Are you hiring your first employee, or have you just discovered that no supplementary health insurance has ever been offered in your company? Since the “mutuelle d’entreprise” (company health insurance) was made general, every private-sector employer, whether a company or an association, must offer its employees collective supplementary health cover, with some exceptions. Only private individuals who employ someone in their home are exempt, points out Entreprendre Service Public, the French administration’s information site for businesses. Here, step by step, is what needs to be put in place, what the contract must cover and how to handle employees who want to be exempted.
Who must be covered, and who pays
The obligation applies to all employees, with no length-of-service requirement. Coverage of children or spouses (dependants, or “ayants droit”) is not mandatory: the employer or the social partners may nevertheless decide to extend it.
As for funding, the employer pays at least 50% of the contribution; the rest is paid by the employee. If the employment contract is suspended, coverage continues as long as the employer or the Sécurité sociale (French social security) is compensating the employee.
What the contract must cover at a minimum
The collective contract must meet a minimum basket of care, detailed by Entreprendre Service Public:
- the ticket modérateur (the share of costs not reimbursed by public health insurance) covered in full for consultations, procedures and services reimbursed by the Assurance maladie (with a few exceptions);
- the daily hospital charge (forfait journalier hospitalier) in full;
- dental prostheses and orthodontics reimbursed at 125% of the agreed tariff;
- optical care, with an allowance per 2-year period (every year for children or if eyesight changes) of at least €100 for simple correction and €150 to €200 for complex correction.
The contract must also be “responsible” (“responsable”) and solidarity-based: no health questionnaire, and no premium set according to the employee’s state of health. It does not, however, reimburse the €2 flat contribution per consultation with a doctor in private practice, nor medical deductibles (franchises médicales).
Setting up the health cover: the steps in order
- Check your collective agreement. If an industry-wide agreement applies, it may set minimum guarantees, or even a minimum contribution rate, and the company must comply with it.
- Failing that, negotiate a company agreement with employee representatives. If there is an industry-wide agreement, the company agreement must offer guarantees that are at least as favourable.
- Failing an agreement, use a unilateral decision by the employer, after informing employee representatives where there are any, LégiSocial specifies.
- Choose the insurer (mutual insurer, provident institution or insurance company) and a contract that meets the minimum basket and the specifications for a “responsible” contract.
- Set out in black and white the exemption cases you accept in the document that establishes the scheme: some exemptions only apply if the agreement or unilateral decision provides for them, for example for a fixed-term contract of 3 months to 1 year.
- Enrol each employee as soon as they start and deduct their share of the contribution from their pay, unless they make an admissible exemption request.
Exemptions: what the employee can request
An employee cannot simply refuse the health cover. They can, however, ask to be exempted in the cases listed by Entreprendre Service Public, including:
- fixed-term or temporary assignment contracts of less than 3 months;
- part-time work of up to 15 hours a week;
- employees already covered by individual supplementary health insurance when the scheme is introduced or when they are hired, until that contract expires;
- beneficiaries of the complémentaire santé solidaire (solidarity-based supplementary health cover), until that entitlement ends;
- employees already covered, including as a dependant, by another mandatory collective supplementary scheme, the Alsace-Moselle local scheme or the public servants’ mutual insurance, for example.
An employee who works for several employers and is already covered by the collective contract of one of them may refuse the others, provided they supply proof each year. The request is in principle made upon hiring or when the cover is introduced.
Keep every exemption request, even after the employee has left. In a ruling of 16 October 2025 (No. 23-16350), concerning a mandatory provident scheme, the Cour de cassation (France’s highest court) upheld a reassessment by the Urssaf, the body that collects social security contributions, against an employer unable to produce the exemption request of an employee who had left the company, reports the CAPEB, the French confederation of craft and small building businesses. Without that document, the Urssaf can challenge the mandatory nature of the scheme, and with it the favourable social security treatment enjoyed by the employer’s share. The request must be explicit and, under Article R242-1-6 of the French Social Security Code, state that the employee was informed beforehand of the consequences of their choice.
The health payment for short contracts
For fixed-term contracts and assignments of less than 3 months and part-time work of up to 15 hours, an industry-wide or company agreement may replace the exemption with a health payment (versement santé): the employer helps the employee pay for their own supplementary cover, on presentation of a certificate showing it is a “responsible” contract. When the amount of the collective cover cannot be determined, the reference amount is €22.27 in 2026 (€7.44 in Alsace-Moselle), multiplied by 105% for a permanent contract and 125% for a fixed-term contract or assignment. This payment is exempt from social security contributions but is subject to the CSG-CRDS levies and, from 11 employees upwards, to the forfait social (an employer levy).
Frequently asked questions
Does a company with a single employee have to offer health cover?
Yes. The obligation concerns all private-sector employers, with no headcount threshold or length-of-service requirement for the employee. Only private individuals employing someone in their home are excluded.
Can the employer pay less than half the contribution?
No: its share is at least 50%. It may pay more.
What happens to the health cover when the employee leaves the company?
Except in the case of dismissal for gross misconduct (faute lourde), the former employee keeps their cover while receiving unemployment benefits, within the limit of the length of their last contract and for a maximum of 12 months.
Can the employee refuse because their spouse already covers them?
Yes, if they are a dependant on another mandatory collective contract: since April 2024, the exemption applies whether that dependant cover is optional or mandatory. They must request it and provide proof.
Where can I get an answer for a specific case?
Your collective agreement, your insurer and the Urssaf are the points of contact for specific situations. The Entreprendre Service Public page sets out the general rules and refers to the applicable texts.
Sources
- Quelle obligation pour l'employeur en matière de complémentaire santé ? — Entreprendre Service Public, 2026-01-20
- La couverture complémentaire santé obligatoire ou mutuelle — LégiSocial, 2023-12-07
- Proposition obligatoire par l'employeur d'une mutuelle : jurisprudence — CAPEB, 2026-03-20
- Article R242-1-6 du Code de la sécurité sociale (version en vigueur depuis le 1er novembre 2019) — Légifrance, 2019-11-01