Mutualist Complementary Health Insurance coverage
What is a mutual insurance organization ?
Mutual insurance organizations, or mutuals, are non-profit associations that aim to provide their members and their families with social protection, solidarity, and mutual aid to cover risks that may affect individuals.
The composition of the mutual insurance sector in Morocco
The mutual insurance sector in Morocco consists of 28 mutual insurance organizations, including the National Fund of Social Welfare Organizations (CNOPS), which is a union of eight mutual organizations from the public sector. These 28 mutual organizations are distributed as follows :
- 11 mutual organizations established by public sector employees
- 7 mutual organizations for employees in the semi-public sector
- 5 mutual organizations formed in the private sector
- 5 mutual organizations covering professionals in liberal professions
How to benefit from complementary AMO coverage through a mutual organization ?
To benefit from complementary Mandatory Health Insurance coverage provided by a mutual organization, individuals must :
- Belong to the target population of the mutual organization
- Enroll in the mutual organization
- Pay the required contributions
The family members of an affiliate may also benefit from complementary medical coverage through a mutual organization. This generally includes the spouse(s) and children, subject to certain age conditions.
What Is ACAPS’s Role in Supervising and Regulating the Mutual Insurance Sector ?
The Supervisory Authority of Insurance and Social Welfare (ACAPS) has broad powers in supervising the social welfare sector and ensuring compliance with regulations applicable to mutual organizations. In this context, ACAPS conducts in-depth technical supervision, including document verification (off-site audits) and on-site inspections.
Additionally, ACAPS is responsible for monitoring the financial and actuarial balance of mutual organizations. It also proposes corrective measures to maintain or restore their financial stability.
ACAPS also ensures the protection of insured persons, affiliates, members, and beneficiaries by reviewing and addressing all complaints related to the mutual insurance sector.
