french military complementary health insurance: pre-mandatory employer coverage

Background :since january 2025, complementary health insurance (chi) has become mandatory and employer-sponsored in the french armed forces. prior to this reform, no study had assessed the status of private chi among active-duty service members (adsm). objectives :this study aimed to estimate the prevalence of noncoverage and to identify factors associated with noncoverage and forgone care. methods :we conducted a retrospective analysis using data from the 2019 enquête nouvelle génération survey, which included 5,000 adsm. results :the estimated noncoverage rate was 4% (95% ci [3.4 - 4.7], n = 165). two factors were significantly associated with noncoverage: contract type and rank. contract personnel had lower coverage than career adsm (or = 0.57; 95% ci [0.33 - 0.97]; p = 0.04). non-commissioned officers were less likely to be covered than enlisted personnel (or = 1.74; 95% ci [1.09 - 2.78]; p = 0.02), while the difference was not significant for officers. in addition, 28.4% of adsm reported having forgone at least one type of care for financial reasons in the past year, mainly alternative medicine consultations. no significant difference was observed based on insurance status. this rate is higher than that in the general population, although direct comparisons are limited. conclusions :the rate of chi coverage among french adsm was similar to that of the general population. factors associated with noncoverage were mainly socioeconomic characteristics. based on these findings, the 2025 reform introducing employer-sponsored mandatory chi is expected to improve coverage among young contract service members, who are generally more vulnerable to risk.