Summary of Health Insurance Coverage and Benefits for Employees of the German Jordanian University, Their Families, and Parents

Second Class	First Class	Private Class	Benefit
80,000	100,000	130,000	Annual coverage limit (JOD)
Inside & outside Jordan			Region
Second Class	First Class	Private Class	Inpatient Coverage
17,000	20,000	23,000	Case coverage limit (JD)
Full coverage 100%   Except for Al-Abdali Hospital, the following co-payments apply: Private Class: 10% First Class: 20% Second Class: 30%			Accommodation, intensive care, and surgical operations
			Consultant and specialist fees, surgeon fees, anesthetist fees, medical supervision fees, and emergency room fees
			Medical examinations, medications, diagnostic procedures, CT scans, MRIs, and X-ray therapy
			Accompanying a sick child under the age of 14
			Ambulance, depending on the patient's health condition, inside and outside governorates
			Supplies - cardiac stints & balloons - routine procedures - day cases - medical devices such as plates and screws - disc cages - cardiac valve replacement & pacemakers - internal devices, etc.
Second Class	First Class	Private Class	Outpatient Coverage (Including Maternity Checkups)
10	12	14	Number of outpatient forms
9			Number of maternity forms
Full coverage 100%			Natural delivery, Caesarean, and legal abortion
4000 JD			Premature birth and cases of incomplete growth
2 JD payment / excluding follow-up			Doctor visits
Co-payment: Employee & family: 15% Parents: 25%			Medications
			Diagnostic procedures, including laboratory tests and X-rays
9	12	15	Physical therapy sessions
300 JD / Annually Co-payment Employee & family: 15% Parents: 25%			Dental Benefits: Dental examination, X-ray, white fillings, silver fillings, surgical extractions, root-canal Treatment, and gum disease treatment.
100 JD / Annually Co-payment Employee & family: 15% Parents: 25%			Eyeglasses Benefit: Eyeglasses (lenses & frames) excluding the eye exam
Second Class	First Class	Private Class	Coverage Outside the Approved Medical Network (Based on Prepaid Invoices)
80%			Reimbursement percentage for treatment outside the medical network
(According to the maximum rate set by the Jordanian Medical Association's and the prices locally approved by the Jordanian Ministry of Health). A medical treatment form must be attached to each claim for treatment outside the hospital when submitting for reimbursement.

1. Personal Accident Coverage.
2. Coverage for Heart Stents and Associated Complications, with an unlimited number of stents, based on the medical necessity as determined by specialists.
3. Coverage for Osteoporosis Screening and Treatment.
4. Coverage for Chronic Medications: Monthly distribution without using or counting claims against the annual limit, with a maximum of 2000 Jordanian Dinars annually, based on the net amount paid, applying co-payment percentages for outpatient treatment as stated above.
5. Coverage for the Inpatient Limit for Chronic Diseases for employees and dependents, within the relevant coverage limit for the insurance level.
6. Coverage for Laparoscopic Surgeries for all medically covered conditions, as determined by the attending physician and medical need.
7. Coverage for Hepatitis Infections of all types.
8. Coverage for Injuries Resulting from Car Accidents, provided there is no third party, and the insurance company has the right to seek reimbursement from the Traffic Accident Victims Fund.
9. Coverage for Vitamin D Testing and Treatment, as prescribed by the attending physician.
10. Coverage for Urinary Incontinence, from the condition limit.
11. Coverage for Immunological Disorders and Their Complications, and everything related to the condition.
12. Coverage for Hernias in Adults, Children, and Newborns, including all types, as well as for undescended testicles.
13. Coverage for Lithotripsy and/or Laser Procedures or other surgeries, based on the specialist’s opinion.
14. Coverage for Shingles.
15. Coverage for Neurological Disorders not related to aging, including facial nerve (seventh and fifth cranial nerve) disorders and their complications.
16. Coverage for Brucellosis, Mediterranean Fever, Kawasaki Disease, Gout, Meningitis, and Behcet’s Disease.
17. Coverage for Echocardiography for both adults and children, even if congenital.
18. Coverage for Endocrine Disorders and Gland Removal Surgeries, including radioactive iodine treatment.
19. Coverage for Spinal and Spinal Cord Diseases, Treatment, Surgery, and Supplies.
20. Coverage for Epilepsy and its Treatment.
21. Coverage for Non-Cosmetic Skin Conditions, including eczema of all types, psoriasis, and alopecia, etc.
22. Maternity Benefits (Case limit applies):

-       Pregnancy and Delivery.

