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Whether through social security systems or more informally, history shows that mutual health insurers have always taken an active role in organising the coverage of health insurance for the population, forging a spirit and identity based on solidarity, democracy and nonprofit values. However, despite their importance nationally, mutuals have come under pressure from European legislation on competition, which treats them like conventional firms. The mutual difference has thus been reduced to an organisational form and a certain type of mission. This article shows how redefining the nonprofit status in European law could restore the mutualist spirit and an identity based on long-held values.