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border="0" cellspacing="0" cellpadding="5" align="center"> <tr> <td align="left" valign="bottom" height="15" bgcolor="#FFCCFF" colspan="2" > <div align="right"><font face="Arial, Helvetica, sans-serif" color="#000000"><a name="hospitalisation"></a></font></div> </td> <td align="left" valign="bottom" height="15" bgcolor="#FFCCFF" colspan="5" > <div align="center"><font face="Arial, Helvetica, sans-serif" size="2" color="#9966FF"><b><i>TOTAL Régime obligatoire & Mutuelle</i></b></font></div> </td> </tr> <tr> <td align="left" valign="bottom" height="15" bgcolor="#FFCCFF" colspan="2" ><img src="images/hosp.gif" width="326" height="51"></td> <td align="center" valign="middle" height="15" bgcolor="#FFCCFF" width="37" > <div align="center"><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFCCFF" width="67"> <div align="center"><font size="2" face="Arial, Helvetica, sans-serif"><i><b>0</b></i></font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFCCFF" width="67"> <div align="center"><font size="2" face="Arial, Helvetica, sans-serif"><i><b>1 </b></i></font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFCCFF" width="67"> <div align="center"><font size="2" face="Arial, Helvetica, sans-serif"><i><b>2 </b></i></font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFCCFF" width="67"> <div align="center"><font size="2" face="Arial, Helvetica, sans-serif"><i><b>3</b></i></font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="2" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1"><b>HONORAIRES (KC, K, CS)</b></font></td> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" width="37" > </td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1"> 80%-100%</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1">125%TC</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">150%TC</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200%TC </font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">AUTRES HONORAIRES (B, Z,...)</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1">80%-100%</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100%TC</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100%TC</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">125%TC</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">PERIDURALE, AMNIOCENTHESE, Refus Régime obligatoire</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1">0</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">45,73 €</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">45,73 €</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">45,73 €</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">SEJOUR, établissements publics ou privés</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1">80%-100%</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100% TR</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">CHAMBRE PARTICULIERE par jour (1)</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> </td> </tr> <tr> <td align="left" valign="top" bgcolor="#E6ACE6" width="5" > </td> <td align="left" valign="top" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1"> <li>SECTEUR PUBLIC</li> </font></td> <td align="left" valign="top" bgcolor="#E6ACE6" > </td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">0</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> </tr> <tr> <td align="left" valign="top" bgcolor="#E6ACE6" width="5" ></td> <td align="left" valign="top" bgcolor="#E6ACE6" width="326" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1"> <li>MAISON DE REPOS ET DE CONVALESCENCE</li> </font></td> <td align="left" valign="top" bgcolor="#E6ACE6" width="37" > </td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">0</font></td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">15,24 €<br> par jour</font></td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">15,24 €/<br> par jour</font></td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">15,24 €<br> par jour</font></td> </tr> <tr> <td align="left" valign="top" bgcolor="#E6ACE6" width="5" > </td> <td align="left" valign="top" bgcolor="#E6ACE6" width="326" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1"> <li>SECTEUR PRIVE SELON L'ETABLISSEMENT</li> </font></td> <td align="left" valign="top" bgcolor="#E6ACE6" width="37" > </td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">0</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">27,44 €<br> par jour</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">36,59 €<br> par jour</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"> <font face="Arial, Helvetica, sans-serif" size="1" color="#000000">54,88 €<br> </font><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">par jour</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">FRAIS D'ACCOMPAGNANT, séjours chirurgie et médecine, limités à 10 nuits</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">0</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">18,29 €<br> par nuit</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">19,82 €<br> par nuit</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">22,87 €<br> par nuit</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">FORFAIT HOSPITALIER à partir du 1er jour (1)</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font color="#000000" face="Arial, Helvetica, sans-serif" size="1">0</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% FR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100% FR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% FR</font></div> </td> </tr> <tr> <td align="left" valign="top" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">SAMU - SMUR</font></td> <td