-       Vitamins for Pregnant Women (Testing and Treatment), including vitamins, nutritional supplements, minerals, calcium, hormones, and zinc.

-       Anti-D Injection before or after delivery, based on the specialist’s recommendation.

-       One 4D Ultrasound during the pregnancy, based on the specialist’s recommendation.

-       Cases of Incomplete Lung Development for the fetus or after birth (not premature).

-       Child Vaccinations according to the Ministry of Health’s national schedule.

-       Pregnancy Complications such as pre-eclampsia, bleeding, pregnancy-supporting medications, and hysterectomy.

-       Blood Thinning Injections for pregnant women and cases of recurrent miscarriages, with medical reports, applying a 30% co-payment (New Benefit).

-       Care for the mother and fetus before, during, and after delivery.

-       Coverage for Newborns from Day One, provided they are added to the policy within one month of birth and treated using the mother’s insurance until their own insurance documentation is issued.

-       Ear Piercing and Infant Circumcision.

-       DHD Birth Dislocation Imaging.

23.  Coverage for Eye Diseases (including Strabismus) and Surgeries not related to visual acuity or keratoconus.

24.  Coverage for Eye Diseases Treatment, Cataract Surgery, Retinal Disorders, Retinal Detachment, Corrective Lenses, and Corneal Stabilization Surgeries.

25.  Coverage for Chronic Medication Compensatory Packages for those with less than 30 pills per package, distributed at the start of the contract with monthly prescriptions for relevant insured individuals based on the prescribed dosage.

26. Option to Complete Treatment Procedures using the form if the physician is not part of the network.

27.  Coverage for Interventional Radiation and All Related Procedures.

28.  Coverage for All Heart Diseases and Procedures including heart surgeries, electrical heart treatments, pacemakers, valve replacements, vein replacements, etc., and related complications, within the inpatient limit (New Benefit).

29. Coverage for Mammogram Testing is related to a condition covered by insurance.

30.  Coverage for Acute Kidney Failure.

31.   Coverage for Thalassemia and related tests and procedures for insured conditions (New Benefit).

32.  Coverage for Cancer Treatment with a limit of 5000 Jordanian Dinars per case, covering 5 cases for the entire contract (for employees only), covering conditions arising after the start of the insurance and within the approved medical network, excluding those not enrolled in the Care program.

33.   Coverage for Funeral Expenses for employees aged 18 to 65, according to the following mechanism:

-       Geographical Coverage: Worldwide, except for war zones.

-       Coverage: Funeral expenses for death from any cause, whether natural or accidental, provided the death occurs during the insurance year and after fulfilling necessary conditions.

-       Compensation Amount: 5000 Jordanian Dinars, payable according to the mechanism specified in the contract, after completing the required documentation.

 

Mechanism and Policies of Subscription to Health Insurance

 

Current Subscribers:

• Employees wishing to cancel their subscription in health insurance filling out the attached form.
• Student proof for each male son older than 18 years and less than 25 years, noting that the insurance will be canceled for them automatically if the student's proof is not presented, as of 01/01/2025.
• Disclosing information about sons who have reached the age of 25 years or more so that their insurance will be cancelled according to the regulations.
• Disclosing information about working or married daughters so that their insurance is cancelled according to the regulations.

 

New Subscribers:

• Fill out the application form with all the required information and submit attached the following documents for (non-currently subscriber):
• Family Book in case of insurance of family members (note that it is not allowed to insure a number of children excluding others)
• Parents' Family Book if any of the parents are insured
• Personal identity if only the employee is insured without any family members
• Passport for non-Jordanians
• Student proof for each male son older than 18 years and less than 25 years
  • Note that any form lacking written data or any of the person's supporting documents will be rejected.
  • The need to disclose the health history of any disease and chronic diseases in detail for each subscriber (note that undisclosed previous cases will NOT be covered).

 

Health Insurance Subscription Classes:

Health insurance subscription shall be in one of the following classes, according to the benefits and premiums listed in the benefits and premiums appendix: 

• (1- Private class, 2 - First class, 3 - Second class).
• The insurance class for family members and parents shall be the same as that of the employee.
• No changes to the insurance class shall be permitted during the term of the contract.

