Cegema

What Cegema does

Cegema is a French delegated administrator (délégataire de gestion) specializing in the end-to-end management of health and provident insurance contracts, serving as an outsourced operations partner to insurance carriers, corporate HR departments, insurance brokers, and individual policyholders. Founded in 1990 and headquartered in Villeneuve-Loubet in the Alpes-Maritimes, the company protects approximately 200,000 insured lives, processes €133 million in annual premium contributions, and pays out €100 million in reimbursements annually. Cegema employs 120-180 staff, including 100+ dedicated health insurance experts and 20+ provident insurance experts, and is registered with ORIAS (n° 07 001 328) under ACPR supervision. Since November 2022, Cegema has operated as a wholly-owned subsidiary of the Kereis group, a French insurance brokerage group with 1,700 employees across seven European countries.

The company's product portfolio spans three core service lines: health insurance contract management (gestion de contrat santé), provident insurance contract management (gestion de contrat prévoyance), and since 2021, delegated borrower insurance (assurance emprunteur) deployed with Swiss Life. Distribution is delivered through three role-based digital portals — Espace Assuré for individual policyholders, Espace RH for corporate HR departments, and Cegecour for insurance brokers — supplemented by two mobile applications on iOS and Android. Core technology capabilities include automated DSN (Déclaration Sociale Nominative) processing, Noémie tele-transmission integration (93% connection rate), OCR-based document recognition for photo-submitted claims, AI-powered fraud detection via a partnership with Shift Technology, and a tiers payant (third-party payment) network of 230,000 contracted healthcare professionals managed through iSanté. Operational performance metrics include 90% of reimbursements processed within 24 hours and a >90% customer service call answer rate.

Cegema generates revenue through management fees earned from insurance carriers for delegated administration services across health, provident, and borrower insurance contracts, with no publicly disclosed pricing tiers. Pricing is negotiated on a per-contract basis with carriers and corporate clients. The go-to-market combines self-serve digital portals (PLG) for individual policyholders and employees, enterprise field sales with dedicated account management for HR departments, and channel-partner relationships with insurance brokers via Cegecour and dedicated commercial support. The company completed a major transformation in 2025 encompassing an information system overhaul, deployment of new digital tools, and a refreshed brand identity, positioning the business for continued operational modernization under Kereis group ownership.

Name

Cegema

Legal name

CEGEMA

Website

https://cegema.com

Company type

Private

Founded year

1990

Operating status

Operating

Headcount range

101–250 employees

Short description

Cegema is a French delegated administrator that manages health, provident, and borrower insurance contracts for 200,000 insured lives on behalf of insurance carriers, corporate HR departments, brokers, and individual policyholders, operating as a wholly-owned subsidiary of the Kereis group.

Ownership category

akta.pro rank

Product category

Health and Provident Insurance Administration

NAICS

Other Insurance Related Activities (52429), Claims Adjusting (524291), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

COBRA & Direct Billing Administration (HLAEALAC)

akta.pro secondary industry

Utilization Management (Prior Auth/Medical Necessity) Administration (HLAEALAF)

Keywords

• Health insurance administration
• Provident insurance management
• Delegated insurance services
• Reimbursement processing services
• Third-party payer network

Headquarters

HQ city

Villeneuve-loubet

HQ country

France

HQ region

Europe

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others

Revenue model

1. Health Insurance Management Fees: Cegema acts as a third-party administrator (gestionnaire) for health insurance contracts, earning management fees from insurance carriers for processing reimbursements, handling memberships, and providing customer service to policyholders. The company processes 133M euros in contributions and 100M euros in reimbursements annually.
2. Provident Insurance Management Fees: Cegema manages individual and collective provident insurance contracts (death, disability, incapacity), earning fees from insurers for claims processing, policy administration, and medical management. Active since 2014.
3. Borrower Insurance (Emprunteur) Management: Cegema provides delegated management services for borrower insurance launched in 2021 and deployed with Swiss Life, earning fees from the insurance carrier for processing credit-related insurance claims.

