National Health Insurance Fund (CNAM) Raises Annual Health Care Expenditure Ceiling
As of February 1, 2024, the National Health Insurance Fund (CNAM) has revised the annual ceiling for external health care expenses. This measure aims to alleviate the financial burden on social insurance beneficiaries and improve access to medical services.
New Ceiling Amounts
According to the new regulations, the annual ceiling varies between:
- 450 dinars for an individual policyholder
- 1,350 dinars for a policyholder with four or more dependents
The ceiling amount will evolve gradually based on family composition.
Additional Adjustments
To better account for specific situations, the following adjustments are made:
- An additional 100 dinars is added for each dependent or child with a disability
- An additional 150 dinars is added for dental care and pregnancy follow-up throughout its duration
Exclusions from the Annual Ceiling
Certain high-cost medical services are excluded from the annual ceiling, including:
- Cone Beam imaging
- Scintigraphy, which is fully covered outside of the annual ceiling
Recommendations for Policyholders
The CNAM encourages social insurance beneficiaries to regularly check their accounts and track their health care expenses to fully benefit from their rights and optimize the use of available ceilings.
