A.A.C.M.A.S INSURED BENEFITS : APRIL 2005

BENEFIT

LIMIT

Pre-notification required for some core Benefits

Hospitalisation covered at state-aided and private institutions for semi-private wards.

Members liable for NAMAS negotiated co-payments where applicable.

Sub-limits apply as follows:

1. General wards

Paid per NAMAS tariffs. Overall limits apply.

2. Theatre fees

Paid per NAMAS tariffs. Overall limits apply.

3. Operations

Paid per NAMAS tariffs. Overall limits apply.

4. Intensive Care Units

Paid per NAMAS tariffs. Overall limits apply.

5. In-hospital Drugs/dressings

Paid per NAMAS tariffs. Overall limits apply.

6. Blood transfusions

Paid per NAMAS tariffs. Overall limits apply.

7. Physiotherapy (in-hospital)

Paid per NAMAS tariffs. Overall limits apply.

8. Pathology

Paid per NAMAS tariffs. Overall limits apply.

9. Radiology

(Pre-notification required for MRI, CT and Bone Densitometry Scans).

Paid per NAMAS tariffs. Overall limits apply.

(Notification required on confirmation of pregnancy and on admission to hospital.)

Paid at 70% of NAMAS as grant-in-aid .

11. Maxillo-facial and Oral Surgery

(Pre-notification required)

Paid per NAMAS tariffs. Overall limits apply.

12. Prosthesis

1. Internal
2. External

Limited to Z$20 million per person per annum.

Limited to Z$1.3 million per person per annum.

Paid per NAMAS tariffs. Overall limits apply.

14. Hospice (Pre-notification required)

Paid per NAMAS tariffs. Overall limits apply.

15. Kidney dialysis (Pre-notification required)

Paid per NAMAS tariffs. Overall limits apply.

Paid per NAMAS tariffs. Overall limits apply.

(Members required to register on the Chronic Care Network (C.C.N.) Registration to be renewed prior to expiry of authorisation.)

Member liable for co-payment of Z$2,000.00 per script item. Overall limits apply.

18. Special appliances.

ii) Glucometers, nebulisers, etc.

Limited to Z$5,850,000 per person. Lifetime award.

Limited to Z$1,463,000.00 per person every 5 years. 100% of internal tariff.

For services offered at Zimbabwe National Family Planning Council Centres (Z.N.F.P.C.) including consultations, drugs and surgery.

Paid per Z.N.F.P.C. tariffs.

A.A.C.M.A.S INSURED BENEFITS : APRIL 2005

BENEFIT

LIMIT

Members covered for MARS ambulances for road and air evacuation within Zimbabwe.

Members also covered for inter-facility transfer by private ambulance services besides MARS.

General and Specialised dentistry (excluding maxillo-facial and oral surgery)

100% of internal tariff. Limited to Z$1,755,000 per person per annum.

100% of internal tariff. Limited to Z$1,755,000 per person every 2 years.

NOTES:

•  Ambulance covered for emergency evacuation only.
•  Members are liable for any co-payments negotiated by the National Association  of Medical Aid Societies (NAMAS).
•  Notification ~ Members are required to notify A.A.C.M.A.S. prior to or  immediately after accessing the following services:-
  
  
  •  Hospitalisation;
  •  Maternity consultations and hospital admission for delivery;
  •  CAT scans, MRI scans and Bone Densitometry scans;
  •  Dialysis;
  •  Chemotherapy;
  •  Emergency room visits (only for bona-fide emergencies).
    
    
•  Failure to pre-notify will result in the service provider claims being shortfalled  by Z$5,000.00.
•  Failure to pre-notify for maternity will result in consultations being paid out  of the members Medical Savings Account, and the member looses out on  benefits.
•  Failure to register for Chronic Medication will result in the cost of  medication being paid for out of the   members Medical Savings Account, and  therefore the member looses out on benefits.

INSURED BENEFITS ARE COVERED BY AGE RELATED CONTRIBUTIONS.