Refractive surgery: what will your complementary health insurance reimburse?

Having myopia, astigmatism or hyperopia operated on represents a budget, and the first question is often a financial one. The key point up front: many complementary health insurance policies (in France, a “mutuelle”) provide an allowance dedicated to refractive surgery, the amount of which varies widely from one contract to another — it is the main lever on what you are left to pay. The national health insurance, for its part, does not cover this procedure, which it classes among elective acts. Here is how to read your contract, how an allowance is calculated, what the waiting period is for, and which steps to take.

Straight answer: an insurance allowance, nothing from the state scheme

Key point. Many complementary health insurers offer a “refractive surgery allowance”, expressed in four different ways depending on the contract — per eye, per procedure, per calendar year, or as a percentage of the monthly social security ceiling. Depending on the level of cover, this allowance ranges from a few hundred euros to more than a thousand euros per eye. The national health insurance, for its part, pays nothing: it covers neither LASIK, nor PRK, nor SMILE, nor the ICL phakic implant (ameli.fr). Finally, keep the waiting period in mind, which is common on this item: it is the leading cause of a forfeited allowance.

Why the national health insurance does not reimburse

Refractive surgery replaces an optical correction (glasses or contact lenses) that the national health insurance regards as visual comfort. On that basis, the procedure is not listed among reimbursable acts, whatever the refractive error being corrected. It is the same logic that explains the absence of any sick leave after the operation.

The national health insurance states it unambiguously on its page devoted to myopia: “Refractive surgery is not covered by the Assurance Maladie. It is covered, often in part, by certain complementary health insurers, depending on the policy taken out” (ameli.fr). This rule applies to every technique for correcting sight by laser or by implant, as long as the aim is to become free of glasses or contact lenses. The distinction matters: an operation motivated by a disease of the eye can, by contrast, qualify for cover. We return to this further down in connection with cataracts, whose regime is very different.

The insurance allowance: how it works

Before comparing amounts, you have to compare units. One and the same figure shown on two schedules of benefits does not mean the same thing depending on the way the allowance is expressed, and that is where the widest gaps are decided. Four wordings are in circulation.

The gaps from one contract to another are considerable, and the highest levels of cover logically provide the most generous allowances. Three further clauses deserve to be read before signing or before scheduling a procedure: the waiting period, dealt with below; the exclusions and ceilings, in particular any sharing of the ceiling with the optical item; and the limit of once in the member’s lifetime, which some contracts provide for.

To find out what you are entitled to, look in your schedule of benefits for the line “refractive surgery”, “eye surgery” or “myopia operation”. If in doubt, a call to your insurance adviser will get you the exact amount and the conditions.

Read the units of the allowance carefully. An amount shown “per eye” doubles when both eyes are operated on, whereas a ceiling “per year and per beneficiary” applies to the procedure as a whole, whatever the number of eyes. Some contracts also reserve the highest allowance for a minimum length of membership, or cap it at once in the member’s lifetime. These nuances noticeably change the final calculation.

Watch out for the waiting period

Many complementary health insurers apply a waiting period to refractive surgery. In everyday practice it runs from three to twelve months after you sign up, depending on the contract — no legislation frames it, each insurer sets its own. If you have the operation before the end of that period, the allowance is not paid, and it is not paid retrospectively either. It is the leading cause of a forfeited allowance, and it is entirely avoidable: the end date of the waiting period appears in your general terms and conditions, and all you have to do is schedule the procedure after it.

This period has a direct bearing on a question many people ask: should you change policy, or move up a tier, to obtain a better allowance? The calculation fits on one line:

Net gain = Allowance obtained − (extra monthly premium × number of months held)

An example makes it concrete. A higher tier costs €25 more a month and opens entitlement to an allowance of €600 after a twelve-month waiting period. By the time of the operation you will have paid €300 in extra premiums: the net gain is €300. If the waiting period is twenty-four months, the extra cost reaches €600 and the net gain falls to zero. And that calculation assumes you keep the policy at least until the procedure — which is to say that you also have to weigh what the higher tier does, or does not, bring you on the other health items.

How to get reimbursed: the steps

The good news: the steps are simple and take just a few stages. They rest on two key documents, the quote handed over before the operation and the paid invoice provided afterwards. It is on that basis that your insurer calculates and pays out the allowance you are entitled to.

1. Obtain a detailed quote at the end of the pre-operative assessment. It specifies the technique chosen (LASIK, PRK or SMILE), the cost per eye and what is included in the centre’s package.
2. Send this quote to your insurer, asking for a “prise en charge” (coverage confirmation) or, at the very least, a written estimate of the amount reimbursed. This step removes any ambiguity before you commit.
3. Check the nature of the allowance quoted by your adviser: an optical allowance that includes surgery, or a dedicated “refractive surgery” line separate from the glasses and contact lenses item.
4. After the operation, send in the paid invoice to your insurer, through your online account or by post. The allowance is then paid according to the terms of your contract.

In most cases, since refractive surgery is not an act reimbursed by the national health insurance, there is no care statement to send to the state scheme. The process therefore comes down to a direct exchange with your insurer, which keeps things simple.

What you are left to pay, and the financing options

Let us be transparent: even with a good allowance, an out-of-pocket amount almost always remains. The insurance allowance covers part of the cost, rarely all of it, especially when both eyes are operated on. Estimating that remaining amount in advance avoids nasty surprises and lets you decide with a clear head.

The calculation is simple: subtract the allowance quoted by your insurer from the amount on the quote. The difference is what you finance yourself. Depending on the contract and the technique, this out-of-pocket amount can range from a few hundred euros to most of the expense, if your cover has no refractive surgery line.

Several levers can ease this effort. Many centres offer payment spread over several instalments, which spreads the expense over several months without having to settle everything on the day of the procedure. It can also be wise to compare your level of cover when your contract comes up for renewal, if the operation is being considered in the medium term. Finally, operating on both eyes within the same calendar year can, on some contracts, optimise the use of an annual allowance.

Lowering what you are left to pay: the right reflexes

• Ask for a detailed quote before deciding: it specifies the technique, the cost per eye and what is included.
• Compare your allowance with the quote to estimate the real out-of-pocket amount.
• Check when the waiting period ends and plan the operation accordingly.
• Ask about the payment facilities offered by the centre, which sometimes let you spread the expense.

FAQ

Frequently asked questions

Sources

1. Assurance maladie. Correction de la myopie et suivi de l’enfant myope — « La chirurgie réfractive n’est pas prise en charge par l’Assurance Maladie. » (Refractive surgery is not covered by the French national health insurance.) ameli.fr.
2. Ministerial order of 22 December 2025 setting the social security ceiling for 2026 — monthly ceiling set at €4,005. legifrance.gouv.fr.
3. Assurance maladie. Lunettes et lentilles: remboursement — annual allowance of €39.48 per fitted eye, reimbursed at 60%, subject to eligible indications. ameli.fr.
4. DREES. L’optique médicale, in Les dépenses de santé en 2024, 2025 edition, sheet 16. drees.solidarites-sante.gouv.fr.

Further reading

• Contact lenses or surgery: the true 10-year cost
• Refractive surgery prices

Estimating the budget for your operation in Cachan or Paris 5

The cost depends on the technique suited to your eye, determined during the pre-operative assessment. For a clear view of the budget and the terms, see our refractive surgery prices page, then book an appointment with Dr Moïse Tourabaly in Cachan or Paris 5 for a personalised quote.

This article is informative and educational in purpose. It does not replace a medical consultation or insurance advice. Allowance amounts, conditions and waiting periods depend on each complementary health insurance policy: check your cover with your insurer. Refractive surgery is not covered by the national health insurance.