PROFESSIONAL AGREEMENTS

Purpose of the CID agreement

• The purpose of this agreement for the Direct Compensation of Material Automobile Claims, also known as CID, is to enable insurance companies to compensate their own policyholders directly, whether or not they are partially responsible for the claims, in order to improve service quality and the customer experience. It defines the conditions of compensation between insurance companies for the direct indemnification of their motor third-party liability (TPL) policyholders who are victims of traffic accidents causing material damage to their vehicles.
• It should be noted that this agreement applies to the settlement of property damage, even if the accident has resulted in bodily injury, provided that the beneficiary of the indemnity at the time of the accident is not injured.

Purpose of the CICA agreement

• The purpose of this Motor Bodily Injury Indemnity Agreement, also known as the CICA, is to enable insurance companies to compensate their own policyholders directly, whether or not they are partially responsible for the claims, in order to improve service quality and the customer experience.
• It defines the conditions of compensation between insurance companies for the direct indemnification of their motor third-party liability (MTPL) policyholders who are victims of traffic accidents involving bodily injury.
• Under certain conditions, this agreement also applies to the settlement of property damage.

Purpose of the Third-Party Payment agreement – CNSS

• Insurance companies that are members of the FMA commit themselves to offering their policyholders a third-party payment system, whereby they assume responsibility for hospital costs in accordance with the terms of their contract. Polyclinics accept policyholders with insurance company cover without reservation, while respecting the principle of the policyholder’s free choice of hospital establishment.
• The purpose of this agreement is to :
  • Define the rates for medical procedures applicable in CNSS polyclinics.
  • Establish the terms and conditions of the third-party payment system for the total or partial settlement of hospitalization costs in CNSS polyclinics, for the benefit of the beneficiaries concerned.
  • The beneficiaries concerned are those insured with insurance companies, who benefit from the system within the limits of the coverage, ceilings and percentages stipulated in their insurance contract.
  • Third-party payment applies to medical expenses for illnesses covered by insurance companies, as well as to medical expenses resulting from accidents other than those occurring at work, subject to compliance with admission provisions.

Purpose of the Third-Party Payment agreement – CNOM

The contracting insurance companies, members of the FMA, commit to providing their policyholders with a third-party payment system for the reimbursement of hospital expenses, in accordance with the percentages defined in the contract.

Signatory clinics and doctors undertake to accept unreservedly policyholders in possession of a “prise en charge” which can only be issued for the following services:

• Surgical hospitalization with a surgical procedure coefficient greater than K20.
• Medical hospitalization necessitated by the patient’s pathological condition;
• Hospitalization following an accident (excluding industrial accidents).

In addition to the exclusions stipulated in the insurance contract, normal childbirth and outpatient procedures are also excluded (unless otherwise stipulated in the contract).

This agreement guarantees the patient’s free choice of attending physician and place of hospitalization. However, to benefit from third-party payment, the patient must choose a clinic from the list of clinics that have signed up to the terms of this agreement.