OMNES Education splits health cover into three tiers from 2024

The 26 OMNES Education entities grouped under EDUCIN TOPCOLegifrance split their health-cost reimbursement scheme into three tiers from 1 January 2024LegifranceLegifrance, under amendment n°1 signed in Paris on 21 December 2023 with the BETOR PUB CFDT, SNEPL CFTC and SNPEP FO group coordinators. The text revises Articles 4 and 5 of the 21 December 2021 group agreement after the incumbent insurer sought a rise the group rejected, a tender, and talks on 17 October to 4 December 2023.

The structure keeps the base guaranteesLegifrance but separates the old supplementary tier. The scheme now has a mandatory responsible baseLegifrance, a new optional responsible add-onLegifrance, and a retained non-responsible top-upLegifrance. Taking both add-ons preserves the previous top-up cover. The chronic deficit came mainly from the over-complementary tier, where contributions and payouts were out of balance.

The responsible base is compulsoryLegifrance. Monthly contributions, as a share of the monthly social-security ceilingLegifrance (€3,864 in 2024)Legifrance, are 2.36% for single coverLegifrance and 4.52% for family coverLegifrance. Single cover insures only the employee; family cover insures the employee and eligible dependants as defined in the insurer's notice, and dependants must join. Staff pay the rate matching their real family situation, but may stay single on written request by proving dependants hold equivalent group cover each year. Funding is 61% employerLegifrance and 39% employeeLegifrance, with any later change shared in the same proportions.

The optional responsible tier, fully employee-paidLegifrance, costs 0.43% of the ceiling single and 0.59% familyLegifrance. The non-responsible top-up, also fully employee-paid under its own policyLegifrance, costs 0.43% single and 0.54% family. Neither optional tier gets the favourable social and tax treatment, whose conditions they do not meet. Any later change to either optional rate, from legislation or claims experience, falls entirely on the employee, who cannot oppose it.

Choice is in writing at rollout or hiring, with silence counting as refusal. Staff may move from base to either optional tier on 1 January, 1 July, or the first day of the month after a family change, with the request within two months of the change or deferred to the next window, and may return to base only after two years of optional cover except on family change.

Mid-year moves on the compulsory tier are allowed once a year on written request with proof: joining takes effect the first day of the next month, as does exit on a qualifying change, except for statutory dispensations governed by article D. 911-5 du code de la sécurité sociale. Other Article 4 terms are unchanged.

Benefits in force are annexed for information only; they bind only the insurer and may be amended with the employer without revising the agreement. Each employee and new hire receives the insurer's information notice, with individual notice of any change, and the CSE is informed and consulted before any change under article R. 2312-22. The parties meet each half-year to monitor the scheme.

The amendment is open-ended and replaces all same-subject group rules, notably the 2021 agreementLegifrance. It was filed via TéléAccords and with the conseil de prud'hommes of the place of signing, and published in the national database.

Legal basis: Avenant n°1 à l'accord collectif de Groupe EDUCIN TOPCO instituant un régime de garanties collectives de remboursement de frais de santé, articles L.911-1, L.242-1, L.862-4, L.871-1, L.911-7, L.2231-6, L.2231-5-1, D.911-2, D.911-5 et D.2231-2 et suivants du Code du travail, article 83, 1° quater du code général des impôts.