Go-to-market motion3 records

Distribution channels4 records

Marketing channels4 records

Core offering

Cegema is a French delegated insurance administrator (gestionnaire délégataire) that designs, manages, and administers health and provident insurance contracts on behalf of insurance carriers, enterprises, and brokers. The company handles policy subscription, contributions collection, claims reimbursement, third-party payment agreements with healthcare providers, and provides digital self-service portals and mobile applications to policyholders, employees, and HR departments. It also administers borrower insurance (Assurance Emprunteur) and offers accelerated daily allowance (Prest'IJ) services.

Product overview

Cegema offers a unified insurance contract management platform for health and provident insurance, consisting of three primary digital portals (Espace Assuré for policyholders, Espace RH for employers, and Cegecour for insurance brokers) supported by two dedicated mobile applications (Espace Particulier and Espace Salarié). The service modules include Tiers payant iSanté for third-party payment processing, Gestion de contrat santé for health insurance management, Gestion de contrat prévoyance for provident coverage, and Prest'IJ for accelerated daily allowance processing. The platform also features specialized tools like online hospitalization pre-authorization and AI-powered fraud detection to support the complete insurance management lifecycle from enrollment through claims reimbursement.

Differentiator

Problem solved

Functional benefit

Products and services

• Health Insurance Contract Administration (Gestion de contrat santé)

Quantifiable outcome

• 90% of reimbursements processed within 24 hours
• +4 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability2 records

Feature7 records

Partnerships

Two partnerships are on record, tiered core.

• Swiss LifecoreStrategic or Co-development Partner · 1 January 2022Swiss Life partnered with Cegema in 2022 to deploy borrower insurance (assurance emprunteur) management services. Cegema acts as delegated administrator for Swiss Life's borrower insurance products, handling policy administration and claims processing for credit-related insurance.
• iSantécoreTechnology or IntegrationiSanté manages the tiers payant (third-party payment) network for Cegema. Healthcare professionals submit take-charge requests directly to iSanté. iSanté provides the infrastructure for the 230,000-contracted-professional network that enables policyholders to avoid advance payment of medical expenses.

Scale indicators10 records

Recent moves9 records

Expansion highlights6 records

Broad incumbents

• AXA France: Largest French multi-line insurer with group health, provident, and retirement products distributed through brokers and direct channels. Broad incumbent rather than delegated-administration specialist, but overlapping product lines and a potential carrier client for Cegema-style services.
• Malakoff Humanis: Major French social protection group providing health and provident insurance, retirement, and savings. Overlaps with Cegema in employer-sponsored health/provident administration but operates at much greater scale as a multi-line social protection platform.
• Vyv (Harmonie Mutuelle): Major French mutual health insurance group combining a mutuelle with delegated services and a digital health ecosystem. Larger and broader than Cegema, but overlapping health-administration capabilities and distribution through brokers and employers.
• Generali France: Major French multi-line insurer with health, provident, life, and P&C offerings through a broker-led distribution model. Comparable product surface but a broad incumbent rather than a dedicated delegated administrator.
• Swiss Life France: Major French health/provident insurer and Cegema's anchor borrower-insurance delegated-administration partner. Broader portfolio but comparable product surface; a key client-distribution counterparty for Cegema.
• Groupama: French mutual insurer with extensive health, provident, and property-casualty lines, primarily via regional mutuals. Overlaps with Cegema in employer-sponsored health/provident and broker distribution but operates a much broader insurance franchise.

Direct peers

• Almerys: French third-party health insurance administrator focused on claims processing, reimbursement flows, and digital tools for policyholders. Overlaps directly with Cegema on TPA services, reimbursement processing, and digital portal/ecosystem delivery to French insurance carriers.
• Henner: Major French delegated manager for group health, provident, and retirement insurance. Direct comparable: both act as third-party administrators managing reimbursements, affiliations, and broker/HR portals for insurers and employers in France.
• SPVIE: French delegated administrator of health and provident insurance contracts serving brokers, insurers, and policyholders. Operates the same delegated-management business model as Cegema, processing reimbursements and managing individual and collective contracts.

Regional players

• Pro BTP: French social protection group dedicated to construction-sector employees, operating its own health and provident plans with in-house delegated management. Comparable TPA-style business model but specialized to a single industry segment.

Market position

Strengths5 records

Weaknesses6 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/CEGEMAAssurance

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Cegema