Private Hospital Package

Transcription

1 Private Hospital Package Benefits Summary Vol 1: 2018

2 The Private Hospital Cover Your Cimas Private Hospital card gives you access to Private and Public Healthcare Institutions.

3 Private Hospital Package Benefit limits for Private Hospital package are paid per beneficiary per membership year and accrue from 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. Medical Benefits The following benefits are paid 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 /Government facilities Blood Transfusion Services (BTS) Drug Benefits 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. Optical Benefits Benefit is paid to tariff up to package sublimit once every two (2) years. It caters for either lenses, frames or contact lenses. Eye tests are paid to tariff once every year.

4 Maternity Benefits 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. Dental Benefits This caters for general and preventive dentistry up to package sublimit. The following benefits are subject to prior authorisation: inlays, root treatment, crowns, bridges, dentures and implants. Foreign Treatment Covers treatment outside 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 Appliances Awards are paid up to tariff subject to available sublimit; Internal Prosthetics External prosthesis. Nebulisers. Ostomy bags. Hearing aid repairs

5 Lifetime Limits: Hearing Aids paid to tariff subject to available sublimit. Glucometers paid to tariff subject to sublimit. Rehabilitative Services This caters for occupational and Speech Therapy, Clinical Psychology, Social Work and Physiotherapy. Awards are paid to tariff up to the package sublimit. Psychiatry Benefits This caters for consultation by a psychiatrist. Awards are paid to tariff subject to available sublimit. Emergency Evacuation Services Covered for life threatening situations only Road Ambulance services is paid to tariff Air evacuation is paid to tariff Supplementary Services 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)

6 Alternative Services This caters for Chiropody, Chiropractic, Homeopathy, Osteopathy and Naturopathy provided the suppliers are registered under the appropriate regulators. Awards are paid to tariff subject to available sublimit. Healthguard Products Cimas, in association with HEALTHGUARD International Limited, offers the following products: Global Travel Cover (GTC) Cover for travellers outside their country of usual residence for emergencies and unexpected illnesses. It is available upon application to both Cimas and non-cimas members (See GTC Brochure for detailed information). International Student Cover Studymate is an international student plan that offers comprehensive medical aid cover for students studying outside their country of normal residence. This product is available to Cimas and non-cimas members. (See the Studymate Brochure for detailed information). Healthguard Deluxe The package covers medical services anywhere within Sub Saharan Africa. Cover includes in-patient and out-patient treatment. (See Healthguard Deluxe Brochure for detailed information)

7 Waiting Periods The following benefit waiting periods apply to those joining the Society or where there has been a lapse in membership. The society reserves the right to waive waiting periods for members transferring from AHFoZ affiliated medical aid societies. The waiting periods include: Three (3) months for: A mandatory three (3) months waiting period will apply to all new members Six (6) months for: Specialist treatment MRI, CT scans and Nuclear medicine Admission or treatment at a hospital Dental treatment Nine (9) months for: Maternity benefit One (1) year for: Homes providing constant nursing care Spectacles/Contact Lenses Foreign Treatment Two (2) years for: All internal prosthetic devices Oncology benefit Haemodialysis Pre-existing conditions Four (4) years for: Orthodontic Treatment For orthodontic work, members must seek prior-authorisation from the Society before accessing treatment The age limit for the benefit is 18 years. Upgrades and Downgrades Upon upgrade from a lower package, members will enjoy benefits after serving the waiting periods at the right levels. Members are only authorised to upgrade or downgrade once within a year. Prior-Authoristaion 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. Disclaimer The Private Hospital Package Benefit summary must be read together with the Cimas Constitution and the Cimas Membership Rules. This benefit summary does not supersede the Cimas Constitution and the Cimas Membership rules.

8 Harare Cimas House, Cnr. Jason Moyo Ave/Harare St. P.O. Box (4) Bulawayo Medical Centre, Cnr J.Tongogara St/8th Ave. P.O. Box (9) bulawayo@cimas.co.zw Gweru 23 Sixth Street P. O. Box (054) gweru@cimas.co.zw Mutare Cimas House, 98 Second St (20) mutare@cimas.co.zw Masvingo 39 Robert Mugabe, ZB Bank Building +263 (039) /2 masvingo@cimas.co.zw HEALTHCARE Centres Healthcare Services Division Primary Healthcare Clinics Head Office, Cimas House 9 Jason Moyo Avenue, Harare Cimas Rescue 13 Rowland Square Milton Park, Harare /6 Medical Service Division Network of Laboratories Harare Haemodialysis Head Office, Medical Chambers 60 Baines, Avenue, Harare +263 (4) /2