The population eligible for the scheme amounted to 8,536,607
The population eligible for Compulsory Health Insurance (AMO) was established at 8,536,607 in 2021 compared to 7,875,950 in 2020. According to the CNSS AMO activity report for the year 2021, the population having had the right opened (insured persons and beneficiaries) represents 92% in 2021 of the total population eligible for AMO (91% in 2021 for employees and 98% for pensioners). The number of insured persons with the right open on monthly average reached 2.90 million in 2021 against 2.38 million in 2020, which represents an increase of 17%. In addition, the CNSS provided 5.8 billion DH in benefits in 2021, a figure up 24% compared to 2020. The number of beneficiaries consuming AMO stood at 1,933,574 in 2021, recording an increase by 15%. As for the files submitted, their number increased by 20% to 5,951,000 in 2021 against 4,949,191 in 2020. The number of files reimbursed in 2021 increased by 21% compared to 2020, going from 4,395,202 to 5,336,632, which increased the amount paid by 24%.
The loss rate stood at 25% compared to 22% in 2020, an increase of 3 points. It should be noted a growth of 7% in the average cost per file in 2020 and 0.8% in 2021. The average cost per file increased from 1,104 DH in 2020 to 1,113 DH in 2021. The CNSS points out in its report that the frequency of files has increased from 2.5 in 2020 to 2.8 in 2021. The average cost per beneficiary has increased from 2,838 DH in 2020 to 3,070 DH in 2021. A pensioner filed an average of 3.76 files in 2021 compared to 2.43 cases for working people. The average cost per file for a pensioner is 1,429 DH against 949 DH for active insured persons. The claim rate for a pensioner is 44.9% compared to 21.8% for an active insured. It should be noted that 11% of AMO beneficiaries carry ALD and consume 60% of AMO benefits in 2021. The average time for payment of reimbursement files is 12 days, an improvement of 4 days compared to 2020. The CNSS reports a reduction of 11 days in the average time for payment of healthcare provider reimbursement files in 2021. As for the average time for payment of pharmacist reimbursement files, it stabilizes at 13 days between 2020 and 2021.
Contributions collected increased by 19%
The collection rate of contributions due for 2021 stands at 93% compared to 89% in 2020. In 2021, contributions due increased by 15% compared to 2020. Contributions collected increased by 19% between 2020 and 2021 from 6.72 to 7.99 billion DH. A drop of 5% is to be noted between 2019 and 2020 from 7.09 to 6.72 billion dirhams. AMO’s debt in 2021 amounts to 6.64 billion DH, i.e. an average annual growth of 10% over the period 2017-2021. The debt net of provisions is 2.17 billion DH in 2021, with an average annual growth of 4% over the period 2017-2021. It should be noted that the 7.46% drop in the gross receivable is due to the payment of collection collections broken down in 2022 (free rebate) for an amount of 237 MDH. In 2021, 49% of the gross receivable is made up of late payment surcharges and penalty payments. As for the net claim, this fell by 39.9% following the review of the method for determining the provision for affiliate claims. In 2021, 38% of the net receivable is made up of late payment surcharges and penalty payments.
Nearly 175,000 files checked
The CNSS has set up a control system with the aim of better controlling the risks of overconsumption and fraud. This system includes the control of the filed files and the medical control. Regarding the control of AMO files, the number of files checked amounted to 174,967. The number of files rejected following the control amounted to 21,526. Thus, the rejection rate of files checked reached 12%. Regarding medical checks, 295,356 checks were carried out. In total, 30,737 files were rejected and the rejection rate following the medical check is 10%. In addition, in order to better control the risk of fraud, the CNSS carried out analysis of AMO files and salary declarations giving rise to the right to AMO. The results of this work revealed that the number of doubtful cases checked is 3,848 for policyholders and 51 for healthcare providers. On the insured side, 270 cases of fraud were notified and 3 cases concerning healthcare providers. With regard to checking the veracity of the employee-affiliate salary link, the number of doubtful cases checked is 5,075 for insured persons and 778 for affiliates. As for cases of proven fraud, 1,651 cases reported concerning policyholders and 387 cases for affiliates.
