ALD Morocco 2026: 41 illnesses fully reimbursed (cancer, diabetes…)

01What is a long-term illness#

The Long-Term Illness, better known by its acronym ALD, is a central scheme of Moroccan Compulsory Health Insurance (AMO) allowing full 100% coverage of care related to a serious, chronic, costly or progressive illness. Concretely, when a patient is granted ALD recognition, they benefit from removal of the part usually charged to them (the moderating ticket, generally 20-30% of expenses) for all care directly related to this pathology. This protection was designed so that no Moroccan facing a heavy illness gives up care for financial reasons.

The scheme was established by law 65-00 on the basic medical coverage code, promulgated in 2005 and entered into force progressively from 2006. It is part of a national solidarity logic: contributions from all affiliates fund enhanced coverage for patients suffering from serious pathologies. This mechanism covers all AMO schemes equally: CNOPS for civil servants, CNSS for private sector employees, and since December 2022, AMO Tadamon which replaced RAMED for low-income populations. Self-employed under AMO TNS (law 98-15) are also concerned.

It is important to distinguish ALD from disability or incapacity for work. Being recognised as ALD does not mean being unfit to work: a type 2 diabetic on insulin, a patient followed for rheumatoid arthritis or a person HIV-positive on triple therapy can perfectly exercise normal professional activity. ALD is an administrative status linked to financial care coverage, nothing more. This is an important distinction, as many patients hesitate to request their ALD for fear of professional consequences, which do not exist in Moroccan legislation.

02The 41 affections recognised by ANAM#

The National Health Insurance Agency (ANAM) publishes and updates the official list of pathologies entitling to ALD status. To date, 41 affections are recognised, grouped into major clinical families. This list is periodically reviewed to account for evolving medical knowledge and care costs.

In the cardiovascular field, severe arterial hypertension, congenital and acquired heart diseases, chronic heart failure, sequelae of myocardial infarction and disabling stroke, as well as occlusive arteriopathies of the lower limbs stage III-IV are recognised. These pathologies alone represent nearly a third of ALD files in Morocco, reflecting the cardiovascular epidemic affecting the country.

In endocrinology, ALD covers type 1 diabetes, type 2 diabetes with complications (retinopathy, nephropathy, neuropathy or diabetic foot), congenital hypothyroidism, severe pituitary diseases (acromegaly, Cushing's disease) and chronic adrenal insufficiencies. Simple type 2 diabetes without complications does not automatically open the right to ALD according to strict ANAM rules, but in practice many medical advisers accept files presenting persistent glycaemic imbalance requiring therapeutic intensification.

The cancer and haematology chapter is probably the most mobilised in terms of costs: it encompasses all malignant tumours regardless of their location and stage, acute and chronic leukaemias, Hodgkin and non-Hodgkin lymphomas, haemophilia, sickle cell disease, major thalassaemia and severe haemolytic anaemias. For these pathologies, ALD covers including costly chemotherapies, radiotherapy, targeted therapies and long hospitalisations.

In rheumatology and immunology, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, myositis, systemic vasculitis and primary or acquired immune deficiencies are recognised. The arrival of biotherapies (anti-TNF, anti-IL6, rituximab) has considerably increased the cost of management of these patients, fully justifying their ALD status.

The neurological side covers drug-resistant epilepsy, Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, paraplegia and tetraplegia of traumatic or medical origin, as well as genetic myopathies (Duchenne, Becker, etc.). In pneumology, severe persistent asthma, chronic respiratory failure on oxygen therapy, cystic fibrosis, pulmonary and extrapulmonary tuberculosis entitle to ALD. Nephrology is represented by chronic kidney failure on dialysis or transplant and chronic glomerular nephropathies (nephrotic syndrome, glomerulonephritis). In hepato-gastro-enterology, Crohn's disease, ulcerative colitis, cirrhosis whatever its cause, and chronic viral hepatitis B and C are eligible, the latter now benefiting from new direct-acting antivirals covered at 100%.

Finally, several affections fall into specific categories: HIV/AIDS, severe psychiatric diseases (schizophrenia, bipolar disorder, treatment-resistant depression), chronic glaucoma, certain serious benign tumours (meningiomas, neurinomas), and more recently rare diseases documented within the National Rare Diseases Plan. The detailed and constantly updated list is available on the official ANAM website.

03The procedure step by step#

Obtaining ALD status requires an administrative procedure in five steps, which is important to understand well to avoid delays and rejections for form defects. This procedure applies similarly in the three funds (CNOPS, CNSS, AMO Tadamon), with some variations in submission counters.

The first step is the diagnosis made by a specialist physician. They establish the long, severe and costly nature of the pathology. In practice, your treating doctor can of course suspect and refer, but the ALD file must obligatorily be countersigned by the relevant specialist — endocrinologist for diabetes, cardiologist for cardiac pathologies, oncologist for cancers, etc. Without this specialist signature, the file will be systematically rejected by the fund's medical adviser.

