Benefit limits for the Prime package are paid per beneficiary per membership year and accrue from the date the beneficiary joins the Society, subject to waiting periods. Awards are made at Cimas tariffs. All benefits and benefit limits are paid up to applicable sublimit.
Where usage is considered excessive the Society reserves the right to restrict usage or recommend cost effective treatment options.
The following benefits are paid at to tariff.
- Hospitalisation in a Private Hospital.
- In-hospital drugs.
- General practitioners.
- Specialist Treatment is covered upon referral by a primary care service provider.
- Pathology and Radiology Services at Private and Government facilities.
- Blood Transfusion Services (BTS).
Benefit covers prescription drugs and is paid at the Cimas tariff up to an annual family limit.
- Drugs supplied on prescription outside Zimbabwe are paid at the Cimas award.
- Members can access generic prescription drugs or equivalent on the Society’s network of pharmacies.
Benefit is paid to tariff up to package sublimit once every two (2) year period
- It caters for either lenses, frames or contact lenses.
- Eye tests are paid to tariff once every year.
Maternity is paid to tariff
- It caters for maternity care, delivery, and hospitalisation. The Society covers nine (9) antenatal and five (5) postnatal visits.
- Two (2) antenatal ultra-sound scans.
This caters for general and preventive dentistry up to package sublimit
- The following benefts are subject to prior- authorization: inlays, root treatment, crowns, bridges, dentures and implants.
Covers treatment outside of Zimbabwe subject to pre-authorisation.
- Foreign claims must be submitted for payment within a period of four (4) months from the date of treatment.
- Reimbursement of foreign claims shall be made in Zimbabwe’s legal tender.
Prosthetics and Applicances
Awards are paid up to tariff subject to available sublimit for:
- Internal Prosthetics.
- External prosthesis.
- Ostomy bags.
- Hearing aid repairs.
- Hearing Aids are paid up to tariff subject to available sublimit.
- Glucometers are paid up to tariff subject to available sublimit.
- This caters for occupational and Speech Therapy, Clinical Psychology, Social Work and Physiotherapy. Awards are paid to tariff up to the package sublimit.
- This caters for consultation by a psychiatrist. Awards are paid to tariff subject available sublimit.
Emergency Evacuation Services
Covered for life threatening situations only
- Road Ambulance service is paid to tariff.
- Air evacuation is paid to tariff.
Awards are paid to tariff subject to prior-authorisation
- Frail Care Homes for providing constant care nursing.
- Medical auxiliary services.
- Hospital Transfers.
- Family planning administered by a primary care provider (prior-authorisation is not required).
- Funeral cash cover up to beneft sublimit.
- Access to non-subscription iGo partner discounts.
- This caters for Chiropody, Chiropractic, Homeopathy, Osteopathy and Naturopathy provided the suppliers are registered in terms of the appropriate regulations. Awards are paid up to tariff subject to available sublimit.
The following benefit waiting periods apply to those joining the Society for the first time or where there has been a lapse in the membership. The Society reserves the right to waive waiting periods for members transferring from AHFoZ affiliated medical aid societies. These waiting periods include:
Four months for:-
- A mandatory four (4) months waiting period will apply to all new members
Six months for:
- Specialist treatment
- MRI, CT scans and Nuclear medicine
- Admission or treatment at a hospital
- Dental treatment
Nine months for:
One (1) year for:
- Homes providing constant nursing care
- Spectacles/Contact lenses
- Foreign treatment
Two (2) years for:
- All internal and external prosthetic devices
- Oncology benefit
- Pre-existing conditions
Four (4) years for:
- Orthodontic Treatment
- For orthodontic work, members seek prior-authorisation from the Society before accessing treatment.
- The age limit for the beneft is 18 years
- 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/service provider does not seek pre-authorisation before accessing services.