Benefit limits for Classic Private 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.
- General practitioners.
- Specialist treatment services at Government, Mission and Municipal hospitals subject to referral by a primary care service provider.
- 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 Emergency Evacuation Services annual family limit
- Members can access generic prescription drugs or equivalent on the Society’s network pharmacies.
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 (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 five (5) postnatal visits.
- General practitioner maternity visits are paid to tariff.
This caters for general and preventive dentistry up to package sublimit
- This caters for general and preventive dentistry up to package sublimit. Services are rendered by Government, Municipal and Mission hospital dentists.
Prosthetics and Applicances
Awards are paid up to tariff subject to available sublimit for:
- 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 situations only
- Road ambulance services provided by a Government, Municipal or Mission facility is paid to tariff.
- Road ambulance services provided by a Government, Municipal or Mission facility is 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:
Three months for:-
- A mandatory three (3) 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:
- Spectacles/Contact lenses
Two (2) years for:
- All internal and external prosthetic devices
- Oncology benefit
- 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.