Mutualist Complementary Health Insurance Coverage Explained

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.

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?

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.

Legal remedies in case of dispute with your social security institution

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 social security institutions. Nevertheless, it is recommended that you first contact the institution 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