Management of a long-term illness (ALD) by the Health Insurance

Verified 15 October 2026 - Public Service / (Prime Minister)

What is the rate of ALD treatment? Some are exempt: the costs of care are reimbursed to the maximum of the ceiling. You are exempt from the user fee. The protocol of care opens the rights to 100%. Others are not exempt: you are then reimbursed at the usual rates. We present you the information to know.

Exempt ALDs

These are conditions involving prolonged and particularly expensive therapeutic treatment.

Different pathologies are affected by ALD. Some are on a list.

List of ALDs 30

Initially, there were 30 conditions. Today, severe hypertension is no longer included in this list. However, it continues to be called: list ALD 30.

These are the following:

  • Disabling stroke
  • Bone marrow failure and other chronic cytopenias
  • Chronic arteriopathies with ischemic manifestations
  • Complicated Bilharzia
  • Severe heart failure, severe arrhythmias, severe valvular heart disease, severe congenital heart disease
  • Chronic active liver disease (hepatitis B or C) and cirrhosis
  • Severe primary immunodeficiency requiring prolonged treatment, human immunodeficiency virus (HIV) infection
  • Type 1 diabetes and type 2 diabetes in adults or children
  • Severe forms of neurological and muscular disorders (including myopathy), severe epilepsy
  • Hemoglobinopathies, hemolysis, chronic constitutional and acquired severe
  • Serious hemophilia and constitutional disorders of hemostasis
  • Coronary heart disease: myocardial infarction
  • Severe chronic respiratory failure (example: severe asthma)
  • Alzheimer's disease and other dementias
  • Parkinson's disease
  • Inherited metabolic diseases requiring prolonged specialized treatment
  • Cystic fibrosis
  • Severe chronic nephropathy and primary nephrotic syndrome (renal failure)
  • Paraplegia
  • Vasculitis, systemic lupus erythematosus, systemic sclerosis
  • Progressive rheumatoid arthritis
  • Long-term psychiatric disorders (e.g. recurrent depression, bipolar disorder)
  • Ulcerative colitis and Crohn's disease
  • Multiple sclerosis
  • Progressive structural idiopathic scoliosis
  • Severe spondylitis
  • Organ Transplant Suites
  • Active tuberculosis, leprosy
  • Malignant neoplasm (cancer), malignant disease of the lymphatic or hematopoietic tissue (example: lymphoma).

If you have ALD 30, you can declare to your health insurance fund the name of the referring nurse you have chosen with his agreement.

The referring nurse is responsible for prevention, follow-up and recourse, in close contact with the treating physician and the corresponding pharmacist.

« off-list » ALD (ALD 31)

In addition to these ALD 30 conditions those called "off-list" (ALD 31, with reference to ALD 30).

They are therefore not included in the list of ALD 30.

These diseases evolve over a foreseeable period of more than 6 months with a treatment is particularly expensive.

The management must include a drug treatment or a device.

2 criteria among the following 4 are also mandatory:

  • Upcoming hospitalization 
  • Repeated medical technical acts 
  • Repeated biological acts 
  • Frequent and regular paramedical care.

Example :

Paget's disease, chronic or recurrent ulcers with severe functional impact, endometriosis

Polypathologies (ALD 32)

The term polypathologies is used when you are suffering from several characterized conditions, resulting in a disabling medical condition and requiring continuous care for a predictable duration of more than 6 months and particularly expensive (ALD 32).

Example :

A 90-year-old person with polyarthrosis with gait disorders, urinary incontinence and essential tremors.

Three types of exempting ALD exist: ALD 30, ALD 31 and ALD 32.

ALD 30

Fees related to ALD care are reimbursed by the Health Insurance to the maximum of the reimbursement limit. We talk of exemption from moderator's ticket or sometimes from « care to 100% ».

Your attending physician establishes for you a request for care at 100% regarding the care and treatment of your ALD.

You benefit from the third-party payer : you do not advance the costs of care and treatment related to your ALD.

Care and treatment are provided at 100% on the basis of the Social Security rate.

For this purpose, a specific model of prescription, called dual-zone prescription, has been created. This Ordinance has 2 separate zones:

  • An upper part reserved for care related to ALD, taken care of 100%
  • A lower part reserved for care unrelated to ALD, reimbursed at the usual rates of Social Security.

Some fees remain at your expense like:

Your complementary can cover the hospital fee and excess fees.

The exemption is granted for an initial period depending on the condition.

She is renewable for an equivalent period or for 10 years.

At the end of your protocol of care, if your illness still requires acute care, your doctor will apply for a renewal of ALD. This renewal is possible as long as your state of health justifies it, without age limit or number of renewals.

FYI  

The transport costs for treatment or examination related to ALD, patients with one of the disabilities requiring medical transport (lying down, oxygen or monitoring needs...) are treated on medical prescription.

ALD 31

The costs related to ALD care are reimbursed to the maximum of the reimbursement ceiling by the Health Insurance. We are talking about the exemption of moderator's ticket or sometimes from « care to 100% ».

