Mandatory company health insurance: setup, exemptions and ANI rules

Quick answer. Since 2016, every private sector employer must offer mandatory collective health coverage meeting the ANI minimum care basket (100% consultations and treatments, full daily hospital fee, dental at 125% conventional tariff, optical flat rate per 2-year period). Employer finances at least 50% of premium. Certain employees (CDD under 3 months, part-time under 15 hours/week) are exempt. Setup is formalized via employer unilateral decision (DUE), collective agreement or majority referendum.

Since January 1, 2016, every private sector employer with at least one employee must offer collective supplementary health coverage. This obligation stems from Law n° 2013-504 of June 14, 2013 on employment safeguarding and Articles L911-7 and L911-8 of the French Social Security Code.

In 2026, this obligation is well-established, yet remains frequently misunderstood or misapplied by SME directors. Three points structure employer decisions in Paris:

1. The ANI minimum care basket (panier de soins), set since 2015 and unchanged in 2026.
2. Legitimate exemptions: certain employees are not required to enroll in collective coverage.
3. Formalization method: unilateral decision, collective agreement, or referendum.

ANI basket composition since 2015#

The National Inter-professional Agreement (ANI) of November 4, 2015 defines the minimum guarantee floor that all collective health coverage contracts must meet. The basket comprises four elements:

Key point: this ANI basket represents the strict minimum floor. No employer can offer less. Many employers offer extended baskets (audiology, orthodontics, enhanced medical supplies) to remain competitive in salary packages, but ANI is the legal baseline.

Sector agreements and enhanced guarantee levels#

In certain sectors (construction, hospitality, transport, healthcare), collective bargaining agreements impose enhanced baskets. For example, the restaurant industry agreement may require optical coverage at 200 euros/year instead of ANI minimum. Employers subject to sectoral agreements must follow those terms in priority over ANI baseline.

At Cabinet Hayot Expertise, we systematically verify this hierarchy during setup: sector agreement first, then ANI minimum as fallback.

The 50/50 minimum financing rule#

Article L911-7 of the Social Security Code mandates that employers finance at least 50% of collective premium, with employees covering the remainder (typically 40-50% via payroll deduction). This employee portion has been non-deductible from personal income tax since 2013, making health coverage slightly less tax-attractive than equivalent salary raise.

Worked example: 20-employee firm#

Parameters: collective premium 120 euros/month/employee, 55% employer / 45% employee split.

The employer portion is exempt from social security contributions (URSSAF) within the legal limit, but it remains subject to CSG-CRDS at 9.7% (9.2% CSG + 0.5% CRDS, with no base allowance) and, for companies with 11 or more employees, to the 8% social tax (forfait social). This is a point directors often overlook: health insurance contributions are not fully exempt from payroll taxes.

Legal exemption cases under Article D911-2#

Certain employees are not required to enroll in mandatory collective coverage. Article D911-2 of the Social Security Code lists exemptions:

1. Fixed-term contracts (CDD) under 3 months
2. Temporary work assignments under 3 months
3. Very part-time employees: ≤15 hours/week average
4. Employees already covered: benefiting from other collective or individual supplementary coverage at implementation date; or covered as dependents; or receiving Universal Health Coverage Supplement (CMU-C) or Health Coverage Allowance (ACS)
5. Apprentices: if employer contribution would exceed 10% of their pay (rare in practice)
6. Pre-existing employees: may request exemption in writing if holding individual coverage

Caution: no automatic double-contribution avoidance#

An exempt employee does not receive duplicate contributions. If employer doesn't apply payroll deduction for exempt staff (e.g., CDD under 3 months), employer must instead provide compensatory allowance or incorporate cost in gross salary to maintain equality principle.

At Cabinet Hayot Expertise, we've seen multiple URSSAF assessments against SMEs that implemented collective coverage without offering alternatives to exempt CDDs or apprentices—URSSAF deems this wage discrimination.

Three legal implementation methods#

Article L911-7 of the Social Security Code and case law recognize three legitimate paths to institute mandatory collective coverage:

1. Employer unilateral decision (DUE) — written and dated

   • Formal document, signed by director or authorized representative.
   • Must specify: premium amount (monthly contribution), employer/employee percentage split, insurer name, effective date, enrollment mechanics.
   • Written notice required for each affected employee.
   • No advance ratification legally required (contrary to common misconception).

