JOFICO Jordan French Insurance Company offers “Standard” health insurance program which provides the basic in-patient and out-patient coverages with the best prices especially designed for corporates and institutions
| Benefits |
- To avail our medical services members have to only show the membership card since all our medical forms are readily available at doctors and hospitals of our medical network
- Using our Med. Service Network consists of more than 3500 healthcare providers throughout Jordan, consisting of the best and most qualified in their respective fields.
- The availability of a 24/7 Pre-approval medical center to cover all cases and hospital admissions.
- Payment and settlement of any cash claim will be completed upon receiving the Original documents and receipts.
- Insured members will be provided with a user name and password to log into our online reporting system.
| Coverages |
In Patient Cover
| (In Hospital): | VIP Class | Class A | Class B | Class C |
| Maximum per person per year | 120000 | 100000 | 80000 | 50000 |
| Maximum per admission | 10000 | 8000 | 6000 | 5000 |
| Coverage for network | ||||
| – Room and Board | 100% | |||
| – I.C.U, MRI & CT Scan | ||||
| – Doctors; (visits, surgery, anesthesia) | ||||
| – Lab tests, medicines and diagnostic procedures | ||||
| – Accompanying parent for the child under the age of 13 years | ||||
| – Ambulance | ||||
| Coverage for non-network 70% | ||||
Out Patient Cover
| VIP Class | Class A | Class B | Class C | |
| Maximum per person per year | 1200 | 1000 | 800 | 600 |
| Maximum forms per person per year | 14 Forms | 12 Forms | 10 Forms | 8 Forms |
| Coverage for network | ||||
| – Doctor’s visit | Two JD Deductible | |||
| – Drugs | 80% | |||
| – X-ray | ||||
| – Labs | ||||
| Coverage for non-network 70% | ||||
Delivery Cover
| VIP Class | Class A | Class B | Class C | |
| – Normal Delivery* | 1000 | 900 | 800 | 600 |
| – Caesarean Delivery* | 1200 | 1000 | 900 | 800 |
| – Legal Abortion * | 500 | 400 | 350 | 300 |
| *To avail maternity and delivery benefits, all family members must be included in the insurance contract as per member’s family book. | ||||
| Additional Benefits within Previously Stated Ceiling and Conditions |
| 1. | Pregnant women will be provided with additional 9 forms that would be used for the pregnancy cases only and dispensed for the remaining duration of the pregnancy in accordance to a medical report. |
| 2. | Coverage of newborn babies from day one provided having no congenital malformations and added to the insurance contract within a period not exceeding a month from the date of birth. |
| 3. | Coverage of vitamins and supplements (calcium included) prescribed by physicians to pregnant women which are subject to 16% tax. |
| 4. | Coverage of child circumcision within the limit of maternity. |
| 5. | Coverage of tests and treatments of Vitamin B12 deficiency. |
| 6. | Coverage of non-fertility related hormonal disorders (for outpatient procedures only). |
| 7. | Coverage of kidney stones laser lithotripsy. |
| 8. | Coverage of sedatives related to covered cases. |
| 9. | Coverage of ophthalmological diseases and conditions not related to vision correction. |
| 10. | Coverage of registered eye drops medication prescribed by a physician. |
| 11. | Coverage of accompanying parent for children under the age of 13 during hospitalization. |
| 12 | Coverage of physiotherapy treatment with a limit of 12 sessions at an appointed medical center, using one form only per year. |
| 13 | Coverage of declared and covered preexisting chronic conditions after being further studied by the company to determine premiums, conditions and acceptance. |
| Waiting Periods |
Waiting periods do not apply to members who are enrolled on the inception date of the medical insurance contract, all members whose enrolling date falls beyond the inception date shall be subject to the below:
| Back pain & Arthroscopy | Waiting period 12 months |
| Pregnancy & Maternity | Waiting period 9 months |
| Hemorrhoids, Fistula and Anal Fissure | Waiting period 6 months |
| Tonsillectomy & Adenoidectomy | Waiting period 6 months |
| Deviated Nasal Septum & Sinusitis | Waiting period 6 months |
| Hernia | Waiting period 6 months |
| Fibroids | Waiting period 12 months |
| Uterine and Hysterectomy | Waiting period 12 months |
| Varicose Veins, Varicocele & Hydrocele | Waiting period 6 months |
| Cataract & Glaucoma | Waiting period 12 months |
| Hypertension & Hyperlipidemia | Waiting period 12 months |
| Diabetes | Waiting period 12 months |
| Additional Benefits (optional): |
* Dental Treatment
Unlimited and includes: dental examination, consultation, surgery, scaling and polishing, amalgam fillings, composite fillings, endodontic treatments, orthodontic treatments, implant logy treatments and fixed & removable prosthetic with an additional premium provided by the exclusive network (MEDCONNECT).
