Outpatient care and care without accommodation

To receive payment of their medical expenses, the insured, member or beneficiary must satisfy the basic eligibility conditions stipulated by the health insurance

Définition

This includes:

  • Outpatient care: consultations, minor surgery, medical imaging and biological analyses conducted externally within public and private establishments.
  • Ambulatory care or care without the need for a hospital stay: for surgical and diagnosis procedures, specified on an exhaustive list, performed with or without general anaesthetic and requiring observation or monitoring time without a full overnight stay (the hospital stay is less than 24 hours).
  • Day admission to hospital during which medical procedures, check-ups and treatments are performed which do not require a hospital stay (the time in hospital is less than 24 hours).
  • Treatment provided under the emergency services of care facilities and not requiring a hospital stay of more than 24 hours.
  • Home hospital care: this is a hospital service. An alternative to being an inpatient, home care allows the management of patients requiring medical supervision and ongoing care.
  • Home care: a service keeping elderly people requiring nursing and hygiene care in their own homes.

Reimbursement

Outpatient care in the public hospital sector uses the third party payment system, i.e. the patient does not have to pay all the medical expenses up front, but pays just the  patient contribution, in the event of an 80% entitlement.