align="center" valign="middle" height="15" bgcolor="#CC99CC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">65%-100%</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFFCC" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF99" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">100% TR</font></div> </td> <td align="center" valign="middle" height="15" bgcolor="#FFFF66" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> </tr> <tr valign="top"> <td align="left" height="15" bgcolor="#E6ACE6" colspan="3" ><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">ASSISTANCE </font></td> <td align="center" height="15" bgcolor="#CC99CC" width="67" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">NON</font></div> </td> <td align="center" height="15" bgcolor="#FFFFCC" width="67" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">OUI</font></div> </td> <td align="center" height="15" bgcolor="#FFFF99" width="67" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" color="#000000" size="1">OUI</font></div> </td> <td align="center" height="15" bgcolor="#FFFF66" width="67" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">OUI</font></div> </td> </tr> <tr valign="top" bgcolor="#FFCCFF"> <td valign="middle" height="15" colspan="2" ><img src="images/denortpar.gif" width="326" height="51"><a name="dentaire"></a></td> <td valign="middle" align="left" height="15" width="37" ><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></td> <td valign="middle" height="15" width="67" align="center" bgcolor="#FFCCFF"><i><b><font size="2" face="Arial, Helvetica, sans-serif">0</font></b></i></td> <td valign="middle" align="center" height="15" width="67" bgcolor="#FFCCFF"><i><b><font size="2" face="Arial, Helvetica, sans-serif">1</font></b></i></td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"><i><b><font size="2" face="Arial, Helvetica, sans-serif">2</font></b></i></td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"><i><b><font size="2" face="Arial, Helvetica, sans-serif">3</font></b></i></td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>DENTAIRE</b></font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">SOINS</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">70%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">150% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">FLUORISATION, forfait annuel</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">45,73 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">45,73 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">PROTHESES - sur base Régime obligatoire plus participation en points Présence (PP) selon le barème interne</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">Plafond 1219,59 €<br> par an<br> Pendant 2 ans</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">Plafond 1524,49 €<br> par an<br> Pendant 2 ans</font></div> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Accord Régime obligatoire</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">70%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"> <font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP<br> (16,01 €)</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP<br> (25,15 €)</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"> <font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP<br> (31,25 €)</font></div> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Refus Régime obligatoire, sur avis dentiste conseil</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP<br> (3,05 €)</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP<br> (16,77 €)</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC<br> + 1PP <br> (22,87 €) </font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">ORTHODONTIE</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Accord Régime obligatoire</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">150% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">175% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Refus Régime obligatoire de 16 à 18 ans, sur avis dentiste conseil</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">75% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>OPTIQUE</b></font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">VERRES + MONTURE, accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">400% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">600% TR</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">FORFAIT OPTIQUE, pas de forfait pour les enfants de moins de 18 ans</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">45,73 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60,98 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">LENTILLES</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Accord Régime obligatoire</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">400% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">600% TR</font></div> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Refus Régime obligatoire, forfait annuel sur prescription médicale</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">45,73 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60,98 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> TRAITEMENT DE LA MYOPIE PAR LASER EXCIMER, forfait par oeil</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">121,96 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">152,45 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="14" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>HONORAIRES MEDICAUX </b></font></td> <td bgcolor="#CC99CC" valign="middle" height="14" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="14" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="14" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="14" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">RADIOLOGIE, ECHOGRAPHIES, côtées en Z, KE, accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">70%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">BIOLOGIE, accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">ANALYSE HORS NOMENCLATURES, après avis médical</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">DENSITOMETRIE OSSEUSE, refus Régime obligatoire après avis médical</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">AUXILIAIRES MEDICAUX, soins infirmiers, kinésithétapeute, orthophoniste, orthoptiste, pédicure...