Benefit limits for Basicare 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 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 Government, Mission and Municipal hospitals and clinics, including Parirenyatwa.
- In hospital drugs.
- Specialist treatment services at Government, Mission and Municipal hospitals.
- Pathology and Radiology services at Government, Mission and Municipal hospitals.
- Blood Transfusion Services (BTS)
Benefit covers prescription drugs and is paid at the Cimas tariff up to an annual family limit.
Members can access generic prescription drugs or the equivalent on the Society’s network of pharmacies.
The optical benefit is paid to tariff up to package limit once every two (2) year period.
It caters for either lenses, frames or contact lenses. Eye tests are paid to tariff once every year (limited to Government suppliers only)
Maternity is paid to tariff.
It caters for maternity care, delivery and hospitalisation. The Society covers nine (9) antenatal and fve (5) postnatal visits in Government, Mission and Municipal facilities.
This caters for general and preventive dentistry up to package sublimit.
Services are rendered by Government, Municipal and Mission hospital dentists.
Prosthetics and Appliances
Awards are paid to tariff at Government, Municipal and Mission hospitals.
Caters for Occupational and Speech Therapy, Clinical Psychology, Social Work and Physiotherapy at Government hospitals. Awards are paid to tariff up to package sublimit.
Emergency Evacuation Services
Covered for life threatening situation only
Road ambulance services provided by a Government, Municipal or Mission facility is paid to tariff.
Family planning services administered by a primary care provider are paid to tariff.
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 year for:-
- Spectacles/Contact lenses
Two Years for:-
- All internal prosthetic devices
- Oncology beneft
- Pre-existing conditions
- 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.