JOFICO
JOFICO
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Standard Plan

Standard Plan

“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. 

Endoscopy and lithotripsy Waiting period 6 months
Hotripsy , ulcer and gallbladder Waiting period 6 months
Spine and joints diseases Waiting period 6 months
Hemorrhoids, fistulas and anal fissures Waiting period 6 months
Tonsillectomy adenoids, and paranasal sinuses Waiting period 6 months
Non-cosmetic perversion Waiting period 6 months
Uterine endometriosis and hysterectomy Waiting period 12 months
Chronic diseases (heart disease, arterial and venous diseases, diabetes, hypertension, etc.) Waiting period 12 months

* 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. 
 14.
  • Cancer, renal dialysis, chemotherapy, jaundice, dementia, hepatic failure.
 15.
  • Chronic diseases (Hypertension, cardiac diseases, diabetes, peptic ulcer, etc.)
 16.
  • Chronic Dermatological diseases (Alopecia, psoriasis, vitiligo, etc.)
 17.
  • The cost of accompanies, cafeteria, telephone calls, non-medical services and supplies.
 18.
  • Previous diseases or disorders, which exist before the issuance of this policy or during waiting period.
 19.

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