* Medical Eyeglasses
One pair of eyeglasses every year (frames & lenses) with a yearly limit of 70 JD, with additional yearly premium.
* Coverage of cancer
within (KHCC): With additional annual premiums for Jordanians and Arab Residents of Jordan.
* Personal Accident
For employees only (up to 60 years old) with an additional yearly premium with the following benefits: Accidental Death, Permanent Total Disability due to (accident), and Permanent Partial Disability due to (accident).
* Critical Illness (CI)
Company is committed to pay the beneficiary a lump sum amount if insured suffers from one of the insured critical illnesses below and survives more than 28 days (survival period) from the date of diagnosis or surgery. Maximum expiry age is 65 years and minimum entry age is 18 years, with additional annual premium that will be calculated according to the age of the participants.The Coverage Includes the below Critical Illness (CI)
| Coronary Artery Bypass Graft |
| Heart Attack (Myocardial Infarction ) |
| Life-threatening Cancer |
| Mayor Organ Transplant |
| Stroke |
| Renal Failure |
If any of these optional benefits were chosen it will be obligatory for all beneficiaries.
| Medical Plan Exclusions |
(Unless stated otherwise in the terms and conditions of the policy)No reimbursement shall be made for any disability treatment, services, diagnostic tests, or complications as a result of injury or illness caused directly or indirectly, totally or partially by:
- Suicidal attempt self-destruction, strike, riot, civil war.
- All cases resulting from wars, invasion, foreign enemy acts, attacks or quasi – military operation (military actions whether declared or not) civil war, rebellion, revolution, martial law, acts of terrorism, and riots.
- Commit or attempt to commit an offense or engage sedition or quarrel directly or indirectly, judicial cases of all kinds.
- Maternity, pre and post-natal care, delivery, abortion, ectopic pregnancy, all contraceptives and related medicines, negative pregnancy tests, all cases or diseases related to newborn babies after birth date.
(New born children must add to the policy from day one after birth date in normal health).
- Mental diseases and disorders, Alcohol and/or drug addiction, drug over-dosage, treatment of handicapped persons, MS. and incontinence of urine.
- Plastic surgery, cosmetic treatment unless related to an accident occurred while commencement of this policy.
- All conditions and diseases related to newborns (prematurity), diseases and congenital, genetic and birth defects.
- Installation of medical consumables and accessories, examination and correction of vision, squint , myopia , hypermetropia, astigmatism, lenses and contacts, cataract and related complications, installation and cost of hearing aid, partial or complete loss of hearing and laser treatment of all kinds.
- Dental and gum care treatment and surgery, unless related to an accident occurred while commencement of this policy.
- All drugs without medical prescription, food supplements, vitamins, sedation and stimulant drugs, consumables and miscellaneous which are not registered as medication at the Jordanian Ministry of Health, bandages, cosmetics, shampoos and all kinds of soaps, acne and all drugs used for the treatment of all kinds of acne, hyper pigmentation.
- Communicable diseases which need isolation, disorders, injuries (such as swine flu, bird flu, corona virus, etc.) which are the responsibility of the government, services furnished or compensated by any governmental institution or agency (social security act, etc.), road traffic accidents which are covered by others.
- Expenses resulting from treatment of long-term difficult cases, paralysis, rickets, blindness, etc.
- Venereal diseases, all types of fibroid, uterine fibroid, hysteropexy, hysterectomy, AIDS and HIV, infertility, sterility, impotence, menstrual and hormonal diseases and disorders.
- Disc prolapse, hip dislocation, Spinal cord and spinal column diseases and disorders, osteoporosis and osteopenia.
- Congenital diseases and malformations, septal deviation, organ transplantation and prosthesis, epilepsy.
- Cancer, Benign tumors, renal dialysis, chemotherapy, jaundice, dementia, hepatic failure, autoimmune-diseases.
- Chronic diseases (Hypertension, cardiac diseases, diabetes, peptic ulcer, etc.)
- Chronic Dermatological diseases (Alopecia, psoriasis, vitiligo, etc.)
- The cost of accompanies, cafeteria, telephone calls, non-medical services and supplies.
- Previous diseases or disorders, which exist before the issuance of this policy or during waiting period.
- Gastric banding and deflected nasal septum.
- General examinations, any tests or treatment not related to specific symptoms or disease, preventive treatment, physical therapy and rehabilitation, laboratory and sleep test, vaccinations and duress, and the examination of allergy.