Social benefits
Health Insurance for Employees in Mali
A doctor's visit, prescription drugs, or a hospital stay can represent a significant expense for an employee and their family. Health insurance helps cover a portion of these costs and facilitates access to care.
To fully understand how it works, it’s important to distinguish between health insurance, occupational health services, and supplemental coverage.
1. What is the purpose of Mandatory Health Insurance?
Mandatory Health Insurance (AMO) provides coverage for the healthcare expenses of individuals within its scope, particularly salaried workers.
It is based on solidarity: contributions are pooled to finance care for beneficiaries. Certain family members may also be covered, subject to the conditions applicable to dependents.
2. How is it funded?
For employees covered by the INPS, the published contribution rates are as follows:
| AMO Contribution | Rate |
|---|---|
| Employer’s share | 3.50% |
| Employee’s share | 3.06% |
| Total | 6.56% |
These rates apply to earnings subject to social security contributions. The employee’s share is deducted from pay; the employer’s share constitutes an additional expense for the employer.
INPS, social security contributions.
Example: For compensation subject to contributions of 100,000 FCFA, the AMO contribution amounts to 3,060 FCFA for the employee and 3,500 FCFA for the employer.
3. What portion of healthcare costs is covered?
The INPS specifies the following coverage levels for eligible medical expenses:
| Type of care | Portion Covered by AMO | Portion paid by the beneficiary |
|---|---|---|
| Outpatient care, without hospitalization | 70% | 30% |
| Care during hospitalization | 80% | 20% |
The amount remaining to be paid by the beneficiary is called the copayment.
The third-party payment system allows the insurance provider to pay its share directly to the service provider. The beneficiary pays their share. Coverage depends on eligible services, reference rates, and agreement rules.
INPS, coverage, and contracted providers.
Example: If a medical consultation is eligible for coverage at a rate of 10,000 FCFA, the AMO covers 7,000 FCFA and the beneficiary pays 3,000 FCFA. Any amount not covered must be addressed separately.
4. What obligations remain for the employer?
Health insurance funds medical care. It does not replace the employer’s obligations regarding occupational health.
Article L.177 of the Labor Code requires companies to provide medical or health services to their employees. The Social Security Code specifically outlines the employer’s responsibilities regarding the prevention and monitoring of employee health.
Labor Code, Article L.177; Social Security Code, Article 36.
Enrolling employees in insurance and preventing occupational risks are therefore two complementary measures.
5. What is the purpose of supplemental insurance?
Supplemental coverage can reduce the out-of-pocket expenses employees must pay after the basic plan has covered its portion. The INPS expressly provides for the option to purchase supplemental insurance to cover the copayment.
Depending on the policy chosen, this coverage may also include other benefits. Before enrolling, you should review:
- the covered medical treatments and medications;
- the facilities available;
- reimbursement limits;
- exclusions and waiting periods;
- who is covered;
- the cost to the employer and, if applicable, to the employee.
Supplemental coverage does not, therefore, mean that all expenses will be automatically reimbursed.
6. Key Points
- AMO covers a portion of healthcare expenses, depending on the types of care covered and the applicable rates.
- It is funded by contributions from both the employer and the employee.
- The beneficiary is responsible for paying a portion of the costs; this is called the copayment.
- Supplemental insurance can enhance this coverage, within the limits of the policy purchased.
- The employer retains its obligations regarding occupational health, particularly the organization of medical or health services and the prevention of occupational hazards.