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Internal regulations of the health insurance institution



Our Coverage Rates

We eliminate financial and administrative barriers so that your employees' health is no longer a headache. With IPM AFRI RH, benefit from comprehensive coverage, fully compliant with legal standards, without compromising on quality.

60 % 


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70 % 


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80 % 


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  • Consultations provided and medications supplied respectively by practitioners and pharmacies not approved by the Institution, reimbursement made at (40%, 50% or 60%). These acts do not give rise to the issuance of guarantee vouchers. Only participants who have already paid their bills are concerned;
  • Consultations provided by general practitioners approved by the institution according to the chosen package (60%, 70% or 80%) based on the rates applied to IPM (4,800 F base calculation general practitioner rate);
  • Consultations provided by specialists approved by the institution according to the chosen package (60%, 70% or 80%) based on the rates applied to IPM (9,400 F base calculation specialist rate);
  • Medications prescribed on prescriptions by an approved doctor and dispensed by an approved pharmacy according to the chosen package (60%, 70% or 80%);
  • Medications prescribed on prescriptions by a non-approved doctor and dispensed by an approved pharmacy according to the chosen package (60%, 70% or 80%);
  • Generic medications prescribed and dispensed by a pharmacy of a public health structure (case, post, health center, regional and municipal hospital). Coverage is (60%, 70% or 80%);
  • At night: Treatment received in a hospital requiring the medical supervision of a participant during the night.
  • During the day: A participant received in a hospital or medical center for a planned daytime hospitalization, includes a hospital room and nursing care, not requiring the supervision of the patient during the night, and for which a discharge authorization is issued on the same day.
  • Local ambulance transport:This refers to ambulance transport, required in case of emergency or medical necessity, to the nearest and most appropriate hospital or authorized medical facility.

Childbirth

This refers to the medically necessary costs incurred during childbirth. This includes hospitalization fees, specialist fees, midwife fees (during childbirth only), and newborn care.

C-sections that are not medically necessary are covered up to the cost of a natural childbirth performed in the same hospital and within the limit of the coverage cap. Medically necessary C-sections are covered by the "Complications in Childbirth" guarantee.

  • Tests, X-rays, surgical interventions, and other treatments on behalf of the patient and provided by a practitioner authorized by the Institution according to the chosen plan (60%, 70%, or 80%);

  • Medical optics, services provided by a licensed ophthalmologist are covered at (60%, 70%, or 80%) according to the chosen plan for consultations and interventions. Additionally, a fee of 12,000 F is paid per pair of prescribed glasses, with the understanding that breakage of lenses, prescription renewals, and frames are not eligible for reimbursement.

Medical products and expenses excluded even with a medical prescription:

  • Perfumes and beauty products including dermatological products that can be used for skin depigmentation, skin lightening products, dermal lotions;
  • Coloring products, relaxers, hair growth or anti-hair loss products;
  • Tonics, wines, mineral waters, alcoholic beverages;
  • Food products (rice, cereals, Nursie milk, nativa, etc.);
  • Diet products;
  • Bottles, nipples, and accessories; prosthetics; teeth cleaning and whitening sessions, etc.;
  • Toothpaste and other oral hygiene products;
  • Medical items (thermometers, syringes, bladders, enema bags and bulbs, basins, inhalers, irrigators, probes, soaps, suction cups, scrubbing gloves, condoms, etc.;
  • Orthopedic, speech therapy, and dental prosthetic devices;
  • Various home pharmacy items, including: bandages, compresses, cotton, aspirin, mercurochrome, hydrogen peroxide, iodine tincture, adhesive bandages, etc...;
  • Refills of medications not prescribed by a doctor;
  • The renewal of a prescription or medication cannot exceed 3 consecutive months;
  • Products that do not have a therapeutic character, but are preventive including serum and vaccine, except in the case of an epidemic (when vaccination is officially recommended). However, the Institution may initiate or participate in vaccination and preventive care campaigns to avoid future costs associated with treating diseases that would be expensive to cure;
  • Medications and procedures that are not curative but preventive;
  • Medications that have an iterative nature for chronic conditions;
  • Medications or treatments for sterility or virility such as Viagra;
  • Contraceptives.

Non-reimbursed surgical interventions:

  • Operations or interventions that have only an aesthetic or rejuvenation purpose;
  • Optional procedures related to painless childbirth;
  • Procedures related to sterility;
  • Preparatory operations and procedures related to in vitro fertilization;
  • Operations and procedures related to voluntary termination of pregnancy/abortion;
  • Operations and procedures aimed at remedying a disability or congenital malformation; (Some exceptions may be made for children under 1 year old);
  • Operations and/or procedures for the placement of artificial body implants and other devices (in internal or external medicine);
  • Operations and procedures related to a work accident or occupational disease;
  • Operations and procedures related to a traffic accident, sports practice, and all other causes involving a third party;
  • MRI sessions (scans) except on medical prescription.
  • Operations and procedures for circumcision;
  • Acts and services resulting from the annual visit of staff, individual or collective medical assessment.

Other excluded costs:

  • Massages; rehabilitation sessions, diathermy, mechanotherapy, and hydrotherapy;
  • Corrective gymnastics;
  • Pedicures and manicures;
  • Rejuvenation and/or beauty treatments or cures.

FRAUDS AND MALPRACTICES

In case of fraud, addition of medications or various products not listed on the prescription issued by the Doctor, the Institution reserves the right to suspend the perpetrator of the act and to initiate criminal proceedings.

Furthermore, the pharmacist or the healthcare provider complicit in this process will be automatically excluded from the list of approved suppliers. These provisions also apply in cases of complicity with a healthcare professional for the substitution of a non-beneficiary.

SUSPENSIONS AND EXCLUSIONS

The temporary suspension of a participant for a period of 3 months, renewable only once, may be pronounced by the Manager with the agreement of the President of the Board and the members of the executive office of the Institution in case of:

  • Non-compliance with the statutes and internal regulations of the IPM;
  • Fraud or attempted fraud in the use of IPM benefits. This is a precautionary measure to limit the observed damage and thus preserve the general interest of the institution. Participants who exceed the threshold of 12 times their garnishable amount or monthly repayment capacity may be suspended by the IPM at the request of the member. Definitive exclusion will be pronounced by the Board of Directors after a contradictory investigation. The Institution, in accordance with decree 75-895 of August 14, 1975, may take legal action against those responsible for fraud and embezzlement of IPM benefits. A participant with a high account (large debtor) that is not medically justified may be provisionally suspended until the balance is reduced to a reasonable range. In the event of non-repayment of the amounts withheld within the required deadlines by a member, the Institution reserves the right to suspend them from its benefits. If necessary, the Board of Directors will be informed of the follow-up to be given to the litigation.