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Tribune Les Echos – Supplementary health insurance for civil servants: the stakes and major maneuvers of a reform

A profound transformation of the complementary social protection for health and provident funds in the public sector has been launched. Public employers and social partners, mutual insurance companies and insurers are preparing for a revolution in practices and acquired positions. 

Between 2021 and 2026 at the latest, the Supplementary Social Protection (PSC) for health and provident funds of the 5.5 million civil servants will have been profoundly overhauled. This reform will also have an impact on the health coverage of 3.5 million public pensioners.

Until now, the supplementary health and provident schemes for public employees have been based on individual, non-compulsory membership of beneficiaries, with schemes specific to each of the three branches of the State, Territorial and Hospital civil service. Intergenerational solidarity has always been expressed and often practiced, with the strong presence of the historical affinity mutual insurance companies of the civil service, allowing retirees to have access to the health coverage of the active population.

Nevertheless, the inadequacies of these little-reformed systems could be pointed out: derisory financial contributions from employers (State), heterogeneous coverage (local authorities), obsolete or inaccessible mechanisms (hospitals).

Deep transformation

The law of August 6, 2019 on the transformation of the civil service and the order of February 17, 2021 set out the principles of a complete overhaul, with the ANI health insurance scheme deployed since 2016 in the private sector as a reference (negotiated baskets of care, minimum financial contributions from employers), while keeping open the specific features of the civil service (the possibility of combining health and insurance, compulsory membership under certain conditions, or a solidarity scheme for retirees).

A five-year deployment schedule has been announced. Additional regulations will be adopted in 2021. Negotiations between social partners will remain intense over the period.

Although many technical unknowns remain, we can already predict new dynamics.

Increased economic and social stakes

Emblematic of a strategy to make the civil service more attractive, and involving new annual expenditure of up to €1.4 billion, the social protection of civil servants will become a real subject of investment for all public employers. At the same time, the trade unions will focus on the sensitive issue of supplements or alternatives to direct pay increases. The subject of the PSC will gain in economic and social density, in collective ambition. This will prohibit any status quo, and will guarantee the revolution of the current stratified and historically marked systems.

Technical and competitive challenges for all, opportunities for the most agile

As an expression of a renewed focus on the identities and professional environments of the civil service, the CSP will first of all be a reminder of the requirements of marketing: knowledge and adaptation to the needs of beneficiaries will be decisive, and prevention and quality of life at work programs will be differentiating.

The stated ambitions of intergenerational solidarity between working people and retirees, while limiting competitive anti-selection, will constitute formidable technical challenges for mutualization.

This will raise the question of group insurance, particularly if it is compulsory, which has never been used in the civil service until now.

If the historical supporters of individual insurance are now defending their positions, they are also preparing their capacity to switch to the world of the collective. This is eminently necessary: the new economic and social density of the PSC can only favour collective decision-making and contractualization frameworks.

This shock to the collective world for the traditional mutuals will, however, be an opportunity for the more agile ones, aware that they will have to know how to use and combine all the insurance and service tools, both individual and collective, to follow and serve their clients in their variety of professional paths and life cycles.

Thus, if the short-term challenges will be technical and distribution, the most sustainable challenges will be in the amortization of service platforms and in the optimal use of data.

A revolution in the playing field, with high social, technical and financial stakes, the reform of the Civil Service PSC will encourage a concentration of offers and operators. Alliances will be the order of the day more than ever, in distribution and services, co-insurance and reinsurance. The competition is already underway.

F Channac

Frédéric Channac

 Senior Advisor Financial Institutions Division

Read the article Published on April 16, 2021 in Les Echos

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