Health insurance
Supplementary health insurance, or complementary health insurance, is a voluntary insurance that supplements basic medical coverage (AMO).The purpose of this insurance is to guarantee the payment and/or reimbursement of medical, surgical, hospitalisation and pharmaceutical expenses incurred by the policyholder following an illness or accident.
How Does it Work?
Depending on the case and as specified in the supplementary health insurance contracts, the Insurer's benefit may consist of:
Coverage: In this case, the policyholder must provide the Insurer with the supporting documents provided for in the contract before the date of hospitalisation, in accordance with the terms and conditions indicated in the contract. The deadline for notification of the assumption of responsibility for the medical/hospital procedure is set out in the contract.
or a Reimbursement: In this case, the policyholder must provide the Insurer with the documents justifying the costs incurred. The time limit for reimbursement is fixed in the contract.
The claim shall be made in accordance with the conditions laid down in the contract.
Compensation shall then be paid in accordance with the Fees Structure set out by the Insurer in the contract and without exceeding the ceilings provided for therein.
Type of Insurance:
Supplementary health insurance is a personal insurance policy that is taken out individually or as part of a group insurance scheme, for example, by a school for the benefit of its pupils/students.
The school, in its capacity as the group contract's subscriber, is required to provide each member with a notice, drawn up by the Insurer, which defines the cover and the conditions for its entry into force as well as the formalities to be completed in the event of a claim.
Populations Concerned:
Parents and legal guardians of pupils and students may take out supplementary health insurance for one or more members of their family, including the pupil/student. The latter shall be named as the policyholder when taking out the contract.
Students with compulsory health insurance (AMO) can also take out supplementary insurance to cover the part of the costs not covered by the AMO.
Rights and Obligations of the Insured?
We invite you to refer to the "Insurance Guide" published on the ACAPS portal.
What does the Authority do?
Within the framework of the powers vested in it by Law No. 64-12 establishing the Insurance and Social Security Supervisory Authority, the latter institution ensures that any and all insurance products offered to consumers are understandable, balanced, useful and that they comply with the regulations in force. It also shall monitor the reliability of the information provided to policyholders and ensure the fair treatment of policyholders by Insurers.
Legal/Judicial Remedies in Case of Dispute with Your Insurer?
In accordance with Article 7 of Law No. 64-12, the Insurance and Social Security Supervisory Authority has the power to investigate complaints from customers of insurance companies and the intermediaries (brokers) thereof. Nevertheless, it is recommended that you first contact the broker or Insurer against whom your complaint is directed. If the dispute persists after this step, you can contact ACAPS by one of the means at your disposal. The Authority shall then examine your complaint and take the most appropriate action, in accordance with the legal and regulatory provisions and within the scope of its powers, to settle the dispute
