover expenses:

• not covered by your French Mandatory Health Insurance other than those mentioned in your Membership Certificate,
• related to stays in establishments not covered by the Hospital Law as identified in the National File of Health and Social Establishments (FINESS),
• related to stays in establishments covered by the Hospital Law and part of the categories of establishments named in the National File of Health Establishments as follows:
  • long-term care establishments,
  • medico-educational centers,
  • therapeutic workshops,
  • part-time therapeutic reception centers,
  • regional medico-psychological services,
  • post-cure centers for alcoholics,
• related to cures, except for thermal cures,
• related to stays in medico-social establishments, such as specialized reception houses (MAS), in medico-social services, or in accommodation establishments for dependent persons (EHPAD).

b. The Comfort and Premium ranges

Your membership does not cover:

• expenses not covered by your French Mandatory Health Insurance other than those mentioned in your Membership Certificate,
• expenses related to stays in:
  • long-stay units or centers (article L174-6 of the Social Security Code),
  • establishments and services that welcome elderly persons or provide them with assistance at home in daily acts of life, care services, or social integration assistance (article L312-1 I 6 of the Social Action and Families Code),
• the daily fee charged by medico-social establishments, such as specialized reception houses (MAS), in medico-social services, or by accommodation establishments for dependent persons (EHPAD).

3. Limitations of guarantees

a. Upon membership

Limitations of guarantees exist if you have chosen the Comfort range with the enhancement.

Serenity or Premium

In this case, your reimbursements are calculated at a different level than the one chosen. From the effective date of your guarantees and for a duration of 6 months, our coverage is limited.

16. CARE GUARANTEES

To know the applicable limitations, you just need to consult the table below:

Ranges	Guarantees
Comfort with Serenity enhancement	– Medical and surgical fees for a doctor who has adhered to a controlled pricing practice system: 220% BR – Medical and surgical fees for a doctor who has not adhered to a controlled pricing practice system: 200% BR – Stay expenses: 200% BR – Transport expenses: 200% BR – Private room: €80 (€40 if hospitalized in psychiatry or rehabilitation care)
Premium	– Medical and surgical fees for a doctor who has adhered to a controlled pricing practice system: 220% BR – Medical and surgical fees for a doctor who has not adhered to a controlled pricing practice system: 200% BR – Stay expenses: 200% BR – Transport expenses: 200% BR – Private room: €80 (€40 if hospitalized in psychiatry or rehabilitation care)

Your hospitalizations resulting from an accident occurring after the effective date of your guarantees are reimbursed immediately based on the level of guarantee chosen. No limitation applies.

No limitation applies for the Eco and Comfort ranges without the Serenity enhancement. Guarantees are therefore all effective from the effective date of your membership.

b. Throughout the duration of your membership

Depending on the chosen offer, your reimbursements are limited when you are hospitalized in a particular establishment. To know the type of establishment in which you are hospitalized, go to http://finess.sante.gouv.fr/jsp/rechercheSimple.jsp.

Refer to the following table to know your level of guarantee according to the establishment:

Type of establishment and/or service	Offers	Guarantees
Medico-social establishments	Comfort	– 100% BR – daily fee not covered – private room not guaranteed
	Premium	– 100% BR – daily fee not covered – private room not guaranteed
Center and medico-psychological services	Comfort	– 100% BR – full daily fee – private room not guaranteed
	Premium	– 100% BR – full daily fee – private room not guaranteed
Establishments, houses, centers, or units for follow-up and rehabilitation (SSR):	Comfort	– During the first 45 days (per insurance year and per insured) of hospitalization: – Guarantees of your membership – Daily fee: actual expenses – Private room: amount indicated on your benefits schedule From the 46th day of hospitalization: – 100% BR – Daily fee: actual expenses – Private room: not guaranteed
	Premium	– During the first 45 days (per insurance year and per insured) of hospitalization: – Guarantees of your membership – Daily fee: actual expenses – Private room: amount indicated on your benefits schedule From the 46th day of hospitalization: – 100% BR – Daily fee: actual expenses – Private room: not guaranteed
Centers or services specialized in the fight against mental illnesses, post-cure centers for mental patients, mental health care houses, crisis centers, or permanent reception centers.	Comfort	– During the first 45 days (per insurance year and per insured) of hospitalization: – Guarantees of your membership – Daily fee: actual expenses – Private room: amount indicated on your benefits schedule From the 46th day of hospitalization: – 100% BR – Daily fee: actual expenses – Private room: not guaranteed
	Premium	– During the first 45 days (per insurance year and per insured) of hospitalization: – Guarantees of your membership – Daily fee: actual expenses – Private room: amount indicated on your benefits schedule From the 46th day of hospitalization: – 100% BR – Daily fee: actual expenses – Private room: not guaranteed

