The reform of the 100% Health basket applied to hair prostheses redistributes the obligations of complementary health insurance and modifies the out-of-pocket expenses for insured individuals. Since January 1, 2026, the nomenclature distinguishes four classes of total prostheses, one category of partial prostheses, and accessories, each with its own rules for coverage by Health Insurance and mutuals.
Decree No. 2025-1131 and responsible contracts: what changes for mutuals
Decree No. 2025-1131 of November 26, 2025, modifies Article R.871-2 of the Social Security Code. It requires so-called responsible contracts to cover the gap between the reimbursement base and the sales price limit on equipment included in the 100% Health program. Hair prostheses thus become the fifth mandatory item of responsible contracts, alongside optics, dental care, audiology, and wheelchairs.
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Specifically, a mutual that markets a responsible contract must cover the entire out-of-pocket expense for a total class 2 hair prosthesis. The deadline for compliance is set for December 31, 2026. We observe that several complementary organizations have not yet updated their guarantee tables, creating a gap between the applicable law and actual reimbursements.
To verify the compliance of your contract, the starting point remains to consult the specific conditions and compare the amounts indicated with the regulatory scale. The mutual reimbursement for hair prostheses directly depends on the level of coverage subscribed and the class of prosthesis prescribed.
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Health Insurance reimbursement base and sales price limit by class
The reimbursement base of mandatory Health Insurance is identical for all classes of total hair prostheses: 350 euros, textile accessory included. What differentiates the classes is the sales price limit set by regulation and, consequently, the potential out-of-pocket expenses.
| Class | AMO Base | Sales Price Limit | Out-of-Pocket Expense (responsible contract) |
|---|---|---|---|
| Class 1 | 350 euros | 350 euros | 0 euro |
| Class 2 | 350 euros | 700 euros | 0 euro if compliant responsible contract |
| Class 3 | 350 euros | 1,000 euros | Between 0 and 650 euros depending on the contract |
| Class 4 | 350 euros | Free | Variable depending on the contract |
Classes 1 and 2 constitute the 100% Health basket. Class 1 generates no out-of-pocket expenses by design, as the sales price limit is aligned with the reimbursement base. Class 2 requires the complementary insurance to cover the additional 350 euros, an obligation now included in the specifications of responsible contracts.
Classes 3 and 4 fall outside the zero out-of-pocket expense perimeter. A class 3 prosthesis can leave up to 650 euros to be covered by the insured if the mutual does not provide enhanced coverage for this item. Class 4, with a free price, concerns high-end prostheses whose reimbursement depends exclusively on the level of coverage subscribed.
Partial prostheses and hair accessories: a distinct scale
Partial hair prostheses with a manually mounted area benefit from a reimbursement base of 125 euros and an identical sales price limit. The out-of-pocket expense is therefore zero for this type of equipment, without conditions related to the complementary contract.
Hair accessories (sold in packs of three) follow a different scale:
- AMO reimbursement base: 20 euros
- Sales price limit: 40 euros
- Out-of-pocket expense: between 0 and 20 euros depending on the guarantees of the complementary contract
These accessories are often overlooked in mutual comparisons, even though they represent a recurring expense for patients undergoing long-term treatment. We recommend checking if the contract provides specific coverage for this item, separate from the prosthesis package.
Medical prescription and conditions for Social Security coverage
The reimbursement of a hair prosthesis by Health Insurance requires a medical prescription established by a doctor. The pathologies that qualify for coverage are mainly alopecia resulting from cancer treatment (chemotherapy, radiotherapy), certain medically-induced alopecias (alopecia areata, scarring alopecia), and situations covered by a long-term illness (ALD).
The prosthesis must be listed on the list of reimbursable products and services (LPP) to trigger coverage. The authorized distributor bills the Health Insurance fund directly for the AMO portion, and the complementary insurance intervenes on the supplement according to the terms of the contract.
- Mandatory medical prescription, renewable according to the lifespan of the prosthesis
- Product registration on the LPP
- Billing via a referenced distributor
- Third-party payment applicable if the mutual provides for it
Renewal is possible every twelve months for total prostheses, which has a direct impact on the annual budget and on the solicitation of complementary guarantees.
Responsible contract or supplementary contract: decide based on the chosen class
For a class 1 or 2 prosthesis, a standard responsible contract is sufficient to guarantee zero out-of-pocket expenses. The issue lies with classes 3 and 4, where only a supplementary contract or enhanced guarantees can absorb the gap between the sales price limit (or the free price) and the combined AMO plus mutual coverage.
The choice of prosthesis class thus determines the necessary level of coverage. Choosing a class 3 without enhanced coverage exposes one to significant out-of-pocket expenses, sometimes exceeding the annual cost of a targeted supplementary contract for this item.
The 2026 reform clarified the scope of 100% Health for hair prostheses, but it did not eliminate coverage gaps between contracts. Verifying the explicit mention of hair prostheses in the guarantee table, and not just the line “medical equipment,” remains the most reliable precaution before any acquisition.