Long-term care insurance: how to read a contract, point by point

Before comparing two insurance policies, read five key clauses: the definition of dependency (how many out of five daily living activities you can no longer perform independently), the type of benefit (annuity or lump sum), the waiting period, the deductible, and any exclusions. These five clauses are based on information provided by the French Directorate General for Competition Policy, Consumer Affairs and Fraud Control (DGCCRF). The DGCCRF also reminds readers that these contracts are "non-refundable" and are not savings products.

This page is for informational purposes only. It is based on the DGCCRF's (French Directorate General for Competition Policy, Consumer Affairs and Fraud Control) fact sheet "Long-Term Care Insurance," written on October 15, 2018, with no update date displayed. It does not recommend any product or organization. It provides no pricing information, current annuity amounts, or address the taxation of contributions and annuities. The figures in the fact sheet are from 2018 and are clearly marked as such.

What the document calls "dependency"«

The DGCCRF (French Directorate General for Competition Policy, Consumer Affairs and Fraud Control) defines dependency as the condition of individuals who, due to a lack or loss of physical, mental, or intellectual autonomy, require significant assistance or support to perform everyday tasks. It specifies that, according to regulations, only individuals aged 60 and over are eligible for dependency benefits.

The state of dependency must be medically confirmed, under the conditions stipulated in the contract.

The five clauses to read

The guide also recommends carefully reading the exclusion clauses, checking the maximum age for subscription and the presence of a clause for reimbursement of contributions in case of dependency during the waiting period.

The pension changes, and so does the contribution.

Three clauses have a long-term impact.

• The revaluation. The annuity is adjusted according to a rate and under conditions determined by the insurer. Check the contract for details.
• The increase in contributions. According to the information sheet, if the insured refuses the increase in the premium, the annuity may be reduced proportionally or the contract terminated by the insurer.
• The age at subscription. The information sheet indicates that you can take out a policy from age 40 and that, for most contracts, the maximum age for enrollment is between 74 and 77 (2018 figures). The later the insured takes out the policy, the higher the premium. Additional premiums may be added after the medical screening.

Any false statement will render the contract null and void, without reimbursement of premiums paid. It is therefore advisable to answer the medical questionnaire accurately.

Individual or group

Contracts are offered by three families of organizations: insurance companies (Insurance Code), health mutuals (Mutual Code) and provident institutions (Social Security Code).

• The individual contract According to the information sheet, it is signed without an intermediary between the insurer and the policyholder.
• The collective agreement The policy is taken out by a company, a mutual insurance company, or an association. According to the information sheet, it does not require a medical questionnaire and does not include waiting periods or deductibles. The employer contributes to the financing ("often up to 50%," writes the DGCCRF). Three options are available: annual coverage, lifetime coverage, and coverage based on "dependency points.".

It is possible to combine an individual contract and a group contract to cover the risk of dependency.

Contract and APA: the same definition?

The DGCCRF advises checking that the definition of dependency stipulated in the contract corresponds to that adopted by the departmental council for the purpose of awarding the personalized autonomy allowance (APA).

The APA (Personalized Autonomy Allowance) is based on the AGGIR scale: 10 physical and mental activities, considered discriminatory, and 7 domestic and social activities, considered illustrative. The individual is classified into one of the 6 GIR groups. From GIR 1 to GIR 4, they are eligible for the APA. Those in GIR 5 or 6 are not eligible.

The APA (Personalized Autonomy Allowance) is capped. The information sheet on service-public.gouv.fr, verified on June 1, 2026, indicates maximum monthly amounts for in-home APA of €2,080.33 for GIR 1 (dependency level 1), €1,682.30 for GIR 2, €1,215.99 for GIR 3, and €811.52 for GIR 4 (dependency level 4). The page does not specify the year these amounts are applicable: verify them before making any decision. For eligibility requirements and out-of-pocket expenses, see the dedicated APA page.

According to the DGCCRF, benefits from a dependency insurance can be combined with the APA.

Numerical example (fictitious profile)

Situation. Hélène is 63 years old. She is studying a hypothetical contract taken out on March 1, 2027. The assumptions of this profile are: a premium of €90 per month, paid on the 1st of each month starting March 1, 2027, constant for 20 years with no increases; a monthly annuity of €1,500; a 12-month waiting period; and a 90-day deductible, calculated from the date of recognition of disability and treated as three months of annuity payments. These figures are not representative of market rates.

Issue. What happens depending on how the addiction develops?

Strategy. Apply the clauses as described in the document: waiting period, exception for accident, deductible.

Result.

In all three cases, even if Hélène needs help with three out of five tasks, she does not reach the level of total dependency (at least four tasks). An annuity for partial dependency requires that the contract expressly stipulate it.

This profile is fictitious. The calculation illustrates clauses. It does not guarantee the acceptance of an application, nor a price, nor a level of annuity.

What changes depending on your situation

• Your age and health status : they have an impact on the age limit for subscription, medical selection and surcharges.
• The type of contract : individual, collective company, or both.
• The exact wording of the clauses : definition in actions, deficiency, franchise and exclusions differ from one contract to another.
• Your resources and your GIR : they determine what the APA can finance.
• The contract you have before you : the document dates from 2018, its figures should be compared with your general conditions.

The rule depends on your situation. No results are guaranteed.