17. CARE GUARANTEES

4. Your Santéclair advantages

With Santéclair, you enjoy the following services:

a. Ranking of hospital establishments

With this ranking, you access essential information to guide your choice towards the best hospital establishments (private or public) by specialty and location and anticipate your out-of-pocket expenses in case of surgical intervention. This ranking lists over 80 medical disciplines, including 52 surgical disciplines. This ranking provided by Santéclair is supplied by Le Point. The service allows access to the various quality indicators retained to constitute the overall score of the establishment. This service also indicates the estimated price of the level of fee overruns as well as the price of the private room (when known).

b. Hospitalization sheets

Thanks to this service, you have useful information throughout your hospitalization journey with practical advice to prepare for your stay, have the right reflexes during your hospitalization, or anticipate your discharge.

c. Online hospital quote analysis

You need to undergo a surgical procedure and want to know the amount of your out-of-pocket expenses left by the surgical, obstetric, or anesthesia fees? With the online quote analysis service, obtain a real-time analysis by entering the quote provided by your health professionals. Get an estimate of your out-of-pocket expenses on the fees as well as a comparison with the rates in your sector. Benefit from advice to discuss with your health professional and reduce your out-of-pocket expenses.

III. Routine care reimbursed by Social Security (excluding optical and dental)

1. Your guarantees

To know the level of guarantee for your routine care (example: general practitioner consultation, medical auxiliaries…), refer to the “routine care” section and the sub-sections “Paramedical fees, Medical fees, Laboratory analyses and examinations, Medications, Medical equipment (excluding optical and auditory), Transport expenses, and Thermal cures” in the benefits schedule in your Membership Certificate. Moreover, we reimburse psychological support covered by your Social Security. These sessions are covered within the limits provided in article R162-65 of the Social Security Code. They must be performed by a psychologist contracted with the health insurance. For more information, visit https://www.ameli.fr. Your guarantees are effective from the effective date of your membership as no limitation of guarantee or waiting period applies.

2. Exclusions

Your membership does not cover:

• Expenses for care not covered by your French mandatory health insurance other than those mentioned in your Membership Certificate.
• The flat-rate participation of €2 (value as of January 1, 2025) and medical franchises on boxes of medications, paramedical acts, health transports.
• The increase in the co-payment and fee overruns if health expenses are incurred outside the care pathway.
• Fee overruns beyond the limit set by regulation for doctors not adhering to a controlled pricing practice system.

(1) Services provided by Santéclair and the participation of its partners. List of partners available in your client area (My procedures/find a doctor, optician ...).

3. Your Santéclair advantages

With Santéclair, you enjoy the following 3 services:

a. City medicine

Via the geolocation tool of Santéclair in your client area, you can easily access the...

following information:

• location of general practitioners or specialists near your residence or workplace,
• their consultation rates,
• making appointments online or by phone.

b. Symptom analysis and orientation(1)

This service is a digital tool designed by doctors, allowing you to get a first idea of the cause of your symptoms in complete confidentiality in just a few clicks.

• an opinion rendered in minutes with a summary of possible causes,
• obtain clear information on how to act: stay at home, consult a doctor, or go to the emergency room,
• you are directed to the most suitable Santéclair services for your situation.

c. Teleconsultation(1)

This service allows you to consult online without fees (2) via video from your phone or computer with a general practitioner or specialist. These doctors, based in France, are accessible 7 days a week and 24 hours a day. You thus obtain a medical opinion very quickly. At the end of the consultation and according to your needs, the doctor can:

• direct you to recommended establishments,
• write a complete report that you can then send to your doctor if you wish,
• prescribe a prescription and thus access reimbursable medications.

