What is supplementary health coverage?
Supplementary health insuranceis an optional insurance that complements basic medical coverage (AMO).
A guarantee that allows you to improve your medical coverage and reduce your "out-of-pocket" expenses.
How does it work?
Supplementary health insurance, as the name suggests,comes in complement to the basic coverage benefits. It covers, partially or in full, procedures that are not reimbursed by the basic mandatory health insurance and those that are reimbursed very poorly, to ensure you have the best possible coverage.
This policy can be taken out with a mutual insurance company, an insurance company or a provident institution.
What guarantees are covered?
Not all contracts offer the same level of reimbursement. A supplementary health insurance will cover :
- Medical consultations and care;
- Medicinal productswhen a medical prescription is available;
- Hospitalizationcosts;
- Dental care and prostheses;
- Optical and ophthalmological care;
- Etc.
And other levels of reimbursement depending on the T&Cs of your policy.
What are the reimbursement terms?
Depending on the case and as specified in the supplemental health insurance contracts, the insurer's benefit may consist of:
- a Coverage: in this case, the insured person must provide the insurer with the supporting documents specified in the contract before the date of hospitalization, in accordance with the contractual T&Cs. The deadline for notifying the insurer that the medical/hospital procedure is covered is set out in the contract.
- or a Reimbursement: in this case, the insured must provide the insurer with the documents justifying the expenses incurred. The reimbursement period is set out in the contract.
The claim must be reported in accordance with the contractual T&Cs.
The compensation is made according to the scales and rate cards explained by the insurer in the contract and without exceeding the ceilings set forth therein.
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 ensures that the insurance products offered to consumers are understandable, balanced, useful and that they comply with the regulations in force and the Authority also ensures the reliability of the information provided to the policy-holders as well as the fair treatment of the policy-holders by the insurers.
In case of a 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 filed from customers of insurance companies and their intermediaries (brokers). Nevertheless, it is recommended that you first contact the intermediary (broker) or the insurer against whom your complaint has been lodged. If the dispute remains unresolved after this step, you may then contact the ACAPS by any of the means available to you. The Authority shall then,in order to resolve the dispute, review your complaint and take the most appropriate action, in accordance with the applicable legal and regulatory provisions and within the scope of its powers.