Carrying out two professional activities at the same time, each covered by a social security system, is a fairly common situation. However, for those concerned, it still raises questions: to which scheme should the contributions be paid? Which will reimburse health expenses? Cocoon, the TNS mutual insurance company , tells you all about double affiliation to the Health Insurance .
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What is dual health insurance affiliation?
Dual affiliation to Health Insurance is the fact of being attached to two distinct Social Security schemes due to the exercise of several professional activities, each falling under a particular scheme. This may be, for example, an individual who is both self-employed and salaried or a civil servant and self-employed worker…
This accumulation of statuses has a name: polyactivity (or pluriactivity). In this case, you should know that the insured must contribute to both schemes, although for his health costs, he will only be covered by one.
With regard to the case of the TNS, which exercises a salaried activity at the same time, we continue to speak of dual affiliation to health insurance despite recent developments concerning the management of the social system for the self-employed, gradually entrusted to the general system: it remains polyactive, but within the same entity.
How to determine the main scheme for health costs?
In the event of dual affiliation to Health Insurance, by default, the main scheme is the one to which the insured was subject on the date on which the situation of multiple activities began. If the insured started his self-employed activity first, this is deemed to be the main activity. If the insured is an employee and subsequently creates his own business, his status as an employee prevails for the management of his health insurance scheme.
It is the scheme designated as the principal which manages the right to sickness and maternity benefits in kind and which then proceeds to the Social Security reimbursements of healthcare expenses. Of course, the general scheme for an employee (or a self-employed since January 1, 2019 ) and the social scheme for the self-employed (for a self-employed worker registered before January 1, 2019 ) provide the same benefits in kind .
Exercise your right of option to choose your healthcare plan
Regardless of the default main regime, it is quite possible to choose the desired main connecting regime. Thus, a self-employed person registered before January 1, 2019 who exercises a salaried activity can decide to come under the general scheme for his health costs by asserting his right of option .
All they have to do is send the dedicated right of option form to the CPAM of their place of residence, with the supporting documents requested. The change then takes effect from the 1st day of the second month following receipt of the request. The new scheme designated to cover health costs will manage all benefits, including the payment of daily allowances in the event of illness or maternity.
Once the main plan has been chosen, it is preferable to take out complementary health insurance plans to better cover the expenses incurred.
There are a few things to keep in mind if you have dual coverage:
- You will still be responsible for two premiums and two deductibles.
- Your secondary insurance will not pay toward your primary‘s deductible.
- You may also owe other cost sharing or out-of-pocket costs, such as copayments or coinsurance.
- Even if you have multiple health insurance policies, plan rules still apply. For example, if you’re in a PPO (Preferred Provider Organization) plan, your primary policy may have provider network rules.
If you’re considering getting dual coverage, it’s important to talk to your insurance company to understand how it will work and what your responsibilities will be. You should also make sure that both of your plans are ACA-compliant, so that you’re protected by the law.
Here are some reasons why you might want to have dual coverage:
- You may be able to get better coverage for certain services or conditions.
- You may be able to lower your out-of-pocket costs.
- You may be able to get coverage for services that your primary plan doesn’t cover.
If you’re considering getting dual coverage, it’s important to weigh the pros and cons carefully. Talk to your insurance company and your doctor to get more information and make the best decision for you.