›› Health insurance

Health insurance benefits include:

Benefits in kind:

Coverage of your preventive and curative healthcare costs for insured individuals and their dependents. These cover the following costs:

• Medical
• Surgical
• Hospitalisation, diagnostic and therapeutic medical procedures, including biological tests
• Equipment and prostheses
• Functional rehabilitation and vocational rehabilitation,
• Dental care and prostheses and maxillofacial orthopaedics,
• Medical optics,
• Thermal or specialised treatments,
• Medical transport or any other means required by the patient’s condition,
• Family planning services.

Cash benefits:

Allocation of a daily allowance to employees who are forced to temporarily stop working due to illness.

To be eligible for these benefits, you must:

• Be covered by social security
• Meet the administrative and medical requirements

Rate of coverage for benefits in kind:

As a general rule, benefits in kind are reimbursed at 80%. This rate may be increased to 100% in some cases provided for in Article 4 of Decree No. 84-27 of 11 February 1984.

To be reimbursed for your pharmaceutical expenses, you should show :

• A prescription with the stickers affixed.

Reimbursement method

These expenses are reimbursed by transfer to a postal or bank account, depending on the choice of the social security beneficiary.

You are exempt from prior medical examination in the following cases:

• If you have a chronic illness. However, if your prescription includes medicines subject to special reimbursement conditions (which are not part of the usual specific treatment), it is subject to prior medical examination.
• If you are over 75 years of age.

Your obligations in the event of a sick leave:

• Report the sick leave to the Fund within two working days, not including the day on which the sick leave began (submit or send by post the medical certificate of sick leave),
• Do not engage in any unauthorised professional activity (unless authorised by the social security organisation),
• Do not leave your home unless prescribed by your doctor for therapeutic purposes (authorised outings between 10 a.m. and 4 p.m.),
• Do not travel without prior authorisation from the Fund (for therapeutic purposes, recovery or justified personal convenience),
• Submit to any medical or administrative checks carried out by the Fund

The daily allowance is equal to:

• 50% of the salary is subject to contributions, after deduction of social security contributions and income tax , for the first 15 days of the sick leave.
• This rate is increased to 100% in the following cases:
• From the 16th day of the sick leave
• In the event of hospitalisation
• In the event of long-term illness