Student Health General

The primary purpose of student health insurance is to keep students in University/school so they can graduate and become productive members of society. Very few students are covered for Medical care by their parents. When students face health problems, they are usually sent home so that their parents can help them seek medical attention. This puts the student at a disadvantaged position, especially boarders, as they will miss University/school activities during the period they would have travelled to their homes. However, the student health plan eases both the University/school and student burden by being able to access immediate health services. When all students are insured, these risks are minimized.

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Why Student Health Plan?

Most Universities/schools understand the importance of providing adequate health care to their students. Primary reasons are as follows:

  • Provision of immediate access to medical care within close proximity to the University
  • Protection against financial catastrophe.
  • Keeping students healthy in order to minimize disruption in their academic goals. A healthy student is more likely to perform at a higher academic level to completion than a student who is constantly disturbed by sickness.

Product Overview

Student health insurance is cheaper than traditional health insurance programs due to the following:

  • Students are usually younger and healthier than the general population resulting in reduced risk.
  • When students complete their education, they are no longer eligible for student health insurance, which means that most participants are only enrolled for a limited, relatively short period of time.
  • Student health insurance plans are custom designed to meet the needs of the students
  1.  VALUE PROPOSITION TO STUDENTS

 

The First Mutual Health adequately addresses the following key issues which add value to both the University/school and the student:-

 

3.1 No Co-payments

Through effective strategic partnerships with the Medical Service Providers who are well represented across Zimbabwe, members of the FML Medical Savings Fund will NOT pay co-payments.

 

3.2 No Waiting Periods

 

There are no waiting periods to access services.

 

3.3 High Annual Benefit Limits

Through Shortfall Insurance Benefit (SIB) and Insurance Benefits (IB), the FML Medical Savings Fund eliminates altogether medical shortfalls. The contribution made by member for their selected plan is the only financial outlay. There is no recovery of shortfall amounts from either the member or the University/school as would be the case where only a medical savings account exists without back-up insurance. The insurance premium is 100% of the member’s contribution.

 

3.4 Evacuation facilities

Through effective and efficient strategic partnerships, the FML Medical Savings Fund allows for emergency evacuation to better equipped Medical Service Providers in Zimbabwe .

4.0 Student Health Plans

 

There are two types of Student Health plans, i.e. General Plan and Private Plan.

 

4.1 Student General Plan (Topaz –Benefits)

 

4.1.1 During the Semester

During the Semester/term, students are able to access the following services from any Government/Mission/Municipal hospital:

 

  • Out-patient consultation
  • Dental benefit- with 4 months waiting period
  • Optical cover with 10 months waiting period.
  • Drug facility with a wide range of pharmacies countrywide

 

4.1.1.1 College Clinic

During the semester/term, students are able to access the following services from the college/school clinic:

 

  • Drugs
  • Out-patient consultation

 

 

4.1.2 Semester Breaks

Students can access health services even during semester/term breaks and they are limited to Government/Municipal/Mission hospitals as above

 

4.1.3 Hospitalization benefit

This benefit is limited to Government/Mission/Municipal hospitals only. The medical aid covers all in-hospital claims.

 

4.1.4 General Practitioner Consultations

 

Students can access health services from General Practitioners during the semester/term and also during vacations.

 

4.1.5 Premium contributions and annual benefits

 

  • University/college – Premiums will be paid six (6) months in advance at the beginning of each semester, $4 per month and thus $24 per semester.
  • Schools - Premiums will be paid four (4) months in advance at the beginning of each term, $4 per month and thus $16 per term.

 

Component Rate
Contribution $4 per month
Annual Global limit $4,400

 

5.0 Other Key Issues

 

5.1 Quality Control Meetings

 

A quality control committee should be constituted in order to monitor the quality of service delivery and fund performance. The committee would hold quarterly meetings.

 

5.2 Pregnancy Benefits

  • Pregnancy benefits are not covered.

 

 

5.3  Period of Coverage, Termination of Coverage

 

 5.3.1 Period of Coverage

 

The annual period of coverage under the student health plan is the University’s/school’s academic year.

 

5.4 Benefit Limits

 

 

 

BENEFIT(S)

   

Student Health Private Plan

 

Student Health General Plan

 

Annual Limit per Person

 

$7,000

 

$4,000

 

Shortfall Cover

 

$ 700

 

$400

 

Prescription Drugs

 

 

$ 600

 

$400

 

Dental Cover

 

$ 320

$240
 

Refraction Fees (Association Tariff)

 

In full

 

In full

 

Optical (10 months waiting period thereafter per every Two Years)

 

$150

$100
 

Psychiatric

 

$300

$250
 

Rehabilitative Services

(physiotherapy)

 

$300

$250
 

Prosthetics Appliances
Treatment (Internal 18 months, External 6 months waiting period)

$500  

$300

 

Homes providing Nursing Services

 

3/day  

none

Ancillary Services** (according to Tariff)  

In full

 

In full

 

Private Ambulance Services (According to Tariff)

 

In full

 

In full

 

Homes for the Disabled

 

 

3/day

 

None

 

Contribution Rates

 

$13.00

 

$4.00


 

5.4.1 Termination of Benefits

 

  • Coverage ends at the end of the academic year

 

 

 5.4.2 Termination of Student Health Plan Benefits Specific to All Enrollees:

 

  • Termination of student status for reasons such as withdrawal (refund for the cost of the Student Health Plan is prorated based upon the date of departure from University/school).
  • The date the University/school terminates the plan as applicable

 

 

  1. Conversion Policy

 

If a student has been covered under the student health plan for at least one semester/term, the enrollee may, subject to established rules, access coverage from First Mutual Health as an individual without waiting periods at the age of 19 years. First Mutual Health guarantees the enrollee options for insurance coverage, and the benefits and provisions of their individual policy may differ from those of the student health plan.

 

Application for the individual policy from First Mutual Health must be made within 30 days after the coverage ends under the student health plan. The purchase of a conversion policy is made directly by the applicant to First Mutual Medical Health.

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