IV. Optical

1. Your guarantees

To know your level of guarantee in optics, you just need to consult the benefits schedule in your Membership Certificate and refer to the “optics” section. Your guarantees are effective from the effective date of your membership as no limitation of guarantee or waiting period applies.

2. Exclusions

Your membership does not cover expenses for care not covered by your French Mandatory Health Insurance other than those mentioned in your Membership Certificate. Within the framework of responsible contracts, there are conditions for renewing your equipment(3). The maximum reimbursement, per insured person, is limited to one equipment (frame + lenses) per period of 2 years (except for insured persons under 16 years old and in case of significant vision changes or in case of particular medical situations for those 16 years and older) with a reimbursement ceiling for the frame at €100. The date retained for calculating the renewal is the date of purchase of your equipment.

3. Your Santéclair advantages

You benefit from Santéclair partner health professionals consisting of:

• opticians,
• refractive surgery centers,
• ophthalmology centers,
• online lens purchases.

(1) Services provided by Santéclair and the participation of its partners. List of partners available in your client area (My procedures/find a doctor, optician...).
(2) Teleconsultation without fees outside of the flat-rate participation of two euros deducted from your next reimbursements made by health insurance.
(3) Source: https://www.ameli.fr/assure/remboursements/rembourse/soins-protheses-dentaires-optique-audition/lunettes-lentille.

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a. The optical network

Santéclair partner opticians can, depending on the level of guarantee chosen, allow you to benefit from “network” supplements, mentioned in your benefits schedule. To take advantage of this, simply go to a Santéclair partner health professional and request the corresponding benefits. To know the Santéclair partners, it’s simple. You can:

• call Santéclair at 0 970 809 815 (non-premium call),
• use the geolocation tool of partners in your client area.

Your advantages:

• preferential rates on lenses from 4 major brands with partner opticians (in free basket),
• up to -20% discount on frames from the free basket (1) and maximum rates on lenses,
• 15% discount on all other products: sunglasses even from major brands (2), lens products, accessories, low vision equipment.

And many other advantages...

• Santéclair also allows you to benefit from the analysis and pricing advice service on your quotes,
• third-party payment: no advance payment.

b. The offerclair

Offerclair is offered by all Santéclair partner opticians. With this offer, and within the framework of the 100% health system, you benefit from equipment with Nocle frame Origin France Guaranteed (choice of 80 frames) and 2 lenses from 4 major brands (Essilor, Nikon, Optiswiss, and Zeiss) thinned (according to the need for visual correction) scratch-resistant and anti-reflective.

c. Online lens purchase(3)

This service allows you to find your lenses online and make savings on your lens renewals. With Santéclair, you benefit from a 5% discount on your order (4) and third-party payment (5).

d. Refractive surgery centers

You benefit from centers specialized in laser eye surgery, with preferential rates on various cutting-edge techniques, for operations for myopia, astigmatism, hyperopia, or presbyopia. Post-operative care is included in preferential rates. Santéclair also allows you to benefit from the analysis and pricing advice service on your quotes.

e. Ophthalmology centers

You benefit within Santéclair partner centers:

• guarantee of appointments in less than 2 weeks and possible up to 48 hours (6),
• making appointments online or by phone in your client area via the Santéclair partner location tool,
• a complete assessment of your visual health with a prescription for your glasses and/or lenses (adult or child) if necessary.

f. The glasses support program

Thanks to this system, Santéclair:

• regularly sends you practical advice to support and inform you before, during, and after your glasses purchase;
• reminds you of the benefits you enjoy with their partner opticians in relation to your specific needs;
• helps you better understand your visual defect.

(1) Frames valued over €30 and up to €100: a 10% discount is applied to the displayed price. Frames valued over €100: a 20% discount is applied to the displayed price.
(2) Without correction, except in special conditions in-store.
(3) Services provided by Santéclair and the participation of its partners. List of partners available in your client area.
(4) Subject to the issuance of a coverage agreement. The discount does not apply to shipping costs.
(5) Depending on the guarantees provided by your complementary health insurance contract and subject to the issuance of a coverage agreement.
(6) Survey conducted on 21/06/2021.

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V. Hearing aids

1. Your guarantees

To know your level of guarantee, you just need to consult the benefits schedule in your Membership Certificate and go to the “Hearing aids” section. Your guarantees are effective from the effective date of your membership as no limitation of guarantee or waiting period applies.

2. Exclusions

Your membership does not cover expenses for care not covered by French Social Security, other than those mentioned in your Membership Certificate. Within the framework of responsible contracts, there are conditions for renewing your equipment(1). The maximum reimbursement is limited to one device per ear per period of 4 years. The amount of reimbursement for a class 2 device (excluding 100% Health) is capped at €1,700 per ear as of January 1, 2024, including Social Security reimbursement.

3. Your Santéclair advantages

With Santéclair, you benefit from partner audioprothesists and enjoy:

• preferential rates on hearing aids,
• 20% discount on batteries,
• 10% discount on listening devices, maintenance products, earplugs, and accessories (remote control, TV headset, battery charger…),
• in case of hearing aid failure within 4 years of purchase, the hearing aid is repaired or exchanged (identical or equivalent) if it cannot be repaired, without deductible,
• you also enjoy a 30-day trial period. Beyond the trial period, you have a “satisfaction or exchange” guarantee valid for one month after purchase. If you are unsatisfied within one month after the trial period, you can change your equipment,
• other privileged services are also offered such as fitting follow-up. The audioprothesist checks, adjusts, and maintains the hearing aids after purchase throughout the device's lifespan, as many times as necessary and at no additional cost,
• the Santéclair advantage: quality equipment at exceptional rates tailored to your needs. Santéclair also allows you to benefit from the analysis and pricing advice service on your quotes.
• third-party payment: no advance payment.

VI. Dental

1. Your guarantees

To know your level of guarantee in dental care, refer to the “dental” section in the benefits schedule in your Membership Certificate. Your guarantees are effective from the effective date of your membership as no limitation of guarantee or waiting period applies.

2. Exclusions

Your membership does not cover expenses for care not covered by your French Mandatory Health Insurance other than those mentioned in your Membership Certificate.
(1) Source: https://www.ameli.fr/assure/remboursements/rembourse/soins-protheses-dentaires-optique-audition/lunettes-lentille.

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3. Your Santéclair advantages

Partner dentists

Thanks to Santéclair partner health professionals in dentistry, you benefit from quality care and equipment at preferential rates:

Dentists

• More than 3,000 general dentists and orthodontists spread across France,
• preferential rates for the most frequent acts at free prices (prosthesis/orthodontics),
• guarantee of compliance with the Limit Billing Fees by partners,
• systematic practice of third-party payment.

Qualified dentists in dental implantology

• Nearly 90 rigorously selected dental implantology offices for their practice in implantology and their high-quality technical platforms,
• up to -30% compared to average prices usually charged outside the Santéclair network on all implantology acts (1),
• a Traceability Certificate indicating the origin of the implant, pillar, and prosthesis provided upon request,
• a network controlled by our team of health professionals,
• systematic practice of third-party payment.

Invisible orthodontics network for adults

• Santéclair partner dentists guarantee quality service at preferential rates for this treatment,
• the semester of invisible adult orthodontics up to 40% savings compared to average prices per aligner for all treatment durations (2),
• a telephone platform open 6 days a week for any information,
• systematic practice of third-party payment.

Non-partner dentists

Dentists performing specific acts

Thanks to Santéclair, you benefit from:

• an enriched directory of qualified dentists performing specific acts:
  • endodontics (treatment of pathologies inside the tooth),
  • periodontics (treatment of the supporting tissues of the tooth),
  • pedodontics (dental care for children),
  • wisdom tooth surgery;
• dentists qualified in orthodontics, in addition to those already partners of Santéclair, offering moderate prices (fees charged less than or equal to the average market price (around €1,000 per semester of orthodontics for all techniques and durations) (3);
• online appointment booking for practitioners offering this feature;
• a geolocation tool allowing you to find these dentists near you. This directory includes over 2,600 dentists.

Do you have a quote from your dentist? Santéclair advisors analyze your quotes to ensure the accuracy of the proposed rates based on the situation and the rates usually charged. Santéclair controls and ensures compliance with the limit billing fees for the acts concerned by the 100% health system. You receive a response within 72 working hours with alternative solutions to reduce your out-of-pocket expenses and a summary letter containing your reimbursement estimates.

(1) Study conducted by Santéclair on analyzed quotes from January 1, 2022, to December 31, 2022. Comparison of strictly identical acts and materials.
(2) Study conducted by Santéclair on analyzed quotes from June 1, 2021, to May 31, 2022.
(3) Study conducted by Santéclair based on analyzed quotes from April 1, 2019, to June 30, 2020, and the rates mentioned by practitioners themselves on their websites.

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22 CARE GUARANTEES

2. Your Santéclair advantages

With Santéclair, find osteopaths and chiropractors (partners or non-partners of Santéclair) near you:

• 370 rigorously selected partner osteopaths and chiropractors for their competence and training,
• quality at preferential prices: up to 15% discount compared to the average market price on sessions, with partners recommended for their training and experience (1).

Santéclair also offers access to an enriched directory of 1,000 naturopaths and over 1,000 recommended sophrologists, recognized by the profession for the quality of their training and validation of professional competence. Practical information for booking a consultation: average observed rates, online appointment booking possible…
(No pricing advantage with these practitioners).

Access to dietitians, selected for the quality of their advice, near you.

• More than 200 rigorously selected partner dietitians for their competence and training,
• quality at price.

VIII. Services you are entitled to

Thanks to your Care guarantee, you have access to several services.

1. Santéclair

In addition to those already detailed in previous chapters, you also benefit from the advantages and services described below. To enjoy all these benefits, simply go to your client area allianz.fr or contact Santéclair at 0970 809 815.

a. Santéclair partner health professionals

Thanks to Santéclair, you benefit from quality care and services at preferential rates with over 8,500 Santéclair partner health professionals. You benefit from preferential rates with:

• opticians,
• dentists and orthodontists,
• dentists qualified in dental implantology,
• laser eye surgery centers,
• audioprothesists,
• liberal dietitians,
• osteopaths and chiropractors.

(1) Compared to prices charged by a sample of health professionals referenced by Santéclair not belonging to the network. Study conducted in March 2022 by Santéclair comparing prices charged by partner professionals in the network to prices charged by this sample.

b. Quote analysis service

Thanks to Santéclair, you benefit from a free quote analysis service in the fields of optics, auditory, dental, surgical, and obstetric. Santéclair specialists indicate the amount that will remain your responsibility and whether the rates are consistent with those practiced in your region. Via your client area, submit your quote. An advisor will get back to you within 72 hours. For dental and surgical quotes, you can enter your quote yourself and receive an immediate response.

c. Home nurses(1)

Santéclair provides you with a service to connect with nurses for home care (dressing changes, vaccinations, assistance with bathing and dressing for you or your loved ones). With this service, you can:

• find a state-certified nurse near your location,
• be directly connected with a state-certified nurse with at least 2 years of practice,
• quickly and easily schedule an appointment for care on the same day,
• submit a care request and be contacted within the hour by a nurse for the management of your request,
• benefit from third-party payment on care contracted by health insurance.

d. Self-medication guide

With this tool, you can practice self-medication with peace of mind thanks to professional advice on all the minor ailments of everyday life. You will find nearly 1,800 over-the-counter medications referenced and rated according to their effectiveness and tolerance, as well as the indication of the average selling price in pharmacies.

e. Second opinion(1)

If you are faced with a serious health problem (serious, rare, or disabling disease) that requires a decision, if you need reassurance, to make the right choice for yourself or your loved ones. This service allows you to obtain a new analysis of your diagnosis in less than 7 days, by a specialist doctor based on your medical file. This service allows you:

• to access more than 300 recognized specialist doctors nationally or even internationally,
• to benefit from a secure and confidential space for the transmission of your medical file and access to the medical opinion,
• to access more than 700 covered pathologies: orthopedic, cardiovascular problems, endometriosis, infertility, oncology,
• to benefit from a telephone assistance to help you with your procedures.

f. Nutrition coaching(1)

To help you lose weight, this service allows you to regain your food (body) sensations and take a step back from your emotions with:

• a personalized program with food learning allowing you to regain sensations and lose weight sustainably,
• a tailor-made sports coaching program to maintain your fitness,
• support from psychologist and nutritionist coaches,
• access to community spaces (chats, blogs, or forums with experts and other insured persons...),
• a method based on the emotional management of eating through Cognitive Behavioral Therapy (CBT) and intuitive eating.

g. Sleep coaching(1)

