Key Benefits:
Publics concerned: employees of private law; companies.
Subject: payment by the employer of amounts intended for the financing of the supplementary health insurance contract for certain employees in a short or very part-time contract; determination of the categories of employees who may be exempted from compulsory corporate coverage.
Entry into force: the text comes into force on January 1, 2016.
Notice: This Order sets out the categories of employees who may be exempted, on their initiative, from the adhesion to compulsory collective coverage in respect of the supplementary reimbursement of expenses incurred by an illness, maternity or accident in the company or in the branch.
It also specifies the thresholds for branch or business agreements to provide employees with a payment for the financing of their individual health supplement, which then replaces collective and compulsory coverage. These are employees whose work contract duration is less than or equal to three months or those whose weekly work time is less than or equal to 15 hours.
References: This decree is taken for the purposes of section 34 of Act No. 2015-1702 of 21 December 2015 on social security financing for 2016. The provisions of the Social Security Code, as amended by this Decree, are available at the Légifrance website (http://www.legifrance.gouv.fr).
The Prime Minister,
On the report of the Minister of Social Affairs, Health and the Rights of Women and the Minister of Finance and Public Accounts,
Considering the social security code, including articles L. 911-7, L. 911-7-1 and L. 911-8;
Considering the labour code;
Considering Act No. 94-126 of 11 February 1994 on the initiative and individual enterprise;
Having regard to Act No. 2015-1702 of 21 December 2015 on social security financing for 2016, in particular its article 34;
In view of Decree No. 46-1541 of 22 June 1946 approving the national status of personnel in electrical and gas industries;
Considering Decree No. 2007-1373 of 19 September 2007 on the participation of the State and its public institutions in the financing of the complementary social protection of their personnel;
Considering Decree No. 2011-1474 of 8 November 2011 on the participation of territorial authorities and their public institutions in the financing of the complementary social protection of their agents;
Considering the advice of the Board of Directors of the Central Agency for Social Security Organizations dated 18 December 2015,
Decrete:
Section D. 911-2 of the Social Security Code is replaced by the following provisions:
"Art. D. 911-2.-Without prejudice to the provisions of the second paragraph of Article L. 911-7, they may waive, on their initiative, the obligation to join the coverage in respect of the additional reimbursement of expenses incurred by a disease, maternity or an accident in their business:
« 1° Employees receiving additional coverage under section L. 861-3 or assistance in the acquisition of additional health under section L. 863-1. The dispensation can only play until the date on which employees cease to benefit from this coverage or assistance;
« 2° Employees covered by individual health insurance at the time of the establishment of guarantees or hiring if it is later. The dispensation can only play until the individual contract expires;
« 3° Employees who receive, for the same risks, including as eligible persons, benefits for another job as a beneficiary of either of the following:
“(a) Guarantee device meeting the conditions mentioned in the sixth paragraph of Article L. 242-1;
“(b) Safeguards provided by Decree No. 2007-1373 of 19 September 2007 on the participation of the State and its public institutions in the financing of the supplementary social protection of their personnel or by Decree No. 2011-1474 of 8 November 2011 on the participation of the territorial authorities and their public institutions in the financing of the complementary social protection of their agents;
"(c) Group insurance contracts under Act No. 94-126 of 11 February 1994 relating to the initiative and individual enterprise;
"(d) Local health insurance scheme of the Upper Rhine, Lower Rhine and Moselle, pursuant to articles D. 325-6 and D. 325-7 of the Social Security Code;
“e) Additional health insurance scheme for electrical and gas industries pursuant to Decree No. 46-1541 of 22 June 1946.
"In all cases, the employer must be able to file the application for exemption from the employees concerned. »
Chapter I of Book IX title I of the same code is supplemented by five articles as follows:
"Art. D. 911-4.-The act referred to in Article L. 911-1 establishing a mandatory collective coverage for the supplementary reimbursement of expenses incurred by a disease, maternity or accident may provide for the ability of employees under certain categories to be exempted from membership in the device, provided that these categories correspond to all or part of those defined in Article R. 242-1-6, under the conditions defined in that same section.
"Art. D. 911-5.-Requests for exemptions referred to in Article III L. 911-7 must be made at the time of hiring or, if they are later, at the date of establishment of guarantees or the date on which coverages referred to in Article D. 911-2 take effect.
"Art. D. 911-6.-The duration of compulsory collective coverage in respect of the additional reimbursement of expenses incurred by a disease, maternity or accident referred to in the second paragraph of Article L. 911-7 is three months.
"Art. D. 911-7.-The employees referred to in the III of Article L. 911-7-1 are those whose duration of the contract of employment or of the contract of mission is less than or equal to three months or those whose actual duration of the work under this contract is less than or equal to 15 hours per week.
"Art. D. 911-8.-I.-The amount of the payment referred to in Article L. 911-7-1 shall be calculated on a monthly basis on the basis of the reference amount defined in Article II to which the coefficient defined in Article III is applied.
"II.-The reference amount referred to in I of this section corresponds to the employer's monthly contribution to the financing of the coverage referred to in III of Article L. 911-7 for the category to which the employee belongs and for the period concerned. It takes into account, where appropriate, the remuneration of the employee.
"When all or part of the contribution is lump-sum and independent of the effective working period, it shall apply to it a coefficient equal to the ratio, within the limit of 1, between the effective working period as it results on the month concerned of the provisions provided for in the employee's employment contract and the monthly period corresponding to the legal duration of the work. This coefficient is not applicable, if any, to the component of the contribution proportional to remuneration.
"The calculation of the payment is made, for employees made available under Article L. 5132-9 of the Labour Code, on the basis of the number of hours made available.
"In the absence of an amount applicable to the financing of the collective and compulsory coverage, the reference amount is set at 15 euros or, for persons subject to the mandatory scheme referred to in Article L. 325-1, at 5 euros. It shall be applied to either of these two amounts a coefficient equal to the ratio, within the limit of 1, between the effective working period as it results on the month considered of the provisions provided for in the employee's employment contract and the monthly period corresponding to the legal duration of the work. These amounts are revalued annually, as of January 1, by order of the Minister for Social Security, following the national objective of health insurance expenses set by the Social Security Financing Act for the previous year, and rounded to the second nearest decimal place.
"The application of this II shall not result in a reference amount less than that calculated in the preceding paragraph.
"III.-The coefficient referred to in I of this Article shall be 105 per cent for employees with an indefinite contract and 125 per cent for employees with a fixed-term contract or a mission contract. »
This Order comes into force on January 1, 2016.
The Minister of Finance and Public Accounts, the Minister of Social Affairs, Health and Women's Rights and the Secretary of State responsible for the budget are responsible, each with regard to him, for the execution of this decree, which will be published in the Official Journal of the French Republic.
Done on December 30, 2015.
Manuel Valls
By the Prime Minister:
Minister of Social Affairs, Health and Women ' s Rights,
Marisol Touraine
Minister of Finance and Public Accounts,
Michel Sapin
The Secretary of State in charge of the budget,
Christian Eckert