The second step consists of filling the ALD care protocol, which is the official ANAM form (often called "PSALD"). This document specifies the diagnosis, severity elements, planned treatment plan, necessary complementary examinations, envisaged consultation frequency and foreseeable duration of care. It must be co-filled by your treating doctor (who ensures overall follow-up) and the specialist (who establishes diagnosis and therapeutic strategy). The protocol must be dated, signed, stamped by both doctors and accompanied by their practice stamps.

The third step is filing the complete file with the fund you depend on. This file classically includes: the signed ALD care protocol, a copy of your fund registration card, a copy of your national ID, relevant medical reports (hospitalisation report, biological examinations, imaging, anatomopathology for cancers), and any document justifying severity (for example a coronary angioplasty report for an MI). Filing can be done at a physical agency or increasingly via online portals (cnops.org.ma, cnss.ma).

The fourth step is the examination of the file by the fund's medical adviser, who has a regulatory deadline of 30 calendar days from receipt of the complete file to render their decision. In practice, this deadline can be shorter (a few days for cancers or obvious pathologies) or longer (up to 60-90 days for complex files or requiring expertise). According to the code, silence kept for more than 30 days equals implicit rejection, opening the way to appeal — an important point to know so as not to leave a file "pending" indefinitely.

The fifth and last step, in case of agreement, is activation of ALD status on your insurance card (whether digital or physical). From this moment, when you present your card to a contracted doctor, at the pharmacy or for hospitalisation in connection with your ALD, the 100% insured share is automatically calculated, without advance fees in third-party payment for usual medications and examinations.

04What 100% coverage covers — and does not cover#

ALD status entitles to integral coverage of all care directly related to the recognised pathology. This includes consultations with your treating doctor and concerned specialists, whether in contracted private practice or in a public structure. Hospitalisations related to the disease are covered at 100%, whether stays in public service, contracted private clinic or day hospital for chemotherapy or dialysis.

Medications listed on the AMO reimbursable list are fully covered when they appear in your ALD care protocol. This clarification is important: a medication may exist on the Moroccan market but not be part of the ANAM reimbursement list, in which case it remains at your expense even in ALD. Biological and imaging examinations prescribed within ALD follow-up are also covered, as are rehabilitation acts (post-stroke physiotherapy, speech therapy, occupational therapy), medical devices (glucose meters, prostheses, wheelchairs, home oxygen therapy), prescribed home nursing care, and even certain medical transport when the patient's condition medically justifies it.

Conversely, some costs are not covered by ALD, which is a frequent source of misunderstanding. First, care not related to ALD pathology remains subject to usual AMO rules (70-80% reimbursement). If you are in ALD for cancer and consult a dentist for scaling, this care is covered according to standard rules and not at 100%. Then, fee overcharges practised by some specialists above ANAM contractual tariffs remain at your expense, unless you have a complementary mutuelle. Finally, medications outside the reimbursement list, non-contracted care (alternative medicines, certain aesthetic techniques) and care abroad fall outside the standard ALD scope.

05ALD renewal#

ALD is never granted for life unconditionally. Depending on the pathology, the initial validity duration varies from two to five years, sometimes less for certain potentially reversible affections (hepatitis C today curable by direct-acting antivirals, for example). One to two months before expiry, you must initiate the renewal procedure, ideally anticipating to avoid a coverage interruption.

Renewal supposes the update of the care protocol by your treating doctor and your specialist, accompanied by a recent clinical assessment (biological examinations, imaging according to pathology, specialist consultation reports). The objective is to demonstrate persistence of ALD criteria: pathology still active, treatment still necessary, surveillance still required. For progressive and incurable pathologies (metastatic cancers, neurodegenerative diseases, dialysed CKD), renewal is in practice automatic as long as clinical conditions are stable. For pathologies that may experience lasting remission (some cancers, lymphomas in complete remission for several years), progressive withdrawal of ALD status can be discussed in consultation with the medical adviser and treating team.

06Refusal, disagreement and appeal procedures#

Not all ALD files receive a favourable opinion. Classic rejection reasons are absence of sufficient severity elements, incomplete file (missing signatures, missing medical reports), pathology not appearing on the official list, or discrepancy between the diagnosis displayed and supporting evidence in the file. In all these cases, the patient has several appeal procedures to have their file re-examined.

The first step, amicable, consists of sending a motivated letter to the fund director (CNOPS, CNSS or AMO Tadamon regional agency), attaching all complementary medical elements likely to justify the expected decision. This route often allows quick resolution when initial rejection simply came from insufficient file processing. If amicable does not succeed within a reasonable delay of 30 to 60 days, the patient can seize the ANAM mediator, an independent body responsible for settling disputes between insureds and funds. The seizure is by registered mail with acknowledgement of receipt or via the ANAM portal.

Finally, as a last resort, the patient can engage a contentious appeal before the administrative court territorially competent. The seizure deadline is four years from the contested decision, leaving time to exhaust amicable routes. This procedure is longer (six months to two years on average) and often supposes the assistance of a lawyer, but it succeeds in a non-negligible proportion of cases, especially when the medical file is solid. Experience shows that a large part of initial rejections end up being granted on second reading, provided the patient does not give up and builds a rigorous file.