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Health insurance (mutuelle) questionnaire

Your health insurance study, in five minutes.

Answer what applies to you: only your contact details are required. No questions about your health: we compare cover, not medical records.

Fill it in online (5 min) Download the PDF
Health insurance (mutuelle) questionnaire, ASSUDIRE
6 stepsabout 5 minutes
Step 1 of 6 · Youabout 5 min left

* Only your contact details are required

1. You
You1 / 6

The policyholder.

Why? Your contact details are used to call you back and to draw up the study in your name.

Title
Marital status
Status
2. People to cover
People to cover2 / 6

You, and your partner and children if any.

Why? Each person's age and where you live set most of the premium.

People to cover
You live in France
3. Your social security
Your social security3 / 6

French social security pays first; the mutuelle tops it up.

Why? Your social security scheme and any employer plan decide what is left to cover.

Your social security scheme
Partner's scheme
Compulsory employer health plan
Madelin contract (self-employed)
4. Your current policy
Your current policy4 / 6

Your current table of benefits is our point of comparison.

Why? To compare like with like, and handle the cancellation for you.

Currently covered
€ / month
Type of policy
What no longer suits you

After one year, a mutuelle can be cancelled at any time, free of charge: we handle the paperwork and there is no gap in cover.

5. Your needs
Your needs5 / 6

Why? So you pay for the cover you use, not your neighbour's.

Your reimbursement priorities
Level wanted
Fees above the official rate
Private hospital room
Payment
Start date wanted
€ / month
6. Documents to attach
Documents to attach6 / 6

Photos or scans are fine.

Why? With these documents, the quote becomes a firm proposal.

No medical information is requested here. If an insurer required a health questionnaire, it would be sent to you directly, in confidence.

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Reply within 24 working hours · No obligation · You receive a copy of your request

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