Health insurance - AMO
The Origins of Mandatory Health Insurance (AMO)
Compulsory Health Insurance (AMO) was created out of a desire to expand protection against illness and facilitate access to care.
To understand this evolution, we must look back at the system that existed previously and then examine the changes brought about by health insurance.
1. How were employees protected before the AMO?
Before AMO, workers covered by the Labor Code benefited from a health protection system organized around the INPS and the Inter-Company Medical Centers (CMIE).
This system had two main objectives:
- preventing work-related health problems;
- providing medical care to workers and, under specified conditions, to their families.
The 1999 Social Security Code specified that this healthcare system was intended to serve as a temporary measure pending the creation of a health insurance system.
Social Security Code, Articles 36–39.
Protection therefore already existed, but the goal was to establish a more comprehensive system.
2. Why Create Mandatory Health Insurance?
An illness can result in expenses that are difficult to bear: doctor visits, tests, medications, or hospitalization.
Health insurance is based on a collective approach: pooling contributions to fund care for beneficiaries. Individuals contribute according to the rules applicable to their income and receive coverage based on their health needs and the guaranteed benefits.
This solidarity is evident, in particular, between healthy people and those who are ill, as well as among insured individuals with different income levels.
3. What were the main stages in its creation?
| Step | What it Provides |
|---|---|
| June 26, 2009: Law No. 09-015 | Establishment of the Compulsory Health Insurance system. |
| June 26, 2009: Law No. 09-016 | Establishment of the National Health Insurance Fund (CANAM). |
| October 12, 2009: Decree No. 09-552/P-RM | Definition of the rules for implementing the system. |
| October 26, 2010: Decree No. 10-578/P-RM | Establishment of contribution rates for the AMO. |
These documents made it possible to gradually organize the beneficiaries, the financing, and the operation of the system.
Ministry responsible for social protection, history, and legal framework of the AMO.
4. What changes has the AMO brought about?
A broader range of beneficiaries
The AMO covers, in particular, employees subject to the Labor Code, civil and military service members, members of Parliament, and the categories of pensioners specified in the relevant laws. Certain family members may also be eligible for coverage, subject to certain conditions.
INPS, individuals covered by AMO.
An expanded healthcare network
Coverage is provided through contracted providers: public, community, and private facilities, pharmacies, laboratories, and healthcare professionals participating in the program.
More Comprehensive Healthcare Coverage
The program covers, in particular, consultations, examinations, medications, maternity care, and hospitalizations, within the limits of the guaranteed benefits.
However, it is incorrect to state that all dental care is excluded: the program, as described at the time of its implementation, includes oral and dental care, while dental prosthetics are among the exclusions.
Ministry responsible for social protection, benefits, and the healthcare network.
5. How has funding evolved?
The former health insurance system was based on a 2% employer contribution.
For employees covered by the INPS, AMO funding now consists of:
- 3.50% paid by the employer;
- 3.06% paid by the employee;
- for a total of 6.56%.
The 3.50% employer share includes the 2% from the previous system: this amount should not be added a second time to cover this previous coverage.
Ministry of Social Protection, AMO funding; INPS, contribution rates.
6. Does AMO replace occupational health services?
Health insurance and occupational health serve complementary functions.
Health insurance helps cover the cost of medical care. Occupational health services are designed, in particular, to prevent occupational hazards and ensure that work conditions are adapted to employees’ health status.
The existence of AMO therefore does not exempt the employer from its obligations regarding medical or health services and prevention.
Labor Code, Article L.177; Social Security Code, Article 36.
7. Key Points
- The AMO extends existing health coverage that was already available to certain workers.
- It was legally established in 2009.
- It is based on solidarity and the pooling of contributions.
- It has expanded the categories of beneficiaries, the healthcare network, and the available benefits.
- It does not mean that all care is free or fully covered.
- Occupational health obligations remain complementary to health insurance.