1.0 NAME
1.1 The name of the Fund shall be Generation Health Medical Fund, hereinafter referred to as "the Fund".
2.0 LEGAL PERSONALITY AND RESPONSIBILITY
2.1 The Fund is a body corporate capable of suing and being sued in its own name, of doing or causing to be done all such things as may be necessary for or incidental to the exercise of its powers or the performance of its functions in terms of these Rules and of in its own name acquiring, holding and alienating and otherwise dealing in and with property of all descriptions, movable, immovable, corporeal and incorporeal.
2.2 No person shall have any claim on the assets or rights or be responsible for any liabilities or obligations of the Fund, except in so far as the claim has arisen or the responsibility has been incurred in connection with transactions relating to the business of the Fund.
3.0 REGISTERED OFFICE
3.1 The registered office of the Fund shall be at Zimnat House, 86 Nelson Mandela Avenue, Harare, but the Board shall have the right to transfer such office to any other situation in Zimbabwe should circumstances so dictate.
4.0 BINDING OF RULES
These Rules and any amendment thereof shall be binding on the Fund and the Members and Officers of the Fund and on any person who claims under the Rules or whose claim is derived from a person so claiming.
5.0 DEFINITIONS
5.1 This is stated in Rule 6. In these Rules, unless inconsistent with or otherwise indicated by the context:-
5.1.1 "Administrator" shall mean the administrator (which may be a body corporate) appointed by the Board in terms of Rule 30.0.
5.1.2 "Admission Date" shall mean:-
5.1.2.1 in respect of an Employer, the date on which the contract between the Fund and the Employer becomes operative;
5.1.2.2 in respect of a Member, the date on which he becomes entitled to membership;
5.1.2.3 in respect of a Dependant, the date upon which such Dependant is registered as a Dependant in terms of the Rules.
5.1.3 "Annual Limit" shall mean the maximum Benefit to which a Member or Dependant is entitled in terms of the Rules during each Financial Year. Where the Member is admitted during the course of the Financial Year, the Annual Limit shall be suitably pro-rated, as will any Annual Limit referring to a "Member Family"
5.1.4 "Approval" shall mean prior written approval.
5.1.5 "Auditor" shall mean an Auditor registered in terms of the Public Accountants and Auditors Act and Chapter 27 and appointed as such for the Fund in terms of these Rules.
5.1.6 "Beneficiary" shall mean a Member or a registered Dependant.
5.1.7 "Benefit/s" shall mean the amount/s payable in terms of the Rules to a Member, whether for himself or in respect of his Dependant.
5.1.8 "Board" shall mean the Board of Trustees constituted in terms of the Rules and charged with managing the affairs of the Fund.
5.1.9 a "child Dependant" is a Dependant who is under the age of 18 years.
5.1.10 "Contribution" shall mean the monthly amount payable to the Fund by the Member or Employer on behalf of the Member.
5.1.11 "Date of Relevant Health Service" shall mean:-
5.1.11.1 in the case of a consultation, visit or treatment, the date on which each consultation, visit or treatment took place, whether for the same illness or not;
5.1.11.2 in the case of an operation, procedure or confinement, the date on which such operation or procedure was performed or such confinement took place;
5.1.11.3 in the event of hospitalisation, the date of each discharge from such hospital or nursing home, or the date of termination of membership or de-registration as a Dependant, whichever date occurs first;
5.1.11.4 in the case of any other Relevant Health Service, the date on which such Relevant Health Service was rendered, or the date of receipt by a Beneficiary of any treatment requirement.
5.1.12 "Dependant" shall mean:-
5.1.12.1 the spouse or partner, dependant children, dependant step children and dependant legally adopted children or other members of the Member's immediate family in respect of whom the Member is liable for family care and support;
5.1.13 "Employee" shall mean a person of the category agreed upon by the Fund and the Employer, who is in the full time employment of such Employer.
5.1.14 "Employer" shall mean a person who has contracted with the Fund that the Employees of such Employer shall become Members of the Fund.
5.1.15 "Financial Year" shall mean the financial year of the Fund, commencing on the 1st day of January and ending on the 31st day of December each year.
5.1.16 "Group" shall mean the Employees of a particular Employer, who are Members.
5.1.17 "In-hospital Treatment" means the rendering of a Relevant Health Service to a Beneficiary during the period spent by such Beneficiary in a facility which is a hospital, nursing home, unattached operating theatre unit or day clinic; provided that the said service is not rendered in an outpatient facility.
5.1.18 "Medical Assessor" shall mean a person who is an expert in relation to any Relevant Health Service and who has been appointed as a Medical Assessor by the Fund or the Administrator.
5.1.19 "Member" shall mean a person who has been registered as a Member of the Fund in terms of these Rules and who is still a Member of the Fund.
5.1.20 "Member Family" shall mean a Member and all his or her registered Dependants.
5.1.21 "Officer" shall mean any Trustee, Manager, Principal Officer, Treasurer, clerk or other employee of the Fund, but does not include the external Auditor and its employees.
5.1.22 "Pensioner" shall mean a Member who has retired from the service of his or here her employer or whose employment is terminated by his or her employer on account of age, ill-health or other disability and who has continued his or her Membership of the Fund by reason of the provisions of rule 7.3. or Rule 7.5.1.
5.1.23 "Plan" shall mean a particular set of Benefits/a benefit option offered to Members and Dependants by the Fund in accordance with a Plan annexed to these Rules.
5.1.24 "Pre-existing Sickness Condition" shall mean a condition for which medical advice, diagnosis, care or treatment was recommended or received within the twelve-month period ending on the date on which an application for membership was made.
5.1.25 "Practice Code Number" shall mean the number allotted to a Supplier as a practice number by the Association of Healthcare Funders of Zimbabwe, herein after referred to as AHFoZ.
5.1.26 "Principal Officer" shall mean the Principal Officer appointed in terms of Rule 29.
5.1.27 "Public Hospital System" means the entire system of hospitals and clinics of the government of Zimbabwe
5.1.28 "Relevant Health Service" shall mean any health care treatment of any person, by a person registered in terms of any law, which treatment is aimed at:-
5.1.28.1 the physical or mental examination of that person;
5.1.28.2 the diagnosis, treatment or prevention of any physical or mental defect, illness or deficiency;
5.1.28.3 the giving of advice in relation to any such defect, illness or deficiency;
5.1.28.4 the giving of advice in relation to or treatment of any condition arising out of pregnancy including the termination thereof;
5.1.28.5 the prescribing or supplying of any medicine, appliance or apparatus in relation to any such defect, illness or deficiency or a pregnancy, including the termination thereof;
5.1.28.6 nursing or midwifery; home, nursing home or similar institution where nursing is practised, or any other institution where surgical or other medical activities are performed, and such accommodation as is necessitated by any physical illness or deficiency or by a pregnancy.
5.1.29 "Rules" shall mean these Rules and shall include the Annexures hereto and the Plan offered by the Fund and accepted by the Member.
5.1.30 "spouse" means the spouse or partner of a Member to whom the Member is married in terms of any law or custom.
5.1.31 "Supplier" shall mean a person who supplies a Relevant Health Service.
5.1.32 An "approved Supplier" shall mean a Supplier who has been stipulated in writing by the Fund as being a Supplier who shall supply particular Relevant Health Services to Beneficiaries under one or other of the Plans.
5.1.33 "Trustee" shall mean a member of the Board;
5.1.34. words in the singular number include the plural and vice versa;
5.1.35 words importing any one gender include each of the other two genders;
5.1.36 where applicable, a reference to a natural person includes a legal persona.
6.0 THE OBJECT OF THE FUND
6.1 The object of the Fund is to undertake relevant health service expenses liability in return for a Contribution:-
6.1.1 To make provision for the obtaining of any Relevant Health Service;
6.1.2 To grant assistance in defraying expenditure in connection with the rendering of any Relevant Health Service;
6.1.3 Where applicable, to render a Relevant Health Service, either itself, or by or through any Supplier or group of Suppliers or by any person in association with or in terms of an agreement with the Fund; and
6.1.4 To assume liability for and guarantee the Benefits to the Members and their Dependants in terms of the Rules.
MEMBERSHIP
7.0 ELIGIBILITY
7.1 The Fund may accept a minor as a Member provided the minor is assisted by his or her parent or guardian.
7.2 Employees
All Employees of an Employer shall become Members of the Fund, subject to:-
7.2.1 the provisions of Rule 8.3;
7.2.2 any condition in the contract of employment between an Employee and his Employer exempting such Employee from membership of the Fund; and
7.2.3 the provisions of any agreement between the Employer and the Fund.
7.3 Retirement/Termination of Employment
A member shall continue his membership of the Fund in the event of his retiring from the service of his Employer or his