#89-1009Law Strengthening Guarantees for Insured Individuals Against Certain Risks
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The law LOI n° 89-1009 aims to enhance the guarantees provided to insured individuals against specific risks such as death, maternity, physical integrity, work incapacity, and invalidity. It establishes comprehensive regulations around health insurance cover for collective and individual subscriptions, emphasizing that insurers must not discriminate against pre-existing conditions after a certain period. The law also outlines the responsibilities of various institutions in providing insurance coverage and mandates strict oversight to ensure compliance with legal provisions regarding these protections.
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Key Changes
- Insurers must cover pre-existing medical conditions if named in the contract, after proof of existing conditions
- Imposing strict regulations on the restructuring of retirement and complementary insurance institutions
- Annual reporting requirements for insurers to companies employing insured individuals
Obligations
What this law requires
Insurance organisms must cover the consequences of pre-existing pathological conditions that occurred before subscription or membership, except where specific conditions are met (clear mention in contract and proof that disease was pre-existing).
After a 2-year period following membership or contract subscription, organisms cannot refuse to maintain reimbursement or indemnification for expenses caused by illness, maternity, or accident, and cannot increase individual tariffs based on health status evolution.
Any tariff increases for a guarantee type or contract must be uniform across all insured persons or members subscribing to that type, not applied individually.
Pre-existing illnesses not covered must be clearly mentioned in individual contracts or collective contract membership certificates, and organisms must provide proof that the illness was pre-existing before subscription.
Complementary retirement or benefit institutions can only be created or maintained with authorization from the competent state authority, with conditions determined by decree.