</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>ACOUSTIQUE et ORTHOPEDIE</b></font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">PROTHESES AUDITIVES - ORTHOPEDIE, accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">300% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">400% TR</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">VEHICULE pour handicapé, après avis médical</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">150% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">175% TR</font></div> </td> </tr> <tr valign="top" bgcolor="#FFCCFF"> <td valign="middle" colspan="2" height="15" ><img src="images/medphar.gif" width="326" height="51"><a name="medecine"></a></td> <td valign="middle" height="15" width="37" align="center"><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></td> <td valign="middle" height="15" width="67" align="center"> <div align="center"><font color="#000000" size="2" face="Arial, Helvetica, sans-serif"><i><b>0</b></i></font></div> </td> <td valign="middle" align="center" height="15" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>1</b></i></font></div> </td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>2</b></i></font></div> </td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>3</b></i></font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">CONSULTATIONS ET VISITES</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">70%</font> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">150% TC</font> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TC</font> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">ACTES DE SPECIALISTES côtés en K non chirurgicaux, ECG, EEG, fond d'oeil...</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">70%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">125% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">150% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">PHARMACIE</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65-35%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">ACCESSOIRES, PANSEMENTS (BASE TIPS)</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR </font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">130% TR </font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">200% TR </font></div> </td> </tr> <tr valign="top" bgcolor="#FFCCFF"> <td valign="middle" colspan="2" height="15" bgcolor="#FFCCFF" ><img src="images/prespar.gif" width="326" height="51"><a name="particulier"></a></td> <td valign="middle" height="15" width="37" align="center"><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></td> <td valign="middle" height="15" width="67" align="center"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>0</b></i></font></div> </td> <td valign="middle" align="center" height="15" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>1</b></i></font></div> </td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>2</b></i></font></div> </td> <td align="center" width="67" height="15" valign="middle" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>3</b></i></font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>VACCINS</b> refus Régime obligatoire, forfait annuel</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">30,49 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60,98 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><b><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">TRANSPORT EN AMBULANCE</font></b></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6" > </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6"> <li><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">Accord Régime obligatoire</font></li> </td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TR</font></div> </td> </tr> <tr valign="top"> <td valign="middle" width="5" bgcolor="#E6ACE6"> </td> <td valign="middle" colspan="2" bgcolor="#E6ACE6"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"> <li>Refus Régime obligatoire, limité à 5 transports</li> </font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">7,62 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">15,24 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">15,24 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>CURES THERMALES</b> (21 jours), accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">Une cure par an et par bénéficiaire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">HONORAIRES DE SURVEILLANCE</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">65%</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">100% TC</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">FORFAIT D'HEBERGEMENT</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">114,34 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">152,45 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">FORFAIT THALASSOTHERAPIE en soins externes, accord Régime obligatoire</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">114,34 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">152,45 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000"><b>ALLOCATIONS</b></font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">NAISSANCE ET ADOPTION forfait par enfant</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">114,34 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">152,45 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">MARIAGE, par bénéficiaire