Attachment_B-2_Medical_Coverage_-_CSR_with_English_Translation.xlsx
XLSX spreadsheet 21 KB Posted
- Solicitation number
- SFR63016R0011
- Issued by
-
Department of State US Embassy Paris
About this file
RFP Health Insurance
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_F_-_Statistic_Report_of_Incumbent_Contractor-PREVOYANCE.pdf | ||
| Attachment_A-Medical_Pricing-Categories_A_and_B.xlsx | XLSX spreadsheet | |
| Attachment_E-Staff_Statistics_-_Unclassified_Information.xls | XLS spreadsheet | |
| Attachment_F_-_Statistic_Report_of_Incumbent_Contractor-HEALTH.pdf | ||
| Attachment_C-Prvoyance_Pricing.xlsx | XLSX spreadsheet | |
| Attachment_B-1_Medical_Coverage_-_Social_Security_with_English_translation.xlsx | XLSX spreadsheet | |
| Attachment_A-1-Medical_Pricing-Categories_C_and_D.xlsx | XLSX spreadsheet | |
| RFP_Health_Insurance-Final.docx | DOCX document | |
| Attachment_D-Prvoyance_Coverages_-_SS_and_CSR_w_Translation.xlsx | XLSX spreadsheet |
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Text version
B-2 CSR Medical
| ATTACHMENT B-2 GARANTIES FRAIS MÉDICAUX |
| SALARIÉS NON AFFILIÉS AU RÉGIME GÉNÉRAL DE LA SÉCURITÉ SOCIALE FRANÇAISE |
| RÉGIME AU PREMIER EURO |
NATURE DES FRAIS OPTION DE BASE OPTION HAUTE
| Hospitalisation Médicale & | conventionné | non conventionné | conventionné | non conventionné |
| Chirurgicale | ||||
| Frais de séjour | 200%TC | 200%TC | 300%TC | 300%TC |
| Honoraires | 200%TC | 200%TC | 300%TC | 300%TC |
| Urgences Médicales | 200%TC | Néant | 200%TC | Néant |
| Forfait hospitalier | GARANTI | GARANTI | GARANTI | GARANTI |
| Frais de chambre particulière | NON | NON | 2.20% PMSS | 2.20% PMSS |
| Transport en ambulance | 100%TC | Néant | 100%TC | Néant |
| (si remboursé par la Sécurité Sociale) |
| Actes Médicaux | conventionné | non conventionné | conventionné | non conventionné |
| Visites, Consultations | 150%TC | Néant | 300%TC | Néant |
| Auxiliaires Médicaux | 150%TC | Néant | 300%TC | Néant |
| Frais de Radiologie | 150%TC | Néant | 300%TC | Néant |
| Analyses | 150%TC | Néant | 200%TC | Néant |
| Traitement psychiatrique (1) | 150%TC | Néant | 150%TC | Néant |
| Soins dentaires (2) | 100%TC | Néant | 200%TC | Néant |
Frais Pharmaceutiques 100%Tarif de Convention 100% Tarif de Convention
| Prothèses dentaires acceptées | ||
| ou refusées par la Sec. Soc. (2 et 3) | 100%TC | 300%TC |
| Orthodontie acceptée par la Sec. Soc. | ||
| (enfant de moins de 16 ans ou traitement | 150%TC | 200%TC |
| commencé avant l'age de 16 ans | ||
| Chirurgie dentaire d'urgence liée à un | ||
| accident | 100%TC | 300%TC |
Prothèses auditives 150%TC 150%TC
| Orthopédie et prothèses autres | ||
| qu'auditives et dentaires | 150%TC | 300%TC |
| Optique | ||
| Verres + montures de lunettes | 5% PMSS par bénéficiaire sur période de 12 mois | 15% PMSS par bénéficiaire sur période de 12 mois |
| Lentilles acceptées ou refusées par | ||
| la Sécurité Sociale | 5% PMSS par bénéficiaire sur période de 12 mois | 10% PMSS par bénéficiaire sur période de 12 mois |
Kinésithérapie 150%TC 200%TC
| Maternité (3) | ||
| Forfait | 915 € minimum dans la limite de 2 287 € | 915 € minimum dans la limite de 2 287 € |
| Fausse couche | 150%TC | 150%TC |
| Enfant mort né (si déclaré) | 1 524 € maxi dans la limite des frais réels | 1 524 € maxi dans la limite des frais réels |
| Avortement | aucune prestation | aucune prestation |
Dépenses à l'étranger (4) 150%TC dans la limite des frais réels 150%TC dans la limite des frais réels
