Health Insurance & Glasses: Are You Getting Enough Back?

Since the generalization of complementary health insurance in companies, most French employees live with one certainty: that of being protected by a contract that complies with the rules in force. However, behind institutional discourse, the reality of the insurance market hides worrying disparities.

Between the complexity of the benefit tables and the lack of control, many employees could well be the losers of a system that drags benefits down.

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1. The 2013 law: a theoretical shield but without police

The law of June 2013 (ANI) marked a turning point by requiring all companies to provide mutual insurance to their employees. To prevent this obligation from transforming into a facade protection, the legislator has provided that the professional branches determine reimbursement “floors”, item by item (optical, dental, hospitalization, etc.).

These branch minimums are obligatory. They constitute the base of protection negotiated by the social partners to take into account the specificities of each sector. Problem: if the rule exists, control is almost non-existent. Today, no one systematically checks whether the contract signed by an SME scrupulously respects the reimbursement levels imposed by its sector.

2. The trap of “discount” mutual insurance companies

In a context of pressure on margins, the temptation is great for certain companies or certain insurers to favor the lowest price to the detriment of the quality of the cover. We are thus seeing the emergence of “discount” contracts which, under the guise of compliance, cut back on real reimbursements, particularly on costly items such as optics.

For the employee, the observation is bitter: when it is time to change his glasses, he discovers a much higher out-of-pocket cost than expected. Finding your way around is all the more difficult as insurance contracts are notoriously complex, between percentages of the BRSS (Social Security Reimbursement Base) and illegible annual packages.

3. AI at the service of transparency: the Asfelia initiative

Because I remain convinced that the insurance market can be virtuous if it is transparent, I wanted to give power back to employees. With the brand Aspheliawe have developed an innovative tool based on artificial intelligence.

The objective is simple: to allow each employee to check, in an instant, whether their company mutual insurance complies with the conventional minimums for their sector. This tool is made available for free on www.asfelia.fr. It transforms a mass of indigestible legal and technical data into a clear and actionable response.

You don’t need to be an expert in insurance law to use our comparator. The procedure is simple:

1. Take your table of guarantees (the PDF or paper document sent by your health insurer when you join or at the start of each year).
2. Go to Asfelia.fr and upload a copy or photo of this table to the tool.
3. Artificial intelligence analyzes the guarantee lines, compares them to the obligations of your professional sector and gives you its verdict in a few seconds.

5. Take back control of your health

If your mutual insurance company does not meet legal obligations, it is your purchasing power that is directly impacted. Don’t let administrative opacity decide your health budget.

So, no time to waste: check your rights and start saving on your healthcare costs now by testing your contract on Asfelia.fr.