The basic mandatory health insurance (AMO) guarantees for the insured and their dependent family members, regardless of the policy they subscribed to, the reimbursement or the direct payment of a part of the health care costs by the basic AMO organization, the other part remaining at the insured's expense. The insured is free to take out supplementary insurance policies to cover the remaining costs.

However, in the case of a serious or disabling illness requiring long-term care or in the case of particularly expensive care, the part remaining to be paid by the insured is then totally or partially exempted.

How can i be reimbursed?

There are two types of reimbursement:

  • Reimbursement requiring prior consent
  • Reimbursement without prior consent

In both cases, you will have to prepare and submit a file including the documents required by your managing body within the time limit defined by the latter in order to get partial refund based on the nature of the care expenses. Please note that the part of the medical care costs that has not been reimbursed by your AMO managing body and that remains at the insured's expense is called the "co-payment rate". This is the difference between the real costs of a treatment (x-rays, lab analyses...) and the amount actually being repaid by the AMO.

As a rule of thumb, the benefits guaranteed under the basic AMO can only be reimbursed or covered if the treatment was prescribed and carried out on the National Territory. However, certain limited exceptions are allowed when the policy-holder falls unexpectedly ill during a stay abroad or when he or she cannot get the appropriate care in Morocco. In such cases, reimbursement or coverage is subject to the prior consent of the AMO’s managing body, in accordance with the regulatory Terms and Conditions in force.

Reimbursement rates differ depending on the AMO’s managing body, the nature of the illness/pathology, the benefit, etc. These rates are set by the applicable legal texts and can be provided by your organization.

What are the coverage rates for medical benefits?

Coverage Rate of Medical Benefits Borne by the CNSS[1]:

Rate of coverage of medical benefits paid by the CNSS:

The rate of coverage by the CNSS of the categories of benefits guaranteed under the AMO is set at 70% of the National Reference Rate;

The above rate is increased to 90% for serious or disabling illnesses requiring long-term or particularly costly care, when the related care is provided in public hospitals, public health establishments and/or State healthcare services.

In addition, the coverage of serious or disabling illnesses requiring long-term or particularly expensive care includes all benefits medically required by the beneficiary's health condition, including organ and tissue transplants.

However, cosmetic surgery, spa treatments, acupuncture, mesotherapy, thalassotherapy, homeopathy and alternative medicine are excluded from the scope of benefits covered by the AMO.

Coverage Rates for Medical Benefits Borne by CNOPS[2]:

The rates of coverage of benefits under the AMO managed by the CNOPS are organized in groups of benefits as follows:

  • 80% of the National Reference Rate (NRR), for general medical procedures as well as medical and surgical specialties, paramedical procedures, functional rehabilitation and physiotherapy delivered on an outpatient basis, excluding medication;
  • 90% of the National Reference Rate for care related to hospitalization and surgical procedures including corrective (or reconstructive) surgery and blood and its labile derivatives; this rate is increased to 100% when the services are rendered in public hospitals, public health institutions and State healthcare services.
  • 70% of the list price in Morocco, for medicinal products (drugs) eligible for reimbursement;
  • fixed prices set in the National Reference Rate, for medical glasses, medical devices and implants necessary for medical and surgical procedures;
  • fixed prices set in the National Reference Rate for medical prosthesis and orthosis devices eligible for reimbursement;
  • 80% of the National Reference Rate for oral care:
  • a flat rate fixed in the National Reference Rate, for medically required orthodontics for children.

In the event of a serious or disabling illness requiring long-term or exceptionally costly care, the insured shall be fully or partially exempt from the remaining part of the costs, depending on the type of illness, as provided for in the list approved by the Minister of Health.

The amount remaining to be paid by the insured may never be higher than 10% of the National Reference Rate for these diseases.


[1] Moroccan National Social Security Fund

[2] National Provident Organizations Fund

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