Platinum Plan

“JOFICO” Jordan French Insurance Company, offers “Platinum ” health insurance program which provides in-patient and out-patient coverage.

Benefits and Services

Providing medical forms at clinics and emergency centres which allows subscribers to only use medical insurance card for treatments
Issuing a medical insurance card with the company logo and information of the beneficiary
Med.Service network contracted with more than 3800 medical centres with different specialties.
Med.Service provides Medical pre-approval centre with high efficiency operating 24/7 to facilitate hospital admissions and give approvals as fast as possible
Quick and efficient settlement of medical reimbursement claims within 10 working days starting from completion of all necessary documents

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.

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