Benefits means those services rendered by the medical, dental and allied professions, payment for which can be claimed from the Society by its members.
Cimas has an open membership policy. Membership is available on application from anyone employed in either the formal or informal sector. The bulk of the Society's membership is from the formal sector.
All registrations are effective from the first day of the month of registration.
Membership of a newly born child may be back-dated to the baby’s date of birth if the relevant application form and contributions are received by the Society on or before the 10th day of the second month following the month in which the child was born.
Newly born babies should ideally be registered on the day of birth to enable the Society to cover any services rendered by the doctor after delivery. If registration is not possible on the day of birth, a completed registration form should be sent to the Society within six weeks of birth. To ensure that the child is not affected by any waiting periods, the joining date should be the first day of the month within which the child was born. This will mean that in‑hospital claims associated with the newborns birth will be covered by the Society.
A shortfall might be the result of the fee charged being higher that the tariff awarded. Claims are paid according to tariffs and any fees charged above the tariff award will result in a shortfall. Shortfalls also arise when a member has exhausted the benefit limit for a given membership year. Some benefits are subject to yearly limits, which when exceeded result in a shortfall. Different packages have different limits. Shortfalls can also be due to waiting periods, which mean that the member is not yet eligible to draw funds for certain benefits.
No. Shortfalls are not claimable from Cimas but 50% of the shortfall can be claimed as a medical credit from the Zimbabwe Revenue Authority (ZIMRA). When you receive your claim settlement advice from Cimas you submit it with the shortfall receipts to ZIMRA or your Human Resources Department.
Drug claims to be submitted within 2 months from the date of treatment
Medical and dental within 3 months from the date of treatment
Foreign claims within 4 months from the date of treatment
Government and mission hospital claims 6 months from the date of treatment
Pensioner membership is available on application for corporate members who have retired from formal employment and have 10 or more years of membership with no break. The pensioner membership application is subject to Cimas Board’s approval. Cut-off age limit is determined by the Cimas Board. Upon the death of such a pensioner, his widow who was a dependent member is eligible to apply for pensioner membership.
Currently vaccination for babies is done only at our Cimas Bulawayo clinic where the local city council gave us the privileges to do so. In other areas including Harare the city council clinics carries out the mandate. Vaccination is actually a government mandate (it is of national interest) so that is why it is carried out by council and government clinic mainly.
Membership of the Society can be terminated on one month’s notice in writing to that effect given by either a member, member firm or the Society.
Waiting periods are applied for certain benefits in order to safeguard existing members' funds from high treatment costs brought about by new members who join medical aid specifically to access expensive treatment and resign thereafter. This would inevitably drive up claims costs resulting in the Society charging higher contributions. Waiting periods may be applied to any new applicants/dependants.
The waiting periods are applied regardless of whether members have pre-existing conditions or not.
Upon upgrade from a lower package, members will enjoy benefits after serving the six months waiting periods at the right levels.
Members are only authorized to upgrade or downgrade once within a year.
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 pharmacy that is on Cimas’s online drug purchase system. This only applies if the purchase price is within the tariff awarded.
The new facility uses e-claims and is now biometric, essentially members can have their finger prints registered before they purchase drugs. Finger print registration can be done at the point of sale or at any Cimas outlet.
Members can also use the One Time PIN (OTP), which is sent through the member’s 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 is registered 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/she can enter it to close the transaction. The PIN is only valid for 10 minutes.
The member or a dependant of the principal member 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.
The one time PIN will be sent to the member’s cellphone that is registered with Cimas. If the member is not present at the pharmacy, then he can forward the PIN number to the family member so that it can be given to the pharmacist.
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. Ordinary members will be 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 or by e-mail. The prescription must be presented or e‑mailed.
Normally it takes 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.
No. Drugs prescribed by a doctor at a Cimas clinic can be obtained from the clinic’s pharmacy.
Yes. It is now possible for members to access drugs prescribed outside the Cimas clinics to be accessed within clinic pharmacies.
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 choice and to purchase drugs from any pharmacy. Where there is no agreement between a health service provider and Cimas for direct payment, then the member can pay the service provider and 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 a refund or seek pre-authorisation, a process that takes only a few minutes.
To access treatment for chronic conditions, members need to register with the Society’s Managed Care department. The Society does not guarantee full cover where a member does not seek pre-authorisation before accessing services.
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.
Yes, the Society has an option where members/member firms can pay the traditional packages through Nostro Accounts. The Society has also launched new packages which are USD based. For more information, please contact Marketing Department. Payment of the claims is remitted in the currency members pay contributions.
Document with details attached.
The Society pays claims weekly.
The waiting period for foreign treatment is one year for treatment benefits that have one year or less waiting periods locally, all other waiting periods apply accordingly i.e. haemodialysis and prosthetic benefits accessed outside Zimbabwe should be after two years from joining date.
Submit to Cimas, a referring letter from the relevant (in terms of illness) local Specialist Doctor who is referring you and the quotation from the Hospital where you will be treated in South Africa. After the treatment has been authorised you will be advised of your authorization number. Please put your member number and contact details on the documents before submitting.
The society reimburses 50% for unauthorized foreign treatment up to the package’s foreign treatment limit for such and usually 70% for authorized foreign treatment limit up to the package’s limit for such. (Refer to below table for package’s limits).
Please come in to our offices with the following documents x-rays, MRI scans and reports as well as a letter from your Doctor explaining the nature of your condition, ask to see someone from the Foreign Department.
No medical treatment costs only.
The refund will be at 75% of cost up to your local drug limit.
Yes, foreign claims are valid six months from date of treatment.
Yes, it is covered, member has to bring in a quotation for authorisation.
We pay 100% of the stipulated prices for members on private, MedExec and Healthguard Deluxe packages, private hospitals however hiked their fees in May 2014 by 5% we absorbed 2.5% so there is always a 2.5% shortfall on most of the charges. On possible shortfalls amount, it is best to consult the hospital as they have the claiming rules and rates and they know what they are likely going to use on you during admission and how the medical aid pays.
It is best to check with the hospital what the payment they are asking you to pay is for. However (applies to Avenues only) if you were seen in the hospital’s casualty and subsequently admitted its likely that the shortfall is for casualty consultation as it is a rule that a service provider cannot charged for both casualty consultation and admission on the same day at the same institution.
Shortfalls may also be from per rule non claimable items – these the hospital can best explain to you- these shortfalls will also reflect on your monthly statement when the hospital submits your claim.
Please verify with the hospital before you come to the Cimas offices, if the shortfall is for a non-claimable item it is non- refundable. Or (Agent can check what the shortfall is for as it may be an error on the provider’s side or Cimas’s side that is claim held up for error 51 –report, or stale period- verify if its genuinely stale per claim submission period durations.