The role of contractual arrangements in improving health sector ...

Tunisia
Coverage of MRI procedures requires the submission of an application made on a special
form available in the above-mentioned facilities.
• Heart transplant. Coverage of heart transplant expenses is provided to the socially insured
undergoing treatment in Tunis Military Hospital. This coverage includes: the cost of clinical,
biological and radiological preparations of the donor and recipient; the surgical procedures
(removal and transplant); and the clinical, biological and radiological follow-up as well as the
treatment of possible complications during the first year and the immunosuppressive treatment
during the first year. Coverage of heart transplant requires: an application for prior approval
submitted on a special form provided by Tunis Military Hospital.
• Haemodialysis. In order to get coverage for haemodialysis sessions, the affiliate member hould
submit to the CNRPS. An application for prior approval made on a special form available in one
of the following hospitals:
Charles Nicole Hospital
The Military Hospital (Tunis)
Fattouma Bourguiba Hospital (Monastir)
Hédi Chaker Hospital ( Sfax)
Also necessary are a written request specifying the haemodialysis centre selected by the
patient, and an application for coverage of long illness made on a special form provided by the
CNRPS.
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The CNSSTP PT agreements
Except where otherwise specified, coverage requires a file consisting of an application made
on a CNSS form, and a medical report. Prior approval is usually required before the procedure is
provided.
The conditions to be eligible for coverage vary according to the socio-professional status of
the person insured; in general the requirements for prior approval areas follows:
Retirees: must be a recipient of a pension from the CNSS.
Salaried employees from the non-farm sector: must have accrued 50 days of work during the past two
terms or 80 days of work during the past 4 terms preceding submission of the application.
Salaried employees from the farm sector: must have paid contributions for at least one term during the
2 terms preceding the submission of application or contributions for at least two terms during
the 4 terms preceding submission of the application.
Non wage-earning workers: must have paid contributions for at least 2 terms during the 4 terms
preceding submission of the application.
Workers abroad: (not covered by a social security bilateral agreement) must have paid contributions
for at least 2 terms during the 4 terms preceding submission of the application.
Students under 28 years: must hold a valid student card during the current academic year.
Students over 28 years or married: must be registered at the CNSS.
Some categories of workers with low income must have paid contributions for at least 3 months in the
2 months preceding submission of the application.
A socially insured person’s spouse: must not have a professional activity or social coverage.
2 For the two social security funds, the agreements relate to the same services for the different conditions/diseases covered.
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