Commencement, suspension and termination of entitlement to AMO

Entitlement to AMO benefits is subject to the prior payment of social security contributions for six months.

To be eligible for benefits, the insured person and their dependants must be registered with CANAM once the employer has enrolled them.

Entitlement to AMO benefits is suspended for an insured person who ceases to pay contributions due to loss of employment after six months. This entitlement will be reinstated as soon as contributions resume.

Entitlement to AMO benefits will cease for dependants 12 months after the death of the insured person who entitled them to those benefits.

Persons registered with the National Medical Assistance Agency (ANAM) under the Medical Assistance Scheme are not eligible for benefits from the National Health Insurance Fund.

The Medical Assistance Scheme is one of the three components of Mali’s national social protection system against illness, which consists of three pillars:

• Compulsory health insurance (AMO). 
• The Medical Assistance Scheme (RAMED), established by Law No. 09-030/AN-RM of 27 July 2009 for the benefit of the country’s indigent population.
• Mutual insurance, which covers those not eligible for AMO or RAMED.
  

The National Medical Assistance Agency is responsible for implementing the RAMED for beneficiaries on the basis of civil status documents certifying their indigence.

The principle of medical assistance is based on national solidarity for the benefit of vulnerable groups, without any prior conditions regarding:

• Payment of social security contributions,
• Payment of patient contributions,
• A compulsory waiting period.

To fund the benefits provided under the RAMED scheme, the State’s contribution is set at 65 per cent, whilst local authorities cover the remaining 35 per cent. Thus, no contribution is required from beneficiaries other than the production of a certificate of indigence confirming their status, issued by their local council of residence.

Healthcare facilities contracted by the ANAM will be public or semi-public:

• National hospitals,
• Referral health centres,
• Community health centres.