The Social Security Financing Law for 2024 (LFSS 2024), enacted on December 26, 2023, modifies the calculation of social contributions, more strictly regulates certain medical prescriptions, and reorganizes part of the control of work stoppages. These changes affect employees, self-employed workers, and employers alike.
Single social base for self-employed workers: what LFSS 2024 changes
Before the reform, self-employed individuals had to deal with multiple calculation bases. Social contributions were based on a net professional income, while the CSG-CRDS included deductible social contributions in its base. This coexistence made it difficult to interpret the contribution calls, even for accountants.
LFSS 2024 initiates a gradual unification. The goal is to apply a single social base serving as a common foundation for social contributions and CSG-CRDS. In practice, this means that the same reference income determines all mandatory social levies.
To understand the new provisions of the social security reform, it should be noted that the system was not implemented all at once. A decree from July 2024 completed the technical modalities, and the financing law for 2025 provided additional clarifications. The adoption of LFSS 2024 set the framework, but several regulatory steps were necessary to make the reform fully operational.
Work stoppages via teleconsultation: the new prescription limits
Since January 1, 2024, prescribing a work stoppage during a teleconsultation is subject to stricter rules. A stoppage prescribed remotely is limited to three days, whether for an initial prescription or a first renewal.
Exceptions exist. If the professional consulting remotely is the patient’s primary care physician or their referring midwife, this limit does not apply. The same applies when the patient justifies an inability to consult in person.
This measure aims to limit prescriptions for stoppages on teleconsultation platforms where the doctor does not know the patient’s file. Before this provision, nothing prevented a practitioner consulted via video from issuing a prolonged stoppage from the first interaction.
Employer control of sick leave: clarifications from the July 2024 decree
LFSS 2024 also laid the groundwork for clearer regulation of employer control over work stoppages. A decree published in July 2024 detailed the practical modalities.
Obligation to communicate the control location
The employee on sick leave must now inform their employer of the location where they can be controlled, if it differs from their usual residence. Without this information, the employer can organize a counter-visit at the office of the designated doctor rather than at home.
Distinction between employer control and Health Insurance control
The employer’s control only concerns the salary supplement, not the daily allowances paid by Social Security. Health Insurance maintains its own verification system, independent of that of the company. Confusing the two is common, but the consequences differ:
- If the employer’s counter-visit concludes that the stoppage is not justified, the employer can suspend the payment of the salary supplement provided by the collective agreement.
- If it is the Health Insurance control that reaches the same conclusion, it is the daily allowances that can be interrupted.
- An employee can be kept on leave by Health Insurance while losing their employer supplement after a counter-visit, or vice versa.
Reform of hospital financing and prevention: the structural axes of LFSS 2024
Beyond individual measures, LFSS 2024 initiates changes to the functioning of the health system as a whole.
The text provides for a transformation of the financing method for hospital establishments. The activity-based pricing logic, often criticized for encouraging the multiplication of procedures, must be gradually supplemented by criteria of quality and relevance of care. However, the timeline for this transition remains dependent on implementing texts.
On the prevention front, the law strengthens access to certain screening programs and expands coverage for preventive appointments to additional age groups. The guiding idea is to detect earlier to reduce curative care expenses.
Control of health insurance expenses
LFSS 2024 sets a national objective for health insurance expenditures (ONDAM) that is higher than the previous year, but this increase remains regulated. The text provides for regulation mechanisms on medications, including a tightening of reimbursement conditions for certain categories of health products.
- Renegotiation of prices for certain medications whose patents have expired.
- Encouragement to prescribe biosimilars when they exist.
- Stronger regulation of reimbursable medical devices.
LFSS 2024 is not a fixed text as of December 26, 2023. Several of its provisions depend on decrees published throughout 2024, or even on additions made by the following financing law. For both self-employed individuals and employees, checking the implementing texts remains necessary before drawing conclusions about the actual amounts of contributions or the rights opened.