Your doctor will prepare a treatment request for you at 100% regarding the care and treatment of your ALD.

You benefit from the third-party payer : you do not advance the costs of care and treatment related to your ALD.

Care and treatment are provided at 100% on the basis of the social security tariff. For this purpose, a specific model of prescription, called dual-zone prescription, has been created. The Ordinance has 2 distinct zones:

  • An upper part reserved for care related to ALD, taken care of 100%
  • A lower part reserved for care unrelated to ALD, reimbursed at the usual rates of Social Security.

FYI  

The transport costs for treatment or examination related to ALD, patients with one of the disabilities requiring medical transport (lying down, oxygen or monitoring needs...) are treated on medical prescription.

Some fees remain at your expense like:

Your complementary can cover the hospital fee and excess fees.

The duration of the necessary procedures and services is proposed by the doctor, examined and validated by the medical service of the Health Insurance.

At the end of your protocol of care period, if your illness still requires acute care, your doctor will request for renewal of ALD.

This renewal is possible as long as your state of health justifies it, without age limit or number of renewals.

ALD 32

We are talking about the accumulation of several conditions resulting in a disabling medical condition requiring treatment:

  • Expected to last longer than 6 months
  • And particularly expensive because of the cost or frequency of the acts, benefits and treatments.

Example :

A 90-year-old person with polyarthrosis with gait disorders, urinary incontinence and essential tremors.

There's no no user fees, that is to say, to remain dependent once the Health Insurance has reimbursed its share.

The protocol of care is a form established by your attending physician, in consultation with the other doctors who follow your ALD.

The protocol has a fixed duration.

It allows support to 100% (on the basis of the Social Security rate), with the agreement of the Medical Adviser of the Health Insurance.

It consists of 3 parts:

  • 1 is stored by your doctor
  • 1 is for the medical adviser of the Health Insurance
  • 1 is intended for you.

You will have to sign this protocol of care and present it to each doctor consulted to benefit from the care at 100% for care related to your illness.

Please note

In some cases, especially when the diagnosis is made during a hospitalization or in an emergency context, a doctor other than your treating doctor can establish this protocol of care and therefore make this request.

The protocol shall include the following information:

  • Care, laboratory tests and treatments necessary for the management and monitoring of your disease
  • Care and treatments taken care of in 100% and those reimbursed at the usual Social Security rates. Some treatments and treatments may not be covered, such as pharmaceutical specialties not included on the list of reimbursable drugs
  • Specialists in « direct access », without passing through the attending physician.

Coverage by health insurance bodies of the acts and benefits of minor and adult beneficiaries infected with the human immunodeficiency virus or the hepatitis C virus is protected by secrecy. Health Insurance will therefore not mention these treatments in the statements sent to parents or legal representatives, whether it is the paper statement or the Ameli account.

FYI  

As part of the care pathway for patients with ALD, any doctor involved in the management can prescribe physical activity adapted to the pathology, physical abilities and medical risk. But it will not be covered by the Health Insurance.

Non-exempt ALD

Non-exempt ALDs are conditions that require a work interruption or continuous care for a foreseeable period of time greater than 6 months.

Example :

Following a broken shoulder that has become complicated with the occurrence of an infection, you are stopped for more than 6 months and you get a non-exonerating ALD. Your care is reimbursed at the usual rates.

They don't open not entitled to exemption from moderator's ticket.

All your care provided under the ALD is therefore reimbursed at the usual Social Security rates.

This « non-exempt » ALD allows you to benefit from a work stoppage of more than 6 months

If you are on sick leave for a long time, you can receive daily allowances beyond 6e months, if your health justifies it. It requires the approval of the medical officer of the Health Insurance.

Since October 15, 2026, the duration of an uninterrupted work stoppage cannot not to exceed 1 year (3 years ago).

This rule applies to:

  • at stops prescribed from 15 october 2026
  • and at stops in progress on 15 october 2026 when the incapacity for work reaches 6 months from that date (for example, an insured whose shutdown began in may 2026 will switch to the new system when he reaches the 6-month shutdown milestone, i.e. in november 2026).

These new provisions therefore do not apply to employees whose work stoppage already exceeds 6 months on October 15, 2026. The employee in this case continues to fall under previous rules, with compensation of up to 3 years: for example, an insured person who has been on leave since January 2026, i.e. more than 9 months as of October 15, 2026, is subject to the old 3-year ceiling.

Preventive support during a pathology at risk of progression to ALD

The Law of 30 December 2025 on the financing of Social Security for 2026 provides for the provision of preventive support services for insured persons suffering from a pathology at risk of progression to ALD.

A decree must organize the implementation of this measure.

Upon publication, this page will be updated.

Until then, the information on this page remains valid.

Who can help me?

Find who can answer your questions in your region

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

    By phone

    01 53 62 40 30

    Price of a normal communication

    Open service:

    • Monday, Wednesday and Friday from 2pm to 6pm
    • Tuesday and Thursday from 2pm to 8pm.

    By email

    https://www.france-assos-sante.org/sante-info-droits/

    The maximum response time by email is 15 days.

  • Ameli