“JOFICO” Jordan French Insurance Company, offers “Standard” health
insurance program which provides in-patient and out-patient coverages.
Benefits and Services Provided
Providing medical forms at clinics and emergency centers which
allows subscribers to only use medical insurance card for treatments.
Issuing a medical insurance card with JOFICO’s logo and information of the beneficiary.
Med.Service network contracted with more than 3800 medical centers with different specialties.
Med.Service provides Medical Pre-approval Center 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 upon completion of all necessary documents.
Schedule of Benefits (Inside Jordan)
In Patient Cover
Class A
Maximum per person per year
25000
Maximum per case
7500
Coverage for network
Coverage for non-network
– Room and Board
100%
70%
– I.C.U, MRI & CT Scan
100%
70%
– Doctors; (visits, surgery, anesthesia)
100%
70%
– Lab tests, medicines and diagnostic procedures
100%
70%
– Accompanying parent for the child under the age of 13 years
100%
70%
– Ambulance
100%
70%
Out Patient Cover
Coverage
Maximum per person per year
900
Maximum forms per person
12
Coverage for network
Coverage for non- network
– Deductible for general practitioner
One JD
70%
– Deductible for specialists.
Two JDs
70%
– Drugs max per disability
80%
70%
– X-ray max per disability
4 visits
70%
– Labs max per disability
4 visits
70%
– Physiotherapy annually
100 JD for 10 visits yearly
100 JD for 10 visits yearly
Waiting Periods
Waiting periods not apply to those who already are in the
insurance at the beginning of contract, while applied to new
participants are added after their entry date.
* Exclude previous diseases or disorders, which exist before the issuance of this policy or during waiting periods.
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.
1.
Natural hazards, hazardous sport activities, aviation balloons,
airplane, unless traveling as a legal passenger on a commercial line.
2.
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).
3.
Mental diseases and disorders, Alcohol and/or drug addiction, drug over-dosage, treatment of handicapped persons.
4.
Plastic surgery, cosmetic treatment unless related to an accident occurred while commencement of this policy.
5.
Check-up exams, any investigation or treatment that is not
related to specific symptoms or diseases, preventive or optional
treatment and surgery, sleeping test, physiotherapy, rest cures,
vaccination, circumcision.
6.
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 .
7.
Dental and gum care treatment and surgery, unless related to an accident occurred while commencement of this policy.
8.
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 and chloasma.
9.
Communicable diseases which need isolation, disorders injuries
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 .
10.
Expenses resulting from treatment of long-term difficult cases, paralysis, rickets, blindness, etc.
11.
Venereal diseases, all types of fibroid, uterine fibroid,
hysteropexy, hysterectomy, AIDS and HIV, infertility, sterility,
impotence, menstrual and hormonal diseases and disorders.
12.
Disc prolapse, hip dislocation, Spinal cord and spinal column diseases and disorders, osteoporosis and osteopenia.
13.
Congenital diseases and malformations, septal deviation, organ transplantation and prosthesis, epilepsy.
