Engineers Association Health Insurance Regulation

Regulation No. 6 of 2013

Engineers Association Health Insurance Regulation

 

Article 1: Regulation name and effect

This Regulation shall be cited “Engineers Association Health Insurance Regulation of 2013” and shall come into force as of the date on which it is published in the official gazette.

Article 2: Definitions:

The following words and expressions, wherever stated herein, shall have the meanings given to them below unless the context implies otherwise:

Law: Engineers Association Law.
Association: Jordanian Engineers Association.
Board: The Association Board.
Fund: The Health Insurance Fund established in accordance with the provisions of Law.
Committee: The Fund Management Committee formed in accordance with the provisions hereof/
Manager: The Fund Manager.
Subscriber: The Association member subscribing to the Fund.
Beneficiary: Any individual other than the subscribers benefiting from the Fund in accordance with the provisions hereof.
Medical service: The treatment provided to the subscriber and beneficiary including the clinical checkup, laboratory tests, x-rays, physical treatment, specialist treatment, surgeries, giving birth, drugs and hospitalization in accordance with the provisions hereof and the instructions made by virtue hereof.

 

Article 3: Fund objectives

The Fund’s objective is to provide a medical service to the subscribers and beneficiaries within the Kingdom in accordance with the provisions hereof and the instructions made by virtue hereof.

Article 4: Health Insurance Fund Management Committee

  1. The Board shall form a Committee to be named “Health Insurance Fund Management Committee,” headed by the Engineers Association President or a person selected by the Board from its members and membered by:
    1. The Association Treasurer as a Deputy Head.
    2. Seven of the Association General Assembly members as may be appointed by the Board, provided they are not Board members.
  2. The Committee shall meet as may be necessary upon an invitation made by the Head or Deputy Head if the former is absent. The meeting will be quorate in presence of six members including Head or his Deputy, and the resolutions are made by the majority of five votes of the attending members.

Article 5: Health Insurance Fund Management Committee missions and powers

The Committee shall have the following missions and powers, and it shall made its recommendations to the Board.

  1. To make the Fund’s general policy.
  2. To approve the physicians, hospitals, pharmacies, laboratories and any other medical or treatment entity licensed in accordance with the provisions of the applicable legislations for the purpose of providing medical services.
  3. To study the proposals submitted by the insurance companies licensed in accordance with the provisions of the applicable legislations to insure medical services.
  4. To review the objections made by the subscribers and beneficiaries.
  5. To suggest the instructions regulating the Fund operations.
  6. To prepare the annual report of the Fund operations.
  7. Any other missions as may be assigned by the Board.

Article 6: Fund Manager

The Board shall appoint a manager dedicated for the Fund to supervise its affairs and take a part in the Committee meetings without having a voting right.

Article 7: Subscription to the Fund

  1. Subscription to the Fund shall be optional.
  2. The subscriber shall determine any of the following so as to benefit from the Fund:
    1. Unmarried and unemployed children no matter how old they are.
    2. Disabled children no matter how old they are.
  3. Notwithstanding the provisions of Clauses A and B of this Article, the subscription to the Fund shall be mandatory for the subscriber and beneficiary’s family members if any of them has a chronic disease.
  4. The family members of the Association diseased member stated in Clause B of this Article shall have the right to benefit from the Fund in accordance with the provisions of this Regulation and the instructions made by virtue hereof. The spouse of the diseased member will be excluded in case of their marriage to nonmember.
  5. The Board shall specify the categories that may benefit from the Fund other than the subscriber’s family members such as the Association employees, their families, engineering offices employees, their families and other categories directly relevant to the Association or the engineering occupation. These categories, their subscription, insurance premium payments and the subscription suspension and termination under instructions to be made for this purpose.

Article 8: Health Insurance Fund subscription conditions

  1. The subscription to the Fund will be available upon a resolution made by the Board, provided that the subscriber and beneficiary comply with paying the insurance premium.
  2. The application for subscription to or benefiting from the Fund shall be made on the form prepared for this purpose and submitted together with the information and documents required in accordance with the provisions of the instructions made for this purpose.
  3. For the applications to be accepted, both the subscriber and beneficiary are required to have been paid the financial liabilities incurred by them to the Association.
  4. The medical service provision to the subscriber and beneficiary will start 14 days following the subscription or benefiting date, and it ends on the 31st day of December of the same year subject to the period necessary to pass as of the date of subscription or benefiting as specified in accordance with the instructions made for this purpose.

Article 9: Miscellaneous

  1. The subscriber or beneficiary shall have no right to claim for being paid the medical service fees or any part thereof by the Fund if they are settled by any other entity.
  2. The Board decides to deprive the subscriber or beneficiary of benefiting permanently or temporarily from the Fund if any of them violates the provisions of this Regulation and the instructions made by virtue hereof. The Committee may recover the amounts borne by the Fund due to any violation following the interrogation therein by a committee formed by the Board consisting of members other than the Board members or the Committee members. The temporary deprivation shall not affect his family beneficiary members until the end of that period of the financial year.

Article 10: Financial year

  1. The Fund’s financial year starts on the 1st day of January and ends on the 31st day of December of the same year.
  2. The Fund’s money shall be deposited with the banks upon a resolution made by the Board.
  3. The financial and accounting rules and principles adopted by the Association shall be applicable to the Fund, and its accounts and records are subject to the auditing of the legal auditor approved by the Association Fund; furthermore, the Fund’s budget and concluding accounts shall be presented together with the Association Fund budget and concluding account for approval.
  4. Any deficit in the Fund concluding budget shall be covered by the Association Fund, and any surplus in the Fund shall be carried forward to the next financial year after reimbursing any deficit previously borne the Association Fund upon a resolution made by the Board.

Article 11: Subscriber and beneficiary prior to the effect of the provisions hereof

Both subscriber and beneficiary registered with the Fund prior to the effect of the provisions hereof shall be considered subscribing to the Fund, provided that the Fund continues to provide the medical service to such subscriber and beneficiary until the end of the financial year.

Article 12: Regulation provisions enforcement

The Board shall make the instructions necessary to enforce the provisions hereof including:

  1. Specifying the health insurance premium amounts payable to the Fund and any due amounts arising out of delay.
  2. The maximum expenses borne by the Fund for the subscriber and beneficiary.
  3. The coverages, exceptions, chronic diseases, emergencies and borne percentages applicable to the subscriber and beneficiary.
  4. Minimum wages and remunerations approved for the purposes of covering the subscriber and beneficiary treatment.
  5. Hospital class.

Article 13: Nullifications

The Engineers Association Members Health Insurance Regulation No. 57 of 1998 shall be nullified, and the instructions made by virtue thereof shall remain effective until they are nullified, amended or replaced in accordance with the provisions hereof.

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