The health insurance made compulsory by law in Benin will apply according to the procedures defined by the Council of Ministers on June 21, 2023.
The State, public and private employers, independent professionals, retirees are concerned to varying degrees by the obligations contained in the decree which details the implementation of the law on the protection of the health of persons in force since February 2021. .
Obligations of the State and public employers
The State, public establishments and local authorities cover, partially or totally, the costs of subscribing to a health insurance policy concerning the basic care basket for the following targets:
- public sector employees, their spouses and dependent children;
- employees of public establishments or non-commercial public bodies, their spouses and dependent children;
- Beninese students residing in Benin and receiving a state allowance;
- public sector pensioners, their spouses and dependent children;
- low-income private sector retirees, their spouses and dependent children;
- the extreme and non-extreme poor.
However, health insurance is only taken out by the State for these targets in the absence of coverage by a policy covering the basket of care as defined.
Obligations of private employers
Private sector employers and commercial public bodies must take out health insurance that includes at least the basic care package for their employees, their spouses and their dependent children.
Retirees from the private sector and the self-employed
Private sector pensioners subscribe to a health insurance contract for themselves, their spouses and their dependent children. They can have the insurance premium deducted from the National Social Security Fund.
As for the actors of the liberal professions and other persons exercising for their own account, they subscribe to a health insurance policy for themselves, their spouses as well as for their dependent children.
Minimum rate of 80%
Employers of all categories must pay at least 80% of the insurance premium for the basic healthcare basket to beneficiaries.
As far as the State is concerned, it pays the entire insurance premium for the extreme poor and half for the non-extreme poor.
Basic care basket
The following conditions make up the basic care basket: trauma to the thoracic limbs, trauma to the pelvic limbs, head trauma, simple and complex obstetric fistulas, acute upper and lower respiratory infections in children, urinary tract infections in children, sepsis in children under 5 years old, bacterial skin infections in children under 5 years old, malaria, diarrhoea, infections in medically treated adults.
Services taken into account
The services taken into account by health insurance concern:
General medicine consultations, natural or assisted childbirth, caesarean section, haemorrhage during the 3rd trimester of pregnancy and postpartum haemorrhage, hospitalization for pathologies in the basic care basket, laboratory examinations for pathologies in the basic care basket. basic, traumatological surgery for conditions in the basic care basket, drainage of a superficial abscess, emergency care, resuscitation care, extraction of foreign bodies in children under 5 years of age as well as surgery relating to appendectomy, hernia repair, peritonitis cure, removal of urine retention, bowel obstruction, management of burns.
The cost of medical transport within the framework of a referral is also taken into account for the services and conditions included in the basic healthcare basket.
In addition, consultations, care with the exception of drugs, diagnostic explorations and hospitalizations for other conditions not contained in the basic care basket are paid for by the State for its agents and retirees from the sector. public, by public establishments and local authorities for their agents, their spouses and their dependent children up to 80%.
One year deadline for formalities
Any employer, with the exception of the State, is required to provide the National Social Security Fund, within 12 months, with the insurance policies taken out for the benefit of its employees and to initiate payment of the premiums. .
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