The coverage of a hair prosthesis by MGEN depends on the type of contract subscribed, the status of the insured, and adherence to a specific administrative process. Between the collective contract of Complementary Social Protection (PSC), individual complementary insurance, and Complementary Health Solidarity (CSS), the reimbursement modalities, out-of-pocket expenses, and access to third-party payment vary significantly.
PSC contract, individual complementary insurance or CSS: different coverages at MGEN
MGEN offers several plans, and not all cover hair prostheses in the same way. The collective PSC contract, intended for public service agents, generally includes a level of guarantee that complements the Social Security base up to the maximum selling price set by regulations. The out-of-pocket expense can then be zero or very low for a class I prosthesis.
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In individual complementary insurance, the level of reimbursement depends on the chosen plan. Some options cover the entire maximum selling price, while others leave a more significant out-of-pocket expense, particularly for class II prostheses whose price exceeds the regulatory ceiling.
For insured individuals benefiting from CSS through MGEN, the logic is different: the coverage aims to eliminate the out-of-pocket expense on devices listed in the List of Products and Services (LPP). However, the choice of model remains limited to references compatible with this framework.
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The reimbursement for women’s hair prostheses by MGEN thus follows distinct rules depending on the contractual status of the insured, making it essential to read the guarantees before any purchase.
Field reports diverge on this point: some insured individuals in individual contracts report out-of-pocket expenses of several hundred euros for a high-end prosthesis, whereas public agents covered by the PSC paid nothing for an equivalent model in class I.
Social Security reimbursement base and MGEN complement: the calculation mechanism
The reimbursement base of Health Insurance is set at €350 for class I and class II hair prostheses. This base serves as the foundation for calculating the complement paid by MGEN, within the limits of the responsible contract.
The responsible contract imposes a ceiling beyond which the mutual insurance cannot reimburse. For a class I prosthesis, the maximum selling price is regulated: the combination of Social Security + MGEN covers the entire price. For a class II prosthesis, the price is free and can significantly exceed the reimbursement ceiling.
Class I and class II: what it means in practice
Class I prostheses use synthetic fibers. Their price remains within the limits set by regulations, allowing a zero or nearly zero out-of-pocket expense for MGEN insured individuals under the PSC contract.
Class II prostheses, made from natural hair or a blend, have significantly higher prices. The portion not covered by Social Security and MGEN remains the responsibility of the insured. In this segment, the out-of-pocket expense can represent a significant portion of the total price, sometimes half or more depending on the chosen model.
Prescription and approved supplier: two non-negotiable conditions
A medical prescription is essential to trigger any reimbursement. The prescription must explicitly mention the need for a hair prosthesis. Without this document, neither Health Insurance nor MGEN will cover the expense. A dermatologist or oncologist can write it, depending on the pathology causing the alopecia.
The choice of supplier also conditions the reimbursement process. An approved distributor by Social Security allows for the activation of third-party payment and avoids upfront costs. A purchase made outside the approved network may jeopardize coverage or even eliminate it entirely.
Here are the steps to follow to secure reimbursement:
- Obtain a medical prescription mentioning the hair prosthesis before any purchase or binding fitting
- Check with MGEN the level of guarantee of your contract (PSC, individual or CSS) and the applicable reimbursement ceiling
- Choose an approved supplier by Social Security, who can practice third-party payment and send the billing directly
- Keep all supporting documents (prescription, invoice, care sheet) for MGEN’s processing of the file
Renewal and accessories: what MGEN takes into account
Renewal is possible every 12 months for total hair prostheses. This period starts from the date of purchase of the previous prosthesis. A new prescription is required for each renewal to trigger coverage again.
Hair accessories (caps, headbands, attachments) may sometimes be subject to separate coverage depending on the MGEN contract. The available data do not allow for a conclusion on a uniform amount: the level of coverage for accessories varies from one plan to another and is not systematically detailed in the guarantee tables accessible online.
Particular case of non-cancer-related alopecia
Non-cancerous alopecia (alopecia areata, severe androgenetic alopecia) also entitles one to coverage, provided that the pathology is recognized and the prescription is compliant. MGEN applies the same reimbursement grids, but the absence of ALD status (long-term illness) may modify the Social Security share, which mechanically increases the out-of-pocket expense for the insured.
Before committing to a model, requesting a detailed quote from the approved supplier and sending it to MGEN allows for an accurate estimate of the out-of-pocket expense. This step avoids unpleasant surprises, especially for class II prostheses where the gap between the displayed price and the actual reimbursement can be considerable.