You benefit from a program to quickly regain sleep. The services offered are:

• a personalized program carried out by specialist therapists to regain sleep naturally in 3 months,
• adapted exercises with relaxation techniques and emotional management to be calm at bedtime,
• support from coaches specializing in sleep behavior,
• access to community spaces (chats, blogs, or forums with experts and other insured persons...).

h. Sports coaching(1)

This service allows you to find a sports coach to introduce you to a sport, get back in shape, maintain your well-being, or increase your sports performance, including in the context of a chronic illness. With this service, you:

• benefit from the geolocation of coaches around you and visualize the sports activities offered among more than 15 disciplines,
• choose the course formula that suits your needs: individual or semi-collective courses, at home, outdoors, or via video with a wide range of hours,
• enjoy a 5% discount on courses regardless of the chosen formula and an additional 20% discount on video courses with the code LIVE.

i. “Feeling good in my head” service

Whatever the need, Santéclair supports you with 6 “Feeling good in my head” solutions. This service is included in your membership.

• Symptom analysis and health orientation tool: Innovative tool allowing you to evaluate the symptoms that worry you in just a few clicks, suggesting probable causes and guiding you towards the appropriate services/professionals.
• Start a video consultation with a psychologist 24/7(1): Allows you to consult a psychologist online without fees (2) via video from your home.
• Discover the best psychiatric hospital services(1): You can access the ranking of psychiatric hospital services near you.
• Get coached on my well-being(1): You can benefit from personalized support to regain a good physical, mental, and emotional balance.
• Find a psychologist (1): Tool allowing you to easily find a psychologist through a reference of 18,000 qualified practitioners (3).
• Find a psychiatric emergency service: In case of crisis or severe disorders, you can access a directory listing the nearest psychiatric emergencies.

To benefit from the “Feeling good in my head” service, simply access your client area and click on “Access my services: teleconsultation with a doctor, mental health…”. You will then be redirected to the Santéclair portal and can choose the solution that meets your need.

2. Your client area

On our site www.allianz.fr, you have a client area that allows you to:

• consult your reimbursements,
• receive an email alert for each reimbursement,
• request a health quote analysis (commitment to coverage within 72 hours, or even immediate for dental and surgical quotes),
• request a reimbursement,
• access the history of your reimbursements.

our letters (example: health statements, Madelin tax certificate for TNS) thanks to the e-mail service,
– download and print your third-party payment certificate,
– update your contact details,
– access all the services set up in partnership with Santéclair, by clicking on “Access my services: teleconsultation with a doctor, mental health,”
– restore the teletransmission of your statements.

(1) Services provided by Santéclair and the participation of its partners. List of partners available in your client area.
(2) Outside of the flat-rate participation of two euros deducted from your next reimbursements made by health insurance.
(3) No preferential rates and paid consultation in the case of a session in the office.

CARE GUARANTEES

The life of your membership

I. Your obligations

1. What are your obligations?

You commit to us:
– pay your annual ADPS statutory contribution and your insurance contributions by the deadlines agreed upon between us. In case of non-payment, the legal provisions regarding suspension and termination of the guarantee apply (article L113-3 of the Insurance Code),
– return your third-party payment certificate, in case of renunciation, denunciation, or termination of your membership. Any abusive use of the third-party payment card exposes its author to a recovery action, and where applicable to legal proceedings.

And also, to inform us of the following events:
– change of address,
– modification of your family composition (birth, marriage, death),
– change of situation regarding the French mandatory health and maternity schemes,
– change of profession. In this case, you must provide us with the necessary documents to modify your membership. This change may in some cases lead to a modification of your membership and contribution,
– intention to stay abroad for more than a year,
– requests for benefits following an accident involving the responsibility of a third party,
– benefit from a guarantee of the same nature as that insured by this membership, subscribed individually or in a collective framework.

Your declarations must reach us, by registered letter, within fifteen days following your knowledge of any of these events. If the absence or delay of declaration causes us harm, we may invoke the forfeiture of guarantees and not proceed with the compensations provided (article L113-2 of the Insurance Code).
In case of aggravation of risk, related to one of these events and independent of your health status, we offer either an increase in contribution or the termination of your membership.
In case of risk reduction, we offer a decrease in your contribution.

2. What are the consequences of a false declaration?

You must provide...