adhérent</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">30,49 €</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">60,98 €</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">76,22 €</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">TRAVAILLEUSES FAMILIALES, si accord Caisse d'allocations familiales lié à la maladie de la mère ou du père seul(e)</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">40%</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">40%</font></div> </td> </tr> <tr valign="top"> <td valign="middle" colspan="3" height="15" bgcolor="#E6ACE6" ><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">AIDES MENAGERES, plus de 65 ans si accord Caisse vieillesse</font></td> <td bgcolor="#CC99CC" valign="middle" height="15" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" height="15" width="67"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0</font></div> </td> <td bgcolor="#FFFF99" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0,61 €<br> par heure</font></div> </td> <td bgcolor="#FFFF66" align="center" width="67" height="15" valign="middle"> <div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">0,61 €<br> par heure</font></div> </td> </tr> </table> <hr size=3 color=#DEA9DE noshade width="640"> <table width="640" border="0" cellspacing="0" cellpadding="0" align="center"> <tr> <td> <p><font size="1" face="Arial, Helvetica, sans-serif">(1) Chirurgie, médecine, maternité, maison de repos et de convalescence. Limite de 30 jours par séjour en psychiatrie, plafonnée à 90 jours par an. </font><font size="1" face="Arial, Helvetica, sans-serif">Limite de 240 jours par an, en centre agréé de rééducation fonctionnelle. Placements à l'année exclus.<br> </font><font size="1" face="Arial, Helvetica, sans-serif">Les prestations décrites ci-dessus sont limitées aux frais réels, et aux accords conventionnels départementaux ou nationaux conclus avec les tiers par la mutuelle. Les pourcentages des garanties sont calculés sur la base des tarifs conventionnels ou homologués par les organismes de Régime obligatoire en vigueur au 7 septembre 2002.<br> T.C.= Tarif Conventionnel - T.R.= Tarif de Responsabilité - F.R.= Frais Réels </font></p> </td> </tr> </table> <hr size=3 color=#DEA9DE noshade width="640"> <a name="obs"></a> <table width="640" border="0" cellspacing="0" cellpadding="5" align="center"> <tr valign="top"> <td valign="middle" bgcolor="#FFCCFF" ><i><b><img src="images/garobs.gif" width="326" height="51"></b></i></td> <td valign="middle" bgcolor="#FFCCFF" ><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></td> <td bgcolor="#FFCCFF" valign="middle" width="67" align="center"> </td> <td bgcolor="#FFCCFF" valign="middle" align="center" width="67"> <div align="center"></div> </td> <td bgcolor="#FFCCFF" align="center" width="67" valign="middle"> <div align="center"></div> </td> <td bgcolor="#FFCCFF" align="center" width="67" valign="middle"> <div align="center"></div> </td> </tr> <tr valign="top"> <td valign="middle" bgcolor="#E6ACE6" colspan="2" ><font face="Arial, Helvetica, sans-serif" size="1">Allocation forfaitaire</font></td> <td bgcolor="#CC99CC" valign="middle" width="67" align="center"> </td> <td bgcolor="#FFFFCC" valign="middle" align="center" width="67"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">152,45 €</font></td> <td bgcolor="#FFFF99" align="center" width="67" valign="middle"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">304,90 €</font></td> <td bgcolor="#FFFF66" align="center" width="67" valign="middle"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">457,35 €</font></td> </tr> </table> <hr size=3 color=#DEA9DE noshade width="640"> <a name="garantie"></a> <table width="640" border="0" align="center" cellspacing="0" cellpadding="5"> <tr> <td bgcolor="#FFCCFF"><i><b><img src="images/garhosp.gif" width="326" height="51"></b></i></td> <td bgcolor="#FFCCFF"> <div align="center"><a href="#haut"><img src="images/fleche-up.gif" width="37" height="34" border="0"></a></div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>1</b></i></font></div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>2</b></i></font></div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>3</b></i></font></div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFCCFF"> <div align="center"><font size="2" color="#000000" face="Arial, Helvetica, sans-serif"><i><b>4</b></i></font></div> </td> </tr> <tr> <td colspan="2" bgcolor="#E6ACE6"> <p><font face="Arial, Helvetica, sans-serif" size="1">Indemnité forfaitaire journalière appliquée à partir du 1er jour d'hospitalisation.</font></p> <p><font face="Arial, Helvetica, sans-serif" size="1">Le crédit d'indemnisation est de 180 jours par année civile</font></p> </td> <td align="center" valign="middle" width="67" bgcolor="#CC99CC"> <div align="center"> <p><font face="Arial, Helvetica, sans-serif" size="1">16,00 €</font><font size="1"><br> <font face="Arial, Helvetica, sans-serif"> par jour</font></font></p> </div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFFFCC"> <div align="center"> <p><font face="Arial, Helvetica, sans-serif" size="1">24,00 €</font><font size="1"><br> <font face="Arial, Helvetica, sans-serif"> par jour</font></font></p> </div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFFF99"> <div align="center"> <p><font face="Arial, Helvetica, sans-serif" size="1">32,00 €</font><font size="1"><br> <font face="Arial, Helvetica, sans-serif"> par jour </font></font></p> </div> </td> <td align="center" valign="middle" width="67" bgcolor="#FFFF66"> <div align="center"> <p><font face="Arial, Helvetica, sans-serif" size="1">40,00 €</font><font size="1"><br> <font face="Arial, Helvetica, sans-serif"> par jour</font></font></p> </div> </td> </tr> </table> <p align="right"> </p> <p> </p> <p> </p> </body> </html>