Product Structure 2016

Transcription

1 Product Structure 2016 is now part of

2 Welcome to Wanthanzi Health Plan Wanthanzi Health Plan was established in 2006 as a medical aid scheme to provide essential affordable care to more people in Zambia. It is a truly Zambian registered health plan and the accumulated funds are maintained in Zambia and reinvested here. Contributions and claims are collected and paid out from a Zambian based banking account in the local currency, Kwacha. Wanthanzi Health Plan provides medical aid cover for members seeking affordable cover in the private sector. The health plan is administered by Metropolitan Life Zambia. Metropolitan Life Zambia is a member of MMI holdings group, a Johannesburg Stock Exchange listed entity that was created out of the merger between two reputable companies namely: Momentum (founded in 1966) and Metropolitan (founded in 1897). MMI Holdings Limited (MMI) is a leading insurance based financial services company providing product solutions across all market segments with an embedded value of R40 billion. MMI s core business is long and short - term insurance, asset management, savings, investment, health care adminstration and employee benefits. Assets under management total over R275 billion with the total number of health lives under administration of over 3 million people. The group has enjoyed phenomenal growth in the African continent with operations in 13 countries. Metropolitan has been able to tailor-make health products designed to cater for the specific needs of each of the countries in which it operates. These countries are; South Africa, Lesotho, Zambia, Botswana, Mozambique, Tanzania, Kenya, Ghana, Mauritius, Namibia, Malawi, Swaziland and Nigeria. This handbook gives you an easy to understand scheme summary of the Wanthanzi Health Plan. Contacts: /8, , Cell / Or visit us on 1

3 Why choose Wanthanzi? You are assured of a financially sound and secure health plan The scheme, administered by Metropolitan Life Zambia, offers both financial stability and sustainability to ensure continued access to healthcare cover at a reasonable cost. Your service satisfaction is our priority At Wanthanzi we are committed to a culture of caring and strive to understand the healthcare needs of our members. We have a dedicated call centre located in Lusaka, with additional service consultants looking after the well-being of our members. 2

4 Product Composition Disease Management Hospital Benefits Emergency Evacuation MAJOR MEDICAL YOUR HEALTHCARE NEEDS DAY - TO - DAY Medicine Management Disclaimer This brochure does not supercede the rules of the plan, a copy of which is available on request. Health Advise Line Primary Care Benefits Special Benefits Health Advice Line HIV Wellness Programme Emergency Evacuation Fit@Work Rewards 3

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6 Additional Benefits In addition to offering comprehensive medical care, Wanthanzi Health Plan includes the following additional benefits for all options: Beyond Life Benefit This benefit will be payable towards funeral expenses upon the unfortunate event of the death of the principal member, registered adult dependant or registered children. Accidental Death Benefit A lump sum payment in the event of death of the principal member due to an accident. Premium Waiver Following the death of the principal member, contributions for the registered dependants will be paid for a period of 12 calendar months. 5

7 6 For Tiny Newbies Special hamper for every baby born on the Scheme. Get yours today! Terms and conditions apply is now part of

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10 Essential Option Hospital benefit Annual Limit - ZMW 18,500 per beneficiary per annum Benefits payable at 100% of agreed tariff (Zambia Price List). In Patient Benefit covers medical expenses incurred when hospitalised, including doctors, specialists, operations, anesthesia etc Hospital Limit - ZMW 14,500 per beneficiary per annum Major Disease Benefit Hospitalisation in General Ward and Specialised Ward General Practitioners and Specialists Prosthesis Neonatal care and premature births Circumcision (per beneficiary per annum) ZMW 860 Medical and Surgical Applicances Specialised Radiology MRI / CT Scans Renal Dialysis Oncology / Chemotherapy Medicine to take home (TTO) Maternity Maxilla-Facial Surgery Psychiatric hospitalisation Radiology and Pathology Ambulance (in country only) Air/Cross Boarder Evacuation Repatriation Medical motivation required Subject to enrolment on oncology programme 3 days supply Not covered Included 9

11 General Practitioners and Specialists Consultations Primary Care Benefit Annual Limit - ZMW 4,000 per beneficiary per annum Beyond Life Benefit Chronic Medication ZMW 3,500 Glucometer and Strips for Insulin Dependant Chronic Members Procedures Acute Medication Radiology and Pathology 1 Glucometer per Insulin dependant chronic member Max 300 Gluco-Sticks per annum Basic Dentistry (per beneficiary per annum) ZMW 900 Advanced Dentistry Physiotherapy ZMW 1,300 Antenatal Auxiliary Services ZMW 900 Optometry including optometrist consultation ZMW 900 Mono/Bi/Multifocal Lenses/frames This benefit will be payable towards funeral expenses upon the unfortunate event of the death of principal member, registered spouse or registered children. Main Member ZMW 5,000 Adult Dependant ZMW 5,000 Child Dependant ZMW 2,000 Hello Doctor ADDITIONAL BENEFITS Within optometry benefit (every two years) Digital doctor included Accidental Death Cover (Main Member only) ZMW 5,000 Health Premium Waiver Contributions for 12 months from date of death of a PRINCIPAL MEMBER 10