 

Addition (adding a new subscriber during the validity of the contract):

Applying for health insurance after the end of the application period mentioned above and during the insurance contract is allowed for the following cases only and within one month of their occurrence:

• Newborns.
• New marriages, starting at the date of the marriage certificate.
• When a beneficiary’s health insurance from other providers terminates, provided that supporting documentation is provided.
• Rejoining the university after sabbatical, secondment, assignment, or unpaid leaves, or in the case of employee transferred from a monthly salary to a contract.

 

Cancellation (during the term of the contract):

Insurance may be suspended (cancelled) during the term of the insurance contract in the following cases:

• A change in the status of one of the beneficiaries and becomes ineligible for insurance according to the categories of eligibility specified in the regulations.
• Resignation, sabbatical leave, secondment, assignment, or unpaid leave, if the participant does not request continuity in accordance with the regulations.
• Death of the insured.

Dispensing Chronic Medications:

• Chronic medications are provided through the health insurance card and through the mechanism determined by the Health Insurance Committee.
• Chronic medications are provided after submitting a medical report and laboratory tests from specialists.
• Providing the insured phone number so that they can be notified of the date their medications will be provided.
• Chronic medications are provided during the first week of each month through the university clinics for employees.

Financial Claims from Outside the Approved Medical Network:

• Financial claims from outside the medical network shall be submitted through the approved internal form and attached with an invoice from the service provider.
• Providing a detailed medical report.
• Treatment (procedures) can be provided and covered within the medical network directly the insurance company even in the case where the treating physician is not part of the medical network.
• Compensation of financial claims outside the network is limited to (80%) based on the prices of the Medical Association.

Waiting Periods:

• This is the period starting from the date of joining the insurance, during which medical conditions covered by the insurance contract are not covered until the waiting periods have expired, in accordance with the attached waiting period table.
• Continuity and cancellation of waiting periods for existing and pre-existing conditions shall be granted to insured persons who are enrolled on the effective date of the insurance contract.
• Waiting periods shall apply to all new insured persons enrolled after the effective date of the contract on 01/01/2026.
• Continuity is granted to new insured persons who are covered by continuity in insurance with other insurance companies with an interruption period not exceeding 30 days before the date of appointment at the university.

Quality of Service Provided:

• Contact the technical liaison officer at the university (university doctor) if you encounter any problems obtaining medical approvals.
• Submit complaints and comments using the form approved by the Human Resources Department.
• It is important to review the university's health insurance regulations and instructions and to contact the Human Resources Department – Talent Division if you have any questions about the above.
• Misuse and termination of insurance based on the university's health insurance regulations and instructions in the following cases:
• If it is proven that the insurance card has been misused by the subscriber or his beneficiaries, or that incorrect data has been provided, in which case the full premiums must be paid, and the subscriber shall bear all legal and administrative responsibilities and the cost of treatment based on the committee's recommendation. (Article 8/d of the health insurance instructions).
• If one of the conditions of insurance eligibility listed in the definitions clause ceases to apply, in which case the subscriber or beneficiary is responsible for reporting the case under penalty of legal and financial liability and shall bear the full cost of treatment regardless of its source or cause. (Article 8/d of the Health Insurance Instructions).

 

Waiting Period Table (Applicable to New Subscribers)

Medical Condition	Waiting Period
Lithotripsy and Gallbladder Diseases	3 months
Varicose veins, Varicocele, Hydrocele (non-related to infertility)	3 months
Stomach and Digestive System Diseases	3 months
Tonsils and Adenoids	3 months
Hemorrhoids, Fistulas, Anal Fissures, and Hernia	4 months
Deviated Nasal Septum (for medical reasons, not cosmetic)	4 months
Cataract Surgery and High Eye Pressure	4 months
Fibroids, Endometriosis, Uterine Lining, Uterine Removal/Repair (non-related to infertility)	4 months
Pregnancy (including delivery, miscarriage, ectopic pregnancy, pregnancy stabilization, and check-ups)	6 months
Back Pain, Disc Herniation, Spinal Disc Slippage, Knee Arthroscopy and Surgery	6 months
Chronic Diseases (Hypertension, Heart, Arteries, Diabetes, etc.)	6 months