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 terms outlined in the supplementary health insurance contract, the insurer’s coverage may take two forms:
- Direct Coverage : The policyholder submits the required documents before hospitalization, as specified in the contract. The insurer’s response time is also defined in the contract.
- Reimbursement : The policyholder provides proof of medical expenses incurred. The insurer then processes reimbursement within the timeframe stated in the contract.
Claims must be submitted according to the contractual provisions, and compensation is paid based on the Fees Structure outlined in the contract, without exceeding the specified limits.
Type of Insurance
Supplementary health insurance is a personal insurance policy that can be subscribed to individually or within a group insurance scheme. For instance, a school may subscribe to a policy for the benefit of its students to provide enhanced medical coverage beyond basic Mandatory Health Insurance (AMO) in Morocco.
As the subscriber of the group contract, the educational institution is required to provide each insured member with a notice, issued by the insurer, detailing the coverage, the conditions of entry into force and the claim procedures. This ensures comprehensive health protection and facilitates access to quality healthcare.
Who’s Concerned by this Insurance
Parents and legal guardians of pupils and students have the option to take out supplementary health insurance to extend medical coverage to one or more family members, including the pupil/student. The latter will be designated as the policyholder upon subscription.
Students already benefiting from Mandatory Health Insurance (AMO) may also subscribe to supplementary insurance to cover the portion of medical expenses not reimbursed by the AMO scheme.
Rights and Obligations of the Insured
To fully understand the rights of the insured , obligations, and procedures for health insurance claims, we invite you to consult the "Insurance Guide" available on the ACAPS portal. This guide provides essential information on contract terms, claim procedures, regulatory compliance, and the role of health insurers in Morocco.
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 (ACAPS), 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
Under Article 7 of Law No. 64-12, ACAPS is authorized to investigate complaints from policyholders regarding insurance companies and intermediaries (brokers).
However, it is recommended to first contact the broker or insurer concerned. If the dispute persists, the policyholder may submit a complaint to ACAPS through the available channels. The Authority will then examine the case and take appropriate action in accordance with the applicable legal and regulatory provisions.
