Optical program covers glasses with no out-of-pocket costs

The 100% Santé optical program allows access to glasses with no out-of-pocket costs, funded by the Social Security and your health insurance supplement. Implemented since 2020, it is based on a basket of equipment with prices capped and fully covered.

Reimbursement is divided into three levels

The reimbursement is divided into three levels: The Social Security reimburses a fixed base (60% of a standard convention rate). Your health insurance supplement covers the remainder up to the price limit set by the regulation. There is no out-of-pocket cost for equipment in the 100% Santé basket, called "class A".

Opticians must offer a 100% Santé quote

Opticians have the obligation to present you with at least one quote containing a 100% Santé offer. You remain free to choose equipment outside the basket ("class B"), for which an out-of-pocket cost applies according to your contract.

Class A equipment has regulated features

The 100% Santé optical equipment refers to a frame and two lenses belonging to the "class A" basket, whose characteristics and prices are regulated by law. This basket offers equipment meeting quality standards defined by the regulation, with basic treatments included.

Class A includes specific features and models

The main characteristics of the 100% Santé basket: Frame price: capped at a maximum of 30 euros. Lens treatments: scratch and anti-reflective treatments included. Lens thinning: lenses are adapted to the correction, including for strong corrections. Frame choices: at least 17 adult models and 10 children's models per optician.

Flexibility allows mixed choices

You can also choose a mixed formula: a frame from the 100% Santé basket with lenses outside the basket, or the reverse. This flexibility allows you to adjust your equipment to your needs while managing your budget.

Progressive lenses are included in class A

The 100% Santé optical program includes progressive lenses in the "class A" basket. People with presbyopia can therefore obtain progressive lenses without out-of-pocket costs, with anti-reflective and scratch treatments included.

Class A covers all correction needs

The 100% Santé basket covers all correction needs: myopia, hyperopia, astigmatism, and presbyopia, including complex corrections. However, some specific treatments (high-end thin lenses, premium blue light filters, photochromic treatments) fall under class B and generate a variable out-of-pocket cost depending on your health insurance.

Renewal period is generally every two years

The renewal of glasses covered by the program generally occurs every two years for adults. This period can be shortened in case of a change in vision justified by a new prescription, or for children. Before the age of 16, renewal is possible every year, and more frequently for those under 6 years old.

Contact lenses are not covered by 100% Santé

The reimbursement of contact lenses depends on your health insurance supplement contract, as contact lenses are not part of the 100% Santé program. The Social Security only reimburses contact lenses in specific cases (irregular astigmatism, high myopia, keratoconus, for example), upon presentation of a prescription.

Contact lens coverage varies by contract

For contact lenses not reimbursed by the Social Security, everything depends on your mutual insurance. Contracts generally include an annual allowance dedicated to contact lenses, expressed in euros per year. This allowance applies whether the contact lenses are disposable, monthly or annual, and often also covers maintenance products according to the guarantees subscribed.

Reimbursement combines two parts

The calculation of your optical reimbursement combines the part of the Social Security and that of your health insurance supplement. For an item outside the 100% Santé, the total reimbursed depends on the level of guarantee in your contract.

Example of reimbursement for non-basket items

Let's take an example for glasses with single lenses outside the basket priced at 250 euros: Social Security base: partial reimbursement on a reduced convention rate. Health insurance supplement: application of the optical allowance provided in the contract (for example 200 euros for a frame and two single lenses). Out-of-pocket cost: difference between the price charged and the total covered.

Reimbursement caps apply to some items

Since 2020, the reimbursement of frames by the health insurance supplement is capped at 100 euros for responsible contracts. It is therefore useful to compare several optician quotes and check the level of your guarantees before any purchase.

CSS beneficiaries get full coverage

Beneficiaries of the Solidarity Health Insurance Supplement (CSS) have access to the 100% Santé equipment basket without out-of-pocket costs, with regulated pricing conditions. A CSS optical reimbursement table specifies the amounts covered according to the type of lenses.

ALD does not change reimbursement rules

If you have a long-term illness (ALD), know that the ALD does not change the rules for glasses reimbursement: it is the 100% Santé and your supplement that determine your optical coverage.

Choosing the right insurance supplement

Choosing a suitable health insurance supplement for your optical needs The right level of optical guarantee depends on your correction and your habits: occasional glasses use, progressive lenses, daily contact lenses. A contact lens user will look for a sufficient annual allowance, while a presbyopia sufferer will prioritize good coverage of progressive lenses outside the basket.

Estimate coverage with an insurance quote

To estimate your coverage and out-of-pocket costs according to your profile, you can get an insurance quote in a few minutes. Our advisors will help you adjust your optical guarantees to your actual situation, to best adapt your guarantees to your situation.

Keep your prescription and quotes

Additional information — Remember to keep your prescription and quotes. In case of a change in your health insurance supplement, these documents facilitate the continuity of your coverage and the calculation of your next renewal.

Optical coverage depends on your contract

Optical coverage is always read in the light of your contract: allowances, caps, and renewal deadlines vary from one formula to another. Taking the time to compare can help you better anticipate your costs when renewing your glasses or contact lenses.

Information is not a substitute for professional advice

The guarantees and conditions are detailed in the contractual documents. Health insurance contracts subscribed with Crédit Agricole Assurances. Pacifica, a company governed by the Insurance Code. The information in this article has no contractual value and is provided purely as an indication and does not engage the liability of Crédit Agricole Assurances; it is in no way intended to replace the knowledge and skills of the reader. It is strongly recommended to consult a professional.