Mandatory company health insurance in France: employer obligations, minimum benefits, exemptions

Mandatory company health insurance in France requires every private-sector employer to offer a group supplementary health plan to all employees, fund at least 50% of the premium and guarantee a minimum basket of benefits under a so-called "responsible" contract. The obligation applies from the first employee and has been in force since 1 January 2016. What changed in 2026 is not the principle but the cost: an average 4.7% increase on group contracts, a shift of costs from the public health system to supplementary insurers and a new 2.05% tax on premiums. For a CEO or CFO, the question is no longer "am I compliant?" but "is my contract still fairly priced for what it covers?".

What does the law require from employers on mandatory company health insurance?

The framework comes from the national interprofessional agreement (ANI) of 11 January 2013, transposed by the law of 14 June 2013 and codified in Article L911-7 of the French Social Security Code. It sets three obligations: cover every employee through a collective, compulsory scheme; pay at least half of the premium; and meet a minimum floor of benefits, known as the "ANI basket".

A collective and compulsory scheme is a contract covering an objective category of employees (all staff, or all managers, or all non-managers) that every employee in that category must join, unless an exemption provided for by the regulations applies. This status is what allows the employer's contribution to escape social security contributions. An employer offering no cover, or funding less than 50%, is exposed to claims from employees and to a reassessment by Urssaf, the French social contributions agency. The dedicated page on service-public.fr summarises these obligations.

What must the minimum basket of benefits include?

The minimum basket, defined in Article D911-1 of the Social Security Code, is the floor every company health plan must reach: the full co-payment (ticket modérateur) on reimbursable care, the daily hospital charge without time limit, dental prosthetics and orthodontics at 125% of the official tariff, and an optical allowance of €100 to €200 every two years depending on the correction.

What is a "responsible" contract, and why does it drive your exemptions?

A responsible contract is a supplementary health plan that meets a specification set by the State: co-payments covered, "100% Santé" caps respected, excess fees reimbursed within limits depending on whether the doctor has signed the OPTAM agreement, and the flat-rate contribution and deductibles excluded. In return, the additional solidarity tax is reduced (13.27% instead of 20.27%) and the employer enjoys a favourable social regime.

The employer contribution is exempt from social security contributions up to 6% of the annual social security ceiling (€48,060 in 2026, i.e. €2,883.60) plus 1.5% of the employee's gross annual pay, with the total capped at 12% of the ceiling (€5,767.20). It remains subject to CSG-CRDS and, from 11 employees, to the 8% "forfait social" levy. The specification keeps moving: the decree of 26 November 2025 added wheelchairs and hair prostheses under "100% Santé", with a grace period until 31 December 2026 to update policy documents and founding acts. A contract that falls out of line loses the exemption on the entire employer share.

A poorly calibrated company health plan costs you twice: first in premiums that are too high for benefits nobody uses, then in a reassessment if the scheme loses its collective, compulsory or responsible status.

DUE, collective agreement or referendum: how do you set up the scheme?

Signing with an insurer is not enough: you need a founding act that gives the scheme its collective and compulsory nature and lists the accepted exemptions, through a collective agreement, an employee referendum or a unilateral employer decision.

The unilateral employer decision (décision unilatérale de l'employeur, or DUE) is a written document by which the employer establishes the scheme, sets the beneficiaries, benefits, funding split and exemptions, then hands it to each employee against signature. It is the most common route in SMEs without union representatives, with one limit: an employee already on the payroll when the scheme is introduced may refuse to join if it means a salary deduction (Article 11 of the Evin law). Check your collective bargaining agreement too: many industry agreements impose a basket or an employer contribution above the legal minimum.

Which employees can opt out of the company plan?

Some exemptions are a matter of public policy and apply even if the founding act is silent (Article D911-2): fixed-term or temporary workers on contracts under three months who can prove they hold responsible cover elsewhere, beneficiaries of the means-tested Complémentaire santé solidaire, employees already covered by an individual policy until it expires, and employees covered elsewhere under a compulsory group scheme, for instance as a dependant on their spouse's plan.

Others only apply if your DUE or agreement mentions them: fixed-term contracts under twelve months, contracts of twelve months or more where the employee proves individual cover, and apprentices or part-time staff whose premium would reach 10% of their gross pay. An exemption is always requested in writing by the employee, with supporting documents, and kept on file by the employer: it is the document Urssaf asks for. For very short contracts, the employer may substitute the "versement santé", a monthly cash allowance (reference amount €22.27 in 2026).

How much does company health insurance cost in 2026, and why are prices rising?

For an SME, a group contract typically costs between €40 and €60 per month per employee for single cover close to the minimum basket, and between €80 and €150 for a comfortable level or family cover. These market ranges vary with the average age of the workforce, the region and the level of benefits chosen.

According to the Mutualité Française, premiums rose on average by 4.3% on individual contracts and 4.7% on group contracts on 1 January 2026. The 2026 Social Security Financing Act (Law no. 2025-1403 of 30 December 2025) created a 2.05% tax on health premiums, estimated at around one billion euros, and shifted some €400 million of hospital costs onto supplementary insurers. Its Article 13 provides for a freeze on premiums for 2026, which insurers are contesting: the Conseil d'État referred the question to the Constitutional Council on 24 July 2026, with a ruling expected in the autumn at the time of writing.

How do you renegotiate your group health plan above 20 employees?

Below around twenty employees, insurers offer standardised products priced on market statistics: negotiation is about benefits, not unit price. Above that, and even more so above 50, your own claims experience matters. The insurer produces an annual account for the scheme. The loss ratio, or claims-to-premium ratio, is the key figure: at 75%, the insurer paid out €75 for every €100 collected, the remainder covering costs, taxes and margin.

Ask for it every spring to prepare the 31 December renewal. A loss ratio consistently below 80% justifies refusing the annual indexation or obtaining richer benefits at constant cost; a high ratio calls for rebalancing the most used lines, or adding an optional top-up plan. Switching insurer is possible every year with two months' notice, without any gap in cover if the new insurer takes on employees receiving ongoing treatment and former employees under portability. Run the renegotiation together with your group life and disability cover, often placed with the same carrier, drawing on our ten levers to reduce an insurance premium.

Frequently asked questions

Is company health insurance mandatory from the first employee?

Yes. Since 1 January 2016, Article L911-7 applies to every private-law employer with no headcount threshold; only private individuals employing domestic staff are exempt.

Can an employee opt out because they are covered by their spouse's plan?

Yes, provided the spouse's scheme is itself collective and compulsory and covers them as a dependant, with proof supplied every year. This exemption is a matter of public policy.

What happens to an employee's health cover when they leave the company?

They benefit from portability (Article L911-8): cover is maintained free of charge for a period equal to their last employment contract, up to twelve months, as long as they receive unemployment benefits from France Travail.

Can the employer fund more than 50% without losing the exemptions?

Yes, up to 100%. The exemption holds as long as the employer contribution stays below the cap (6% of the annual ceiling + 1.5% of pay, capped at 12% of the ceiling) and the scheme remains collective, compulsory and responsible.

At Lesto, we start from your actual headcount, your collective bargaining agreement and your scheme's annual account, then consult nine insurers on average to secure the right benefits at the right price, health and group protection together. Is your current plan still competitive? Discover our group protection offer and request an analysis of your contracts within 72 hours.