| (1) Hors hospitalisation |
| (2) Le remboursement des prothèses dentaires est limité à 100% du PMSS par an et par bénéficiaire |
| (3) Délai de carence : un an d'ancienneté |
| (4) Aucun remboursement ne sera effectué pour les frais médicaux à l'étranger, dans un pays n'ayant aucun accord ou d'échange |
| de ce type en France ou dans un pays pour lequel le régime de la Sécurité sociale francaise n'effectue aucun remboursement. |
Please refer Section C.1.2 for abbreviations cited in this document
Solicitation: S-FR630-17-R-0013 Page: &P of &N
B-2 CSR Medical (English)
| ATTACHMENT B-2 MEDICAL COVERAGE BENEFITS |
| EMPLOYEES NOT AFFILIATED WITH THE FRENCH SOCIAL SECURITY |
| RÉGIME AU PREMIER EURO |
TYPE OF COSTS BASIC OPTION HIGH OPTION
| Hospitalisation Medical & | conventioned | non conventioned | conventioned | non conventioned |
| Surgical | ||||
| Stay in Hospital | 200%TC* | 200%TC | 300%TC | 300%TC |
| Honorarium/fees | 200%TC | 200%TC | 300%TC | 300%TC |
| Emergency Treatment | 200%TC | N/A | 200%TC | N/A |
| Hospital Charge | Covered | Covered | Covered | Covered |
| Private Room | NON | NON | 2.20% PMSS** | 2.20% PMSS |
| Ambulance transport | 100%TC | N/A/ | 100%TC | N/A |
| (if reimbursed by the SS) |
| Medical Treatments | conventioned | non conventioned | conventioned | non conventioned |
| Visits, Consultations | 150%TC | N/A | 300%TC | N/A |
| Auxillary Medical Personnel | 150%TC | N/A | 300%TC | N/A |
| Radiology | 150%TC | N/A | 300%TC | N/A |
| Analyses | 150%TC | N/A | 200%TC | N/A |
| Psychiatric treatment (1) | 150%TC | N/A | 150%TC | N/A |
| Dental treatment (2) | 100%TC | N/A | 200%TC | N/A |
Pharmaceutical/Prescription Drugs 100%TC 100% TC
| Dental prostheses accepted or | ||
| or refused by the SS (2 et 3) | 100%TC | 300%TC |
| Orthodontic treatment accepted by SS | ||
| (child of less than 16 years or older if | 150%TC | 200%TC |
| treatment commenced before 16 years | ||
| Emergency dental surgery associated | ||
| with acccidents | 100%TC | 300%TC |
Hearing Aids 150%TC 150%TC
| Orthopedic prostheses and prostheses | ||
| other than hearing and dental | 150%TC | 300%TC |
| Optical | ||
| Eyeglasses and frames | 5% PMSS per individual during 12 months | 15% PMSS per individual during 12 months |
| Lenses accepted or refused | ||
| by the SS | 5% PMSS per individual during 12 months | 10% PMSS per individual during 12 months |
Physiotherapy 150%TC 200%TC
| Maternity/Obstetrics (3) | ||
| Fixed Sum | 915 € minimum and not to exceed 2 287 € | 915 € minimum not to exceed 2 287 € |
| Miscarraige | 150%TC | 150%TC |
| Stillborn child (if reported) | actual expenses only - not to exceed 1 524 € | actual expenses only - not to exceed 1 524 € |
| Abortion | Not covered | Not covered |
Overseas expenses (4) 150%TC but limited to expenses incurred 150%TC but limited to expenses incurred
| (1) Out-patient |
| (2) Reimbursement for dental care and prostheses is limited to 100% of the PMSS (see C.1.2 of RFP) per year and per individual |
| (3) Eligibility: after one year of service |
| (4) No reimbursements will be made for medical expenses incurred in a country having no agreement or exchange |
| with France or in a country where the French SS does not effect reimbursements |
| Please refer Section C.1.2 for abbreviations cited in this document |
Solicitation: S-FR630-17-R-0013
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