2. Standard collective agreement

   • Signed between management and union representatives or union delegate.
   • Provides enhanced legal protection: difficult to contest in disputes.
   • May establish guarantee levels exceeding ANI minimum basket.

3. Majority referendum (rare in practice)

   • Written consultation of all employees on a proposed agreement/DUE.
   • Vote majority (>50% of votes cast).
   • Used mainly absent union representation or in large firms to legitimize agreement.

Works Council consultation and informal procedure#

For firms with 50+ employees, the Works Council (CSE) must be consulted prior to implementation. However, this opinion is non-binding: it's procedural. Failure to consult exposes employer to obstruction offense (Article L2316-1 Labor Code).

For firms under 50 employees, CSE consultation is not required. Written employee notice suffices.

Cabinet Hayot Expertise recommendation#

We prioritize written DUE for three reasons. First, it's fastest (15 days from notice to effect). Second, it offers immediate legal clarity versus 2-3 months for negotiated agreement. Third, it allows flexibility: modifying DUE terms is simpler than renegotiating a collective agreement.

CSG and CRDS: partial exemption, not total#

The employer contribution to collective coverage is not exempt from CSG-CRDS. It is subject at 9.7% (9.2% CSG + 0.5% CRDS) on the full contribution, without the 1.75% base allowance applicable to wages. An 8% social tax (forfait social) also applies for companies with 11 or more employees. The exemption from social security contributions is itself capped (6% of the annual Social Security ceiling plus 1.5% of gross annual pay, within a 12% ceiling).

However, this CSG-CRDS charge is not directly passed to employer as URSSAF payroll tax: it's a declarative deduction reported on DSN (Payroll Reporting Declaration) and invoiced per standard regime.

Employee income tax reinstatement#

The employee portion withheld from payroll (e.g., 50 euros/month) is not deductible from income tax. This has been French law since 2013. An employee earning 2,500 euros gross with 50 euros health insurance deduction must report 2,500 euros taxable income to tax authorities (not 2,450). This makes health coverage slightly less attractive than equivalent salary in personal tax terms.

At Cabinet Hayot Expertise, we use this point in collective negotiations: a 50 euros/month health benefit costs the employee roughly 15-20 euros additional tax—a fact generic salary packages often obscure.

Recently, a Paris SME director consulted us about implementing first collective coverage. He mistakenly thought only employees with 1+ year tenure were required, that informal email DUE sufficed, and that reduced-basket coverage (50-euro optical) was legal. Three costly errors.

In practice, the three most common pitfalls are:

1. Misunderstood exemptions: believing CDDs, apprentices, and part-timers are all exempt without employer counter-contribution. Law says: exemption from enrollment requirement, not from employer contribution obligation. Thus either reduced employee deduction or compensatory allowance must appear on their paycheck.

2. ANI basket confused with commercial offerings: insurer proposes "enhanced optical basket at 300 euros." Tempting for employee recruitment, but employer forgets they must finance 50% of this enhanced basket, not just ANI minimum. This can raise annual costs 30-40%.

3. Informal DUE without written proof: verbally telling an employee "next month you have health insurance" does not constitute written DUE. URSSAF upon audit demands dated written proof. Several SMEs have been denied CSG-CRDS exemption on periods lacking formal DUE.

Annual basket audit#

In 2026, insurers update ANI baskets and optical/dental flat rates in line with indexation. At each contract renewal, verify that your guarantee level still meets the ANI minimum: an insurer cannot drop below it without a written amendment. Keep the renewal documentation, since it is the proof URSSAF will request if your social-contribution exemption is challenged during an audit.

DSN payroll reporting details#

The payroll health-insurance deduction must be declared via code 0015 or the dedicated CTP, depending on your payroll software (Silae, PayFit, Lucca, Sage). A common error is to omit this line in the DSN, which triggers "missing contribution" flags during URSSAF audits and can cost the exemption retroactively. Reconcile the deduction shown on the payslip with the DSN total every month.

Works Council and insurer change: material modification rules#

If the firm switches health insurers, determine whether the change is material. If it is (new rates, a new basket of guarantees), the works council (CSE) must be re-consulted in companies with 50 or more employees, and the DUE or collective agreement must be updated before the new contract takes effect.

To implement or audit your collective coverage in 2026, ensure three non-negotiable points: