tierpayant

Tierpayant, also written tiers-payant, is a payment mechanism in health care under which the provider is paid directly by a health insurance fund or mutual health organization for covered services, so the patient does not need to pay upfront. If a service is fully covered by the insurer, the patient’s out-of-pocket payment may be zero; otherwise the patient may owe only a controlled remainder.

In practice, the patient presents a health card or enrollment proof. The health professional or pharmacy submits the claim to the insurer or mutual fund, which settles the bill directly with the provider. The patient may still be responsible for any non-covered portion (a co-payment or gap) if the contract or service does not fully cover the charge. The process aims to simplify access to care and reduce immediate financial barriers for patients.

There are variations of tierpayant. The tierpayant intégral (or général) covers the entire amount for eligible services, leaving the patient with no upfront payment. The tierpayant partiel covers only part of the bill, with the patient paying the rest. Some systems distinguish between public social security schemes and complementary insurers (mutuelles) that may also participate, coordinating payments to providers.

Benefits of tierpayant include easier access to care, reduced administrative burdens for patients, and more predictable immediate expenses. Limitations include that not all services or providers participate, some payments remain the patient’s responsibility, and reimbursement times can vary. The mechanism is commonly associated with national or social health insurance setups in which a third-party payer coordinates settlement between providers and payers, contributing to the broader financing and administration of health care.