Question 16362 — maternity health insurance

Summary

Mr. Romain Eskenazi draws the attention of the Minister of Health, Families, Autonomy and Disabled People to the guarantees that will be provided, within the framework of the decrees implementing article 21 (ex article 5) of the law relating to the fight against social and tax fraud, in order to ensure respect for medical confidentiality during the exchange of information necessary for third-party payers. Decision No. 2026-904 DC of the Constitutional Council of June 18, 2026 declared conformity with the Constitution, subject to reservations and with partial censorship, the provisions authorizing supplementary health insurance organizations (OCAM) to process certain data relating to health procedures and services. This compliance is expressly based on the existence of a decree in the Council of State, taken after advice from the CNIL, which must precisely define the categories of data likely to be processed, their methods of access, storage, traceability as well as the guarantees surrounding this processing. However, several organizations representing health professionals and in particular the Union of Women Dental Surgeons (SFCD), in a contribution to the Constitutional Council, underline the need to preserve an essential distinction between the grouping codes, used to for administrative and reimbursement purposes and which neutralize the most sensitive medical information and refined CCAM codes, likely to directly or indirectly reveal information covered by medical confidentiality, such as a pathology, a long-term condition, a specific treatment or certain particularly sensitive medical situations. In the dental sector, for example, over 645 codes refined, nearly 92 would include references to particular pathologies or medical situations, while the grouping codes (36 in number, including 30 specific to dental) already make it possible to ensure reimbursement and the operation of the third-party payer. Until now, the latter was mainly based on these grouping codes in order to preserve medical confidentiality. Therefore, the regulatory definition of categories of data likely to be transmitted to OCAM is of particular importance, especially since the law does not explicitly reserve authorized processing solely for cases of serious suspicion of fraud. The SFCD also notes a fear of seeing the emergence, in the long term, of profiling or segmentation mechanisms for policyholders based on their state of health, in a competitive environment where control of data can constitute a strategic asset, despite the prohibitions imposed by law. This concern is all the greater since the Constitutional Council itself censored, in the same decision, the use of an intermediary for the exchange of information on the grounds that the legislator had not sufficiently specified the categories of data concerned nor the guarantees surrounding their processing. In these conditions, he asks her what guarantees the Government intends to include in the implementing decree in order to ensure that the exchanges of data necessary for reimbursement and third-party payment with a view to legitimately combating fraud remain strictly proportionate to their purposes and fully compatible with respect for medical confidentiality and the private life of policyholders.

Machine translation from French. The official text remains authoritative.

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