Moderator ticket, package and deductibles (Social security)

Verified 01 October 2026 - Public Service / (Prime Minister)

Wondering if the Health Insurance (Social Security) covers all medical expenses? It does not fully reimburse medical expenses. Indeed, a part of the expenses remains at your expense: user fee, €32 for certain heavy acts, flat-rate contribution of €2, medical franchises. However, exceptions do exist. Here we explain the rules to know.

Definition

The user fee represents the part of the expenses that remains at your expense after reimbursement of the Health Insurance and before deduction of the flat-rate contributions.

The user fee applies to all benefits covered by the Health Insurance (examples: consultation with a doctor, purchase of prescribed medicines).

Exempt persons

In certain situations (e.g. Long-term medical condition - ALD, if you are pregnant, costs related to abortion), you are exempt from paying the user fee.

The Health Insurance then covers him at 100% within the limits of conventional rates.

Amount 

The amount of the user fee varies according to the services (care, medication, equipment...).)

For example, for a consultation with your GP, it is equal to €9.

Calculation detail:

  • Conventional rate : €30
  • Support at 70% by the Health Insurance: €21
  • User Fee Amount: €9.

Markup

The moderator ticket can be increased if you consult a health professional outside coordinated care pathways.

For example, for the consultation of a general practitioner outside the coordinated care pathway, it is equal to €21.

Calculation detail:

  • Conventional rate: €30
  • Support at 30% by health insurance: €9
  • User Fee Amount:€21.

Reminder

The user fee represents the part of the expenses that remains at your expense after reimbursement of the Health Insurance and before deduction flat-rate contributions.

The surcharge is not reimbursed by the health supplements under a responsible contract.

Payment

The moderator ticket is automatically deducted the amount of your refunds. It is deducted from the refund statements.

FYI  

If you have complementary health, it can support the user fee according to the contract you have subscribed. Ask your complementary organization.

Services concerned or not

For certain heavy medical procedures (procedures whose fee is at least equal to €120), the user fee is replaced by a flat-rate contribution.

Certain acts and costs are not covered by the flat-rate contribution and are covered by 100%. Examples:

  • Hospitalization costs from 31e consecutive day of hospitalization
  • Emergency transport costs, in the case of hospitalization during which an act is performed whose rate is greater than or equal to €120.

Amount

The package is capped at €32.

The same applies if several heavy procedures are performed during the same consultation or hospitalization.

Exempt persons

The package does not apply to persons who receive care at 100% because of their situation or state of health.

It is in particular of the following persons:

  • Person with a long-term assignment (LTA) for procedures, care and treatment related to this ALD and which are mentioned on the protocol of care
  • Pregnant woman (from 1er day of 6e month of pregnancy until 12e day after delivery)
  • Newborn hospitalized
  • Person receiving an accident at work or occupational disease pension
  • Person receiving a disability pension
  • Person benefiting from complementary health solidarity
  • Sexually abused children and adolescents.

Payment

You must pay directly the package you owe to the health professional or health facility.

If you have complementary health, it can cover the package according to the contract you have subscribed. Ask her about it.

Definition

This flat-rate contribution is due following a visit to the emergency department, which is not followed by hospitalization in the medical, surgical, obstetric or dental departments of the institution.

Amount

The amount of the package is €23.

This package is reduced regardless of the reason for the change to €9.96 for the following insured persons:

  • In long-term condition (ALD)
  • Attached to the accident at work and occupational diseases (AT-MP) diet with a disability of less than 2/3.

FYI  

The health insurance or complementary health reimburses this package in full.

Exempt persons

The package does not apply regardless of the reason for the passage for the following persons:

  • Pregnant woman with maternity insurance
  • Newborns less than one month old
  • Person receiving an annuity or an allowance paid under the legislation of accidents at work and occupational diseases (AT-MP) with a disability of at least 2/3
  • Military or disability pensioner.

Finally, this package does not apply for the following people when their emergency room visit is related to their specific situation:

  • Organ donor
  • Victim of an act of terrorism
  • Victim of a serious and exceptional health risk
  • Minor victim of sexual abuse.

Services concerned

A flat-rate contribution remains at your expense for each consultation or medical procedure, except in the context of a complete hospitalization of one or more days.

This participation also applies to any radiological or medical biology procedure.

Amount

The flat-rate contribution shall be €2.

The maximum number of flat-rate contributions to be paid by you during a calendar year is 35. The maximum amount is therefore €70.

If during the same day, you consult the same doctor several times or if you benefit from several procedures performed by the same professional, the number of flat-rate contributions supported can not be more than 4, either €8 per day maximum.

Example :

If a doctor performs 6 different procedures during the same consultation, the maximum participation will be €8 for the consultation of this doctor.

Exempt persons

The flat-rate contribution of €2 does not apply the following persons:

Payment

The lump-sum contributions are automatically deducted the amount of your refunds. They are deducted from the reimbursement statements.

The flat-rate contribution of €2 is not reimbursed by health supplements under a responsible contract.

Services concerned

A medical deductible remains at your expense for the following costs:

  • Medicines
  • Paramedical acts
  • Sanitary transport.

Please note

The franchise does not concern :

  • Boxes of medicines purchased without a medical prescription
  • Paramedical procedures performed during hospitalization
  • Emergency transport (Samu call center 15).

Amount

The amount of the deductible is:

  • €1 per pack of medicines (or any other unit packet, e.g. a vial),
  • €1 by paramedical act within the limit of €4 per day,
  • €4 by medical transport within the limit of €8 per day.

The amount of the deductible is capped at €70 per year and per person.

Exempt persons

The franchise does not apply the following persons:

Payment

Medical franchises are automatically deducted the amount of your refunds. They are deducted from the reimbursement statements.

In almost all cases, medical deductibles are not reimbursed by health supplements under a responsible contract.

Who can help me?

Find who can answer your questions in your region

  • Health Info Rights

    Telephone line created by a collective of user associations to provide legal or social information related to health

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    01 53 62 40 30

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    Open service:

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    • Tuesday and Thursday from 2pm to 8pm.

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    The maximum response time by email is 15 days.

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