We are pleased to present to you our plan benefit summary and how the Savings Accounts operate. Detailed information on the benefits is obtainable from our membership guide and or the benefit limits.
Medical Savings Accounts
This covers foreign and local primary care and outpatient treatment e.g. Doctors consultation, prescription drugs from the available balances. This also covers in-hospitalisation benefits.
Where the available balance in members’ savings account is not sufficient the shortfall cover will make up the difference. Shortfall cover will be awarded if member has used up to annual savings balance.
Insured Benefit Cover
This will cover all high cost treatment benefits e.g. in hospital treatment, specialist treatment, laboratory and radiology, chronic illnesses [cancer, kidney failure, HIV/AIDS treatment, ARVs etc.) at Grace C Private Hospital, Government and mission hospitals. Member benefits are per membership year; they are effective the date the member/beneficiary joins the Fund. These benefits are paid up to an annual global limit. First Mutual Health, reserves the right to recommend members and or beneficiaries to a less expensive treatment where benefit usage is excessive.
• Paid in full in a Grade C Private Hospital, Government, Mission or Municipal hospital up to a general or private ward
• In-hospital drugs are paid for in full
• All life threatening emergency admissions in a Grade C Private Hospital, Government, Municipal or Mission hospital are fully covered
• General practitioners are paid in full at AHFoZ rates with an additional shortfall insurance cover
• Blood Transfusion Services, Pathology & Radiology Services at Grace C Private Hospital, Mission or Government institutions
• Government Specialist treatment services
• Paid in full at AHFoZ rates and there is shortfall insurance cover on the benefit
• Caters for delivery, hospitalisation and maternity care in a Grade C Private Hospital, Government, Mission & Municipal Clinics.
• Ante- and post-natal visits are limited to 9 & 5 months respectively
• Ante-natal Ultra-sound Scans are limited to 2 per pregnancy
• Paid for in full up to annual optical limit thereafter every 2 years at a Government, Municipal and Mission Institutions
• The optical benefit is accessed after pre-authorisation by the Fund
• The fund has agreements with a wide range of service providers
• The drug benefit is a family annual drug limit and covers registered beneficiaries of First Mutual Health at the Fund’s rate.
• The Fund has a drug facility arrangement with a wide range of pharmacies countrywide.
• Over the counter drugs are not covered under the drug benefit
• Awards are paid in full up to annual dental limit at Government, Municipal and Mission Hospitals.
• It covers preventive and general dentistry including fillings, inlays, root treatment, crowns, bridges, implants periodontics and orthodontic treatment provided by Government, Municipal and Mission Hospitals ONLY
PROSTHETICS AND APPLIANCES
• Awards are paid up to annual prosthetic and appliance limit in full in a Government, Municipal and Mission Hospital
– Internal prosthetics
– External prosthetics
– Hearing and repairs
– Ostomy bags
– Miscellaneous appliances
• Lifetime Limits – benefits are accessed once in a lifetime, paid In full up to annual limit
– Hearing Aids
• Covers consultation by a specialist psychiatrist and is paid in full up to limit at a Grade C Private Hospital, General or Mission Hospital
• Covers Clinical psychology, Social Work, Physiotherapy, Occupational and Speech Therapy. Awards are paid up to rehabilitative services limit in a Grade C Private Hospital, General or Mission Hospital
• It is available to members & non-members of the Fund
• Available to students from High School, Vocational training centres, technical and Teachers colleges through to university
First Mutual Health Chronic Disease covers all ailments e.g. Kidney Failure, Cancer, and HIV/AI DS and ARVS
Note – members are required to seek pre-authorisation before accessing the benefit
• Awards are paid up to an annual limit
– Homes for the disabled
– Road and Air Evacuation in Zimbabwe (EMRAS and
– Inter- and intra-hospital transfer (provided by
– Family planning at Grade C Private Hospital, Government or Municipal Hospital
Subject to waiver at the Fund-s discretion, the following benefits have waiting periods. Waiting periods are imposed on members joining the fund for the first time or with a lapse on membership. Waivers may be granted to members transferring from an AHFoZ affiliated Medical Aid business upon presentation of a certificate.
List of Waiting Periods
• Admission or treatment at a hospital (in-hospital)
• Specialist treatment
• Upgrading to a higher plan
• MRI, CT Scans and nuclear medicine at Government & mission hospitals only
• Maternity benefit at Grade C Private Hospital, Government, Council and or Mission Hospital
Ten (10) Months
Spectacle or contact lenses at Government, Mission Hospital
Eighteen (18) Months [1 year 6 months] at Grade C Private Hospital, Government or Mission Hospital
• Internal prosthetic devices
• Chronic disease at Grade C Private Hospital, Government, Mission Hospital
Forty-Eight Months [Four Years]
• Orthodontic treatment at Grade C Private Hospital, Government or Mission Hospitals
• Ex-gratia drug award