“JOFICO” Jordan French Insurance Company, offers “Platinum ” health insurance program which provides in-patient and out-patient coverage.
Platinum Plan
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“JOFICO” Jordan French Insurance Company, offers “Platinum ” health insurance program which provides in-patient and out-patient coverage.
Benefits and Services |
Coverages (Inside Jordan) |
In-Patient Coverage
(In Hospital): | Class A | |
Maximum per person per year | 50000 | |
Maximum per case | 7500 | |
Coverage for network | Coverage for non- network | |
– Room and Board | 100% | 80% |
– I.C.U, MRI and CT Scan | ||
– Doctors (visits, surgery, anaesthesia) | ||
– lab tests, medicines and diagnostic procedures | ||
– Accompanying parent for the child under the age of 13 years | ||
– Ambulance | ||
– Emergency cases | 100% |
Out-Patient Coverage
Class A | ||
Maximum forms per person | 10 forms | |
Coverage for network | Coverage for non- network | |
– Deductible for general practitioner | Platinum 1: 2JD
Platinum 2: 100% |
5 JD MAX |
– Deductible for specialists | 10 JD MAX | |
– Medication | 80% | 50% |
– Radiology | ||
– Lab Tests | ||
– Physiotherapy annually | MAX 5 JD per visit | |
Cash Claims will be
reimbursed based on the minimum prices of the Jordan Medical Association
of 2008, medical network approved prices and according to the
deductible percentage above, whether the claim was in or out patient.
Subject to provide the insurance company with a medical form with each
claim. |
Additional benefits within previously stated limits and conditions |
1. | Pregnant women will be provided 9 additional forms that would be used for pregnancy cases only and dispensed for the remaining duration of the pregnancy in accordance to a medical report. |
2. | Coverage of neonatal incubators for new-borns provided having no congenital malformations with a limit of 1000 JD. |
3. | Coverage of minerals, calcium and vitamins which are subject to 16% sales tax. |
4. | Coverage of child circumcision. |
5. | Coverage of all children vaccines registered by the ministry of health’s national program. |
6. | Coverage of all registered vitamins prescribed as medication by a physician for covered cases. |
7. | Coverage of tests and treatments of Vitamin B12 deficiency. |
8. | Coverage of non-fertility related hormonal disorders (outpatient procedures only). |
9. | Coverage of kidney stones laser lithotripsy. |
10. | Coverage of mammogram screening related to covered cases. |
11. | Coverage of sedatives related to covered cases. |
12. | Coverage of ophthalmological diseases and conditions not related to vision correction. |
13. | Coverage of registered eye drops medication prescribed by a physician. |
14. | Coverage of accompanying parent for children under the age of 13 during ionization. |
15. | Coverage of non-chronic dermatological diseases. |
16. | Coverage of ambulance utilization expenses for emergency cases. |
17. | Royal medical services hospitals are included within (Med. Service) network for this coverage plan. |
18. | Coverage of physiotherapy treatment with a limit of 12 sessions at an appointed medical centre, using one form only per year. |
“Waiting Periods” |
It is understood and agreed that the following conditions and any resulting complications will not be covered until the conclusion of its specified waiting periods mentioned below:
Back related pain and arthroscopy | Waiting period: 12 months |
Pregnancy and Maternity* | Waiting period: 12 months |
Fibroids | Waiting period: 12 months |
Uterine endometriosis and Hysterectomy | Waiting period: 12 months |
Cataract and Glaucoma | Waiting period: 12 months |
Hemorrhoids, fistula and anal fissure | Waiting period: 6 months |
Tonsillectomy and Adenoidectomy | Waiting period: 6 months |
Deviated nasal septum and Sinusitis | Waiting period: 6 months |
Hernia and Gallbladder | Waiting period: 6 months |
Varicose veins, Varicocele and Hydrocele | Waiting period: 6 months |
Endoscopy, kidney stone lithotripsy and peptic ulcer | Waiting period: 6 months |
Hypertension and Hyperlipidemia | Waiting period: 24 months |
Diabetes | Waiting period: 24 months |
* In order to obtain maternity and delivery benefits, all family members must be included in the insurance contract as per the family book.