What does “actual costs” mean ?
Actual costs correspond to the sums incurred by an individual for health expenses. Part of the actual costs may be reimbursed by the compulsory scheme, and part may be covered by the complementary health insurance. The part reimbursed by the latter depends on the level of cover taken out. The amount of both reimbursements may not exceed the actual costs incurred.
Often, insurance reimburses you according to the Social Security reimbursement base.
Example: If an insurance pays you 300 from the Social Security reimbursement base, you will only receive 69 euros for a consultation with a general practitioner because the convention fee for a consultation is 23 euros, or 23-300 – 69 euros. In high-medical countries such as the United States, this type of medical expense can amount to more than $150. It is essential to be reimbursed on the basis of your actual expenses.