Yes, since January 1st, we have all been a little confused by this famous “100% Health” reform! As a reminder, this reform allows all French citizens to access quality healthcare, fully covered by Social Security and their health insurance (optical care, dental care and hearing aids).

Warning: this does not mean that all services offered by these professionals are reimbursed at 100%.

You feel like it’s time to change your glasses, but you don’t know if you will be covered?

Let us help you see things more clearly when it comes to optical reimbursement in 2020!

Prescription from your ophthalmologist

First of all, let’s talk about prescriptions. It is not possible to get your glasses reimbursed by Social Security or your health insurance without a valid prescription. Okay, but how do you know if your prescription is still valid?

Under 16 years old:

For children under 16, the prescription is valid for only 1 year. It can only be used once with an optician. If an ophthalmologist notices a change in your vision during the year following your last purchase, they will issue a new prescription. In this case, you will be covered by Health Insurance. Regarding your health insurance, there is no guaranteed reimbursement, as it depends on your insurance contract.

Over 16 years old:

• For people aged between 16 and 42, the prescription is valid for 5 years.
  
  

• For people over 42, the prescription is valid for 3 years.
  
  

For all these people, it is possible to reuse their prescription and be covered several times. Be careful, there are certain conditions to respect (Of course, otherwise everyone would be getting new glasses all the time!)

• Condition 1: From 12 months and 1 day after the date of your last purchase, you can reuse your prescription. Your qualified optician will perform an eye test. Following this test, if your vision has changed, the prescription can be reused; otherwise, condition 2 applies.
  
  

• Condition 2: Following this famous eye test, if your vision has not changed, you must wait 24 months and 1 day after your last purchase date to reuse your prescription.
  
  

As long as your prescription is valid, you will always be able to get reimbursement from Social Security and your health insurance according to your contract.

Did I lose you? Okay, I’ll make a little diagram for you (Yes, we’re still as helpful at Binocle!)

How optical reimbursement works in 2020

Since this famous “100% Health” reform came into force, many things have changed. Several types of baskets are now available at your optician: Basket A, Basket B or Mixed Basket.

“Basket A, Basket B, mixed basket… it’s complicated!” you might say? Don’t panic! I’ll explain everything!

Basket A

Frame

Opticians must offer frames that meet European standards and cost less than or equal to €30. You will have a choice of 35 adult frames and 20 children’s frames.

Lenses

For lenses, you are entitled to lenses costing between €32.50 and €170 per lens depending on your prescription. These 100% Health lenses have different thinning options (depending on your visual needs) and a basic anti-reflective treatment.

Reimbursement

If both the frame and lenses are chosen from Basket A, then the 100% Health reform applies and the equipment is fully covered.

Social Security covers 60% of the Social Security base for Basket A. Your health insurance (if you have a responsible contract) is required to cover the remaining amount.

Example: A €30 frame and €37.50 per lens:

• Frame: €5.40 from Social Security and €26.40 from your health insurance.
• Lenses: €6.75 per lens from Social Security and €30.75 per lens from your health insurance.
  
  

To summarize, regardless of your prescription, you can be 100% covered by choosing equipment from Basket A. If you do not have health insurance, Basket A is not covered at 100%, but only at 60% of the Social Security base. The reimbursement is only provided by Social Security.

Basket B

Frame

All frames costing more than €30 belong to Basket B. Generally, these represent 80% of an optician’s stock.

Lenses

Basket B lenses are designed to better meet your visual comfort needs with adapted treatments (e.g.: blue light blocking, custom thinning, etc.).

Reimbursement

Regarding Basket B coverage, Social Security covers 60% of €0.05 per item (one frame, one right lens, one left lens), meaning €0.09 for complete glasses (well, aren’t they generous!).

Your health insurance will cover part of your glasses depending on your contract. If you have a responsible contract, the maximum reimbursement for your frame is now set at €100. For lenses, your supplementary insurance can cover between €65 and €720 depending on your prescription.

Mixed Basket

You can also choose a mixed basket, meaning you select one element from Basket A and one element from Basket B.

For example:

• You choose a Basket A frame at €30 (which will be 100% reimbursed) with Basket B lenses (reimbursed at 60% of €0.05 per lens by Social Security, with the remaining amount covered according to your health insurance contract).
  
  

• You choose a Basket B frame (60% of €0.05 for the frame from Social Security, with the remaining amount covered according to your health insurance contract) and Basket A lenses (100% reimbursed).
  
  

I hope this helped you better understand optical reimbursement. Feel free to ask us any questions in the comments!