12 Essential Plus Option hospital Benefit Annual Limit - ZMW 29,250 per beneficiary per annum Benefits payable at 100% of agreed tariff (Zambia Price List). In Patient Benefit covers medical expenses incurred when hospitalised, including doctors, specialists, operations, anesthesia etc Hospital Limit - ZMW 22,500 per beneficiary per annum Major Disease Benefit Hospitalisation in General Ward and Specialised Ward General Practitioners and Specialists Prosthesis Neonatal care and premature births Circumcision (per beneficiary per annum) ZMW 940 Medical and Surgical Applicances Specialised Radiology MRI / CT Scans Renal Dialysis Oncology / Chemotherapy Medicine to take home (TTO) Maternity Maxilla-Facial Surgery Psychiatric hospitalisation Radiology and Pathology Ambulance (in country only) Air/Cross Boarder Evacuation Repatriation Medical motivation required Subject to enrolment on oncology programme 3 days supply Not covered Included 11

13 General Practitioners and Specialists Consultations Chronic Medication Glucometer and Strips for Insulin Dependant Chronic Members Procedures Acute Medication Radiology and Pathology Primary Care Benefit Annual Limit - ZMW 6,750 per beneficiary per annum Beyond life benefit 1 Glucometer per Insulin dependant chronic member Max 300 Gluco-Sticks per annum Basic Dentistry (per beneficiary per annum) ZMW 1,500 Advanced Dentistry Physiotherapy ZMW 1,400 Antenatal Auxiliary Services ZMW 1,140 Optometry including optometrist consultation ZMW 1,500 Mono/Bi/Multifocal Lenses/frames Within optometry benefit (every two years) This benefit will be payable towards funeral expenses upon the unfortunate event of the death of principal member, registered spouse or registered children. Main Member ZMW 5,000 Adult Dependant ZMW 5,000 Child Dependant ZMW 2,000 Hello Doctor ADDITIONAL BENEFITS Digital doctor included Accidental Death Cover (Main Member only) ZMW 5,000 Health Premium Waiver Contributions for 12 months from date of death of a PRINCIPAL MEMBER 12

14 Extender Option hospital benefit Annual Limit - ZMW 96,130 per beneficiary per annum Benefits payable at 100% of agreed tariff (Zambia Price List). In Patient Benefit covers medical expenses incurred when hospitalised, including doctors, specialists, operations, anesthesia etc Hospital Limit - ZMW 87,500 per beneficiary per annum Major Disease Benefit Hospitalisation in General Ward and Specialised Ward General Practitioners and Specialists Prosthesis High Care & Intensive Care Neonatal care and premature births ZMW 9,300 per prosthesis 3 days per hospital episode 3 days per hospital episode Circumcision (per beneficiary per annum) ZMW 4,380 Medical and Surgical Applicances ZMW 4,600 per Family per annum Specialised Radiology MRI/CT Scans Secondary Step Down facilities Renal Dialysis Oncology/Chemotherapy Organ Transplant Medicine to take home (TTO) Maternity Maxilla-Facial Surgery Psychiatric hospitalisation Radiology and Pathology Ambulance (in country only) Air/Cross Boarder Evacuation Repatriation Compassionate travel for one parent accompanying the minor Medical motivation required Not covered Subject to enrolment on oncology programme Not covered 5 days supply 3 days per annum Not covered Included Not covered 13

15 General Practitioners and Specialists Consultations Chronic Medication Glucometer and Strips for Insulin Dependant Chronic Members Primary care benefit Annual Limit - ZMW 8,630 per beneficiary per annum beyond life benefit 1 Glucometer per Insulin dependant chronic member Max 300 Gluco-Sticks per annum Procedures ZMW 1,500 Personal health Assessment Not Covered Acute Medication Radiology and Pathology Basic Dentistry (per beneficiary per annum) ZMW 1,780 Advanced Dentistry Physiotherapy ZMW 1,500 Antenatal Auxiliary Services ZMW 1,500 Optometry including optometrist consultation ZMW 1,780 Mono/Bi/Multifocal Lenses/frames Within optometry benefit (every two years) This benefit will be payable towards funeral expenses upon the unfortunate event of the death of principal member, registered spouse or registered children. Main Member ZMW 5,000 Adult Dependant ZMW 5,000 Child Dependant ZMW 2,000 Hello Doctor ADDITIONAL BENEFITS Digital doctor included Accidental Death Cover (Main Member only) ZMW 5,000 Health Premium Waiver Contributions for 12 months from date of death of a PRINCIPAL MEMBER 14

16 Premier Option Hospital benefit Annual Limit - ZMW 842,000 per beneficiary per annum Benefits payable at 100% of agreed tariff (Zambia Price List). In Patient Benefit covers medical expenses incurred when hospitalised, including doctors, specialists, operations, anesthesia etc Hospital Limit - ZMW 825,000 per beneficiary per annum Major Disease Benefit Hospitalisation in General Ward and Specialised Ward General Practitioners and Specialists Prosthesis High Care & Intensive Care ZMW 27,650 per prosthesis 10 days per hospital episode Neonatal care and premature births 10 days per hospital episode - subject to a limit of ZMW 77,600 Circumcision (per beneficiary per annum) ZMW 5,630 Medical and Surgical Applicances ZMW 6,500 per family per annum Specialised Radiology MRI/CT Scans Secondary Step Down facilities Renal Dialysis Oncology/Chemotherapy Organ Transplant Medicine to take home (TTO) Maternity Maxilla-Facial Surgery Psychiatric hospitalisation Radiology and Pathology Ambulance (in country only) Air/Cross Boarder Evacuation Repatriation Compassionate travel for one parent accompanying the minor Medical motivation required ZMW 27,900 per family per annum ZMW 88,800 per family per annum Subject to enrolment on oncology programme 10 days supply 7 days per annum Included Return economy class ticket and US$ 100 allowance per day (max 14 days) 15

17 General Practitioners and Specialists Consultations Chronic Medication Glucometer and Strips for Insulin Dependant Chronic Members Procedures primary care benefit Annual Limit - ZMW 17,000 per beneficiary per annum beyond life benefit 1 Glucometer per Insulin dependant chronic member Max 300 Gluco-Sticks per annum ZMW 4,480 per ben per annum Personal health Assessment 1 per ben per annum Acute Medication Radiology and Pathology Basic Dentistry (per beneficiary per annum) Advanced Dentistry Physiotherapy Antenatal ZMW 2,550 per ben per annum ZMW 4,480 per ben per annum ZMW 2,300 per ben per annum Auxiliary Services Optometry including optometrist consultation Mono/Bi/Multifocal Lenses/frames ZMW 2,290 per ben every two years This benefit will be payable towards funeral expenses upon the unfortunate event of the death of principal member, registered spouse or registered children. Main Member ZMW 10,000 Adult Dependant ZMW 10,000 Child Dependant ZMW 4,000 Hello Doctor ADDITIONAL BENEFITS Within optometry benefit (every two years) Digital doctor included Accidental Death Cover (Main Member only) ZMW 10,000 Health Premium Waiver Contributions for 12 months from date of death of a PRINCIPAL MEMBER 16

18 Advanced Option hospital benefit Annual Limit - Unlimited per beneficiary per annum Benefits payable at 100% of agreed tariff (Zambia Price List). In Patient Benefit covers medical expenses incurred when hospitalised, including doctors, specialists, operations, anesthesia etc Hospital Limit - Unlimited per beneficiary per annum Major Disease Benefit Hospitalisation in General Ward and Specialised Ward General Practitioners and Specialists Prosthesis High Care & Intensive Care Neonatal care and premature births Unlimited Unlimited Unlimited ZMW 33,800 per prosthesis 10 days per hospital episode 10 days per hospital episode - subject to a limit of ZMW 116,400 Circumcision (per beneficiary per annum) ZMW 5,880 Medical and Surgical Applicances ZMW 8,450 per family per annum Specialised Radiology MRI/CT Scans Secondary Step Down facilities Renal Dialysis Oncology/Chemotherapy Organ Transplant Medicine to take home (TTO) Maternity Maxilla-Facial Surgery Psychiatric hospitalisation Radiology and Pathology Ambulance (in country only) Air/Cross Boarder Evacuation Repatriation Compassionate travel for one parent accompanying the minor Medical motivation required ZMW 42,250 per family per annum Unlimited Subject to enrolment on oncology programme Unlimited 10 days supply 10 days per admission Unlimited Unlimited Unlimited Included Return economy class ticket and US$100 allowance per day (max 14 days) 17

19 General Practitioners and Specialists Consultations Chronic Medication Glucometer and Strips for Insulin Dependant Chronic Members Procedures Primary care benefit Annual Limit - ZMW 34,160 per beneficiary per annum beyond life benefit 1 Glucometer per Insulin dependant chronic member Max 300 Gluco-Sticks per annum ZMW 11,960 per ben per annum Personal health Assessment 1 per ben per annum Acute Medication Radiology and Pathology Basic Dentistry (per beneficiary per annum) Advanced Dentistry Physiotherapy Antenatal Auxiliary Services Optometry including optometrist consultation Mono/Bi/Multifocal Lenses/frames ZMW 5,080 per ben per annum ZMW 11,960 per ben per annum ZMW 4,100 per ben per annum ZMW 3,450 per ben every two years This benefit will be payable towards funeral expenses upon the unfortunate event of the death of principal member, registered spouse or registered children. Main Member ZMW 10,000 Adult Dependant ZMW 10,000 Child Dependant ZMW 4,000 Hello Doctor ADDITIONAL BENEFITS Covered under Optometry Benefit Digital doctor included Accidental Death Cover (Main Member only) ZMW 10,000 Health Premium Waiver Contributions for 12 months from date of death of a PRINCIPAL MEMBER 18

20 Lusaka Telephone: / 8 or Facsimile: Cell: or info@ metropolitanzm.com Kitwe Telephone: Facsimile: