詞彙表

Accident

An involuntary bodily injury caused by factors and events independent of the will of the insured.

Adherent

Person signing the membership form and designated as the holder of the insurance policy. The subscriber is not always the insured or the beneficiary.

Affiliation

Attachment of a social insured to a body responsible for social benefits. All people living in France are affiliated to a social protection scheme.

Annee d'Assurance

Period of twelve consecutive months starting from the effective date of the contract (also called the anniversary date of the contract).

Attestation d'Assurance

Document given to the Adherent confirming their membership to the insurance contract. Also called insurance certificate.

Avenant

Any modification made to the initial contract.

Ayant Droit

Member of the principal insured's family. They can benefit from the guarantees taken out by the principal insured and are covered by the same policy.

Base de Remboursement

Rate used as a basis for reimbursement by the compulsory scheme of fees and care provided by all health professionals.

Beneficiaire

Person designated on the insurance attestation of the insurance policy. Beneficiaries can receive the benefit of the contract's guarantees.

Caisse des Francais de l'Etranger

Organisation that provides social security for French citizens living abroad. You can affiliate within three months of leaving France.

Chambre Privee

During hospitalisation, health establishments can offer the patient a private room. Its cost varies depending on the establishment.

Coassurance

Percentage of costs indicated in the guarantee table that the beneficiary must pay in order to be reimbursed.

Complementaire CFE

International social coverage that completes the basic coverage taken out with the Caisse des Francais de l'Etranger.

Condition Preexistante

Medical condition that manifested itself before the date of signature of the membership application.

Cotisation

Sum paid regularly to the insurer, in exchange for partial or full coverage of the health expenses of the policy's beneficiaries.

Courtier

Insurance specialist, independent of insurers, whose vocation is to help an individual choose and subscribe to the contract that best suits them.

Date d'Effet

Date from which the contract begins. It is indicated on the insurance attestation/certificate.

Date de Renouvellement

The renewal date is generally the anniversary date of the contract. Some contracts are renewed tacitly while others can only be renewed with the explicit agreement of the subscriber.

Demande de Remboursement

Request made by the insured so that the insurer can cover the health costs provided for in the insurance policy.

Delai de Carence

Period during which the beneficiary is not yet covered by the health insurance contract or only for certain guarantees.

Entente Prealable

Prior obtaining of the insurer's agreement necessary before incurring certain types of care or services.

Evacuation et/ou Rapatriement

Act of moving the insured person to another hospital with the necessary medical facilities, either in the country or in a neighbouring country, or bringing the insured person back to their principal country of residence.

Exclusion

All events that are not guaranteed by the insurance contract are considered as exclusions. These exclusions can be general or specific.

Frais Reels

Amount actually spent on care. When the guarantee table indicates that beneficiaries are reimbursed at 'frais reels', it means the total amount spent on care is reimbursed.

Franchise

Part of the medical expenses that the adherent has agreed to pay themselves. All expenses above this franchise will be reimbursed by the insurer.

Hospitalisation

Any stay of more than one night in a public or private care establishment when the purpose of this stay is observation, medical or surgical treatment.

Hopital

Establishment approved by the competent medical authorities of the country or territory in which it is located.

Indexation/Inflation

Adjustment by the insurer of the level of coverage based on medical inflation and the evolution of medical care consumption.

Lettre de Garantie

Formal agreement sent by the insurer to the healthcare establishment, aimed at guaranteeing coverage of medical costs. The insurer reimburses the healthcare establishment directly.

Maladie Chronique

Health condition or disease whose effects are persistent or long-lasting, or a disease that comes with time and requires long-term monitoring.

Maladie Inopinee

Any alteration of health noted by a competent medical authority presenting a sudden and unforeseeable character.

Maternite

Linked to maternity guarantees: the state of pregnancy, interruption of pregnancy, childbirth, postnatal care and the pathological complications of these events.

Medecines Complementaires

Practices not habitually considered as part of conventional medicine. For example, acupuncture, homeopathy, naturopathy, osteopathy, chiropractic, etc.

Pays de Nationalite

Country of issue of the passport and of which the individual holds citizenship.

Pays de Residence

Country where the insured lives for at least six consecutive months of the year.

Police d'Assurance

Contractual document that sets the terms of the insurer's commitments to the insured or a group of insured. It is proof of the contract between the insurer and the insured.

Portabilite

International health coverage plan that insured persons can keep and renew even in the event of a change of country or territory of residence.

Questionnaire de Sante

Series of questions about the beneficiary's health, requested by the insurer before validating the health coverage subscription application.

Responsabilite Civile

Insurance that covers the costs of the insured when they cause bodily, material or immaterial damage to others.

Resiliation

When the insured, the employer or the insurer decides to terminate the insurance policy.

Soins Ambulatoires

A treatment or intervention provided in a doctor's, therapist's or specialist's office that does not require hospitalisation.

Tableau des Garanties

Document detailing the care and services from which insured persons benefit under the insurance policy.

Tiers Payant

Mechanism allowing the insured to be exempt from advancing costs, taken care of by the health insurance scheme and the complementary health insurance.

Traitement de Jour

Planned treatment carried out in a hospital or care establishment during the day and which does not require the patient to spend the night.

Transfert

When the insured designates in writing another broker to advise and represent them with insurers. This has no impact on the insurance policy.

Urgence

Serious medical event, such as illness or bodily injury, requiring immediate attention.

Zone de Couverture

Country or part of the world in which beneficiaries are covered by the insurance policy.