Health cover is vital in assisting you with your medical bills should you happen to fall ill. Because we never know when we will fall ill, and how much it will cost us, we join medical aid so that we know that should we fall ill at any time, the Society will be there to assist us. The Society offers a wide range of benefits on its six packages to meet our health needs.
CIMAS Medical Aid Society has an open membership policy. Membership is available on application from people in both the formal and informal sectors. One can join through their employer’s account or in their own individual capacity. Although the bulk of the CIMAS membership is from the private sector, CIMAS administers medical aid funds for several quasi government organisations
Prospective members who intend to join through existing accounts are required to complete Membership Application Forms and submit them to CIMAS through their Human Resources Department. Those joining individually or through a new account are, in addition to the membership application, required to complete an application to open an account form and submit it together with an initial payment.
CIMAS administers medical insurance on a concept known as the medical aid concept, which basically is the pooling of resources and spreading of risk among the membership so as to afford members higher benefits through cross subsidization.
The answer is YES, as long as the member contributions continue to flow into the pool of funds. Members shall be required to have at least 5 years' continuous membership with the Society to be granted the same corporate rates in their individual capacity, in the event of resigning from a corporate account.
Waiting periods exist on certain benefits in order to safeguard existing members from high treatment costs brought about by new members who suddenly join medical aid after having found out that they need expensive treatment. If no such waiting periods are in place, this would inevitably drive up contributions much to the disadvantage of existing members.
An overview available is that in Zimbabwe there are two systems of paying for services rendered. There is a DIRECT PAYMENT SYSTEM which allows providers to claim directly from the Society and not from the member, and the CASH BASIS PAYMENT SYSTEM which allows the provider to ask for payment direct from the member and not from the Society. Where a member would have paid cash, he/she will be expected to claim his/her refund from the Society at AHFoZ (Association of Healthcare funders of Zimbabwe) agreed rates.
The issue of a no-claim bonus is known to discourage members from seeking vital treatment in order to receive this bonus. For instance in these tough times, one can harbour an illness which might eventually turn out to be very expensive to treat, just because one needed the no-claim bonus to pay off some debts. Unlike under general insurance where premiums are defined depending on things like the individual's age and assessed risk, under medical aid members pay the same contribution rates per package regardless of their state of health and age. Besides medical aid contributions are 100% tax deductible and no-claim bonuses result in the loss of this tax credit.
It is possible for a Cimas member to purchase drugs without having to make payment to the pharmacist, if the purchase is made from a pharmacist that is on Cimas’s upgraded online drug purchase system and the member has the four items needed for this.
The new facility has security features that include the use of a One Time PIN (OTP), which is sent to the principal member and his or her adult dependants’cellphone. This PIN is needed to close the purchase.
Before you can use the online drug purchase facility, you will need to make sure that your mobile phone number and that of your dependants is registered with the Society. It is also imperative to register your chronic conditions with Cimas. It is to this phone that the PIN will be sent when you are purchasing drugs from a pharmacy that has the online drug purchase facility.
When you seek to purchase drugs from one of the pharmacies on the Cimas online system, you give the pharmacist the prescription and your Cimas card. The pharmacist will log onto the online system and enter your membership number. A one-time PIN will automatically be sent to your cellphone number. The pharmacist will enter the drugs that are being purchased on prescription and their cost. To complete the transaction, you give the pharmacist your one time PIN so he can enter it to close the transaction. The PIN is only valid for 10 minutes.
The member or a dependant must be present at the pharmacy, as the pharmacist is expected to verify that the person presenting a membership card is the person whose photograph is on the membership card.
Yes. The on-line drug purchase facility will cover one prescription per month per member. Pre-authorisation will be required for a second prescription. Members registered with Cimas for chronic medication will be able to access up to five drugs per month. Non-chronic members are limited to three drugs per month.Drugs in excess of these limits will require pre-authorisation or they can be purchased for cash and a claim be submitted for a refund of the cost.
The request can be made in person, by e-mail or via WhatsApp. When a member comes in person there is need to present the prescription. Members with access to internet can scan and email their scripts for dental, drug and optical authorisations to the following email addresses, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. For WhatsApp preauthorisation members are advised to take clear photos of their documents with their smart phones clearly showing patient details which include member name, membership number, suffix and all the relevant drug or dental information and send to the number 0784 308 022. Response services will be available between 8am and 4.30pm Monday to Friday, but members are free to send requests for authorisations at all times. The Society will allow members who have not exceeded the number of drug limits to access multiple prescriptions without preauthorisation.
Just a few minutes.
The upgrading of the system has been necessitated by the discovery of extensive fraud in relation to drugs claims paid for through the online system. Such fraud has included non-prescribed drugs being added to online claims. Limiting the number of drugs and prescriptions that can be paid for through the online system is part of the security measures that have been taken to try to prevent fraudulent claims.
Yes. Only a few people require medication more than once a month or more drugs than the stipulated maximum number per month. The process does not take more than a few minutes. Similar pre-authorisation already required for accessing add-on chronic disease benefits have worked well.
No. Drugs prescribed by a doctor at a Cimas clinic can be obtained from the clinic’s pharmacy.
The pharmacy licence for Cimas clinics only allows the pharmacy to issue drugs that have been prescribed at the clinic within which the pharmacy is situated.
No. Cimas healthcare facilities have been established to give members access to affordable health services. However, every member is entitled to be seen by a doctor of his or her choiceand to purchase drugs from any pharmacy. Where there is no agreement between a healths ervice provider and Cimas for direct payment, then the member can pay the service providerand lodge a claim with Cimas for a refund of the payment made.Where the number of medicines or prescriptions exceeds the maximum number ordinarily permitted for payment through the online system, the member can either pay cash and claim arefund or seek pre-authorisation, a process that takes only a few minutes.The restrictions on the online facility have been necessitated by abuse of the facility, whichresulted in members’ funds being depleted through fraudulent claims. The Society has an obligation to protect members’ funds, so that funds are available to pay legitimate claims.
No. Respect for confidentiality is one of our core values. Doctors’ claims already include the doctor’s diagnosis of the patient’s condition. This is information that Cimas has and which is always kept confidential. Seeking pre-authorisation does not, therefore, affect confidentiality.