F.A.Qs

FREQUENTLY ASKED QUESTIONS

 

Why do I need medical cover? 

Because we never know when we will fall ill, and how much it will cost us. Having medical insurance cover gives us peace of mind in the knowledge that should we fall ill we will be taken care of as the medical insurance will assist in paying our bills. First Mutual Health has seven different plans for corporate clients and a private hospital plan for individual members.

I wish to join as an individual member, can I join on any plan I choose?

No. The plan designed for individual members is the Individual Private Plan.

Can I continue being on medical aid even after I have left my job? 

Yes, you may visit any of our offices and arrange for payment of subscriptions via direct debit from your bank, or cash deposits at these branches. You would still maintain the same membership number.

Why are there waiting periods before I can enjoy certain benefits? 

Waiting periods exist on certain benefits in order to safeguard existing members from high treatment costs brought about by new members who suddenly join medical aid after having found out that they need expensive treatment. If no such waiting periods are in place, this would drive up contributions and disadvantage existing members.

Is my new born baby covered?

Yes, babies are covered from the day they are born, as long as they are registered within 6 weeks of birth. Parents are encouraged to register their babies as soon as possible to avoid inconveniences when emergencies arise. Once your baby turns 6 weeks before registration, they would have to undergo a four month waiting period should you decide to register them later.

My child has just turned 18, but is still in school, what happens now?

In terms of the Legal Age of Majority Act of 1982 a child who attains the age of eighteen(18) ceases to be a minor. In line with this act, subscriptions for this category of dependants will be charged at adult rate forthwith, unless prior notification is received that he/she is still a student. Such a student will be treated as a child until their 24th birthday.

 Where can I access medical services and will I experience any shortfalls?

The First Mutual Health card is widely accepted throughout Zimbabwe. You may also walk into any of our branches for the most up to date list of service providers. As a fund we pay 100% according to Ahfoz tariffs hence one may encounter shortfalls should the service provider charge over and above these tariffs.

Do you cover over the counter drugs?

We only cover prescription drugs (drugs that cannot be bought without a doctor’s prescription).

Do you have a maximum age limit for new members?
Members must be below 60 years old at the time of joining the Fund. However existing members can remain on the Fund for life as long as they are paying contributions.

Please explain the Savings aspect of your product.

The Savings Pot shall constitute 15% of gross contributions while 85% is the insured benefit. The Savings pot shall be allocated annually in advance at the start of the membership year.

All claims will first debit the Savings Pot before triggering the Insured Benefit.

Members joining during the year shall, have their Savings Pot allocation pro-rated.

The balance standing to the credit of a member  in terms of 15% of contributions received which provides for individual medical Savings Pots shall be for the exclusive benefit of the member and his dependents: provided that such Savings Pot balance:-

  • Shall at the end of a financial year be rolled over to the following year.
  • May be taken as a cash benefit refundable exclusively to the member three (3) months after termination, subject to applicable income tax laws.
  • Will accrue interest payable on any positive accrued savings balance at a rate determined by the Scheme from time to time
  • Will be paid out to member upon termination three (3) months after date of termination

On termination of membership, funds available in the member’s Medical Savings Pot may be used to offset outstanding contributions upon giving due notice to account holder.

In the event that the Savings Pot balance remains unclaimed six (6) months after date of termination, the Savings Pot balance shall be transferred to a reserve pool.

 

How does one get their cash back?

The Scheme shall award 25% of the family Savings balance including interest earned as cash benefit accrued in the Savings Pot three (3) months after a continuous membership of 2 years, provided the member has claimed at most 25% of total received contributions over the period.

Cash back is for the exclusive benefit of the member and his dependents. In the event of the corporate insisting on accessing the savings balance of its employees an exception to the rule may be considered depending on the corporate overall claims ratio as follows:

If the claims ratio is greater than 75%, no cash back shall be redeemable to the corporate.

If the claims ratio is less than or equal to 75% cash back is redeemable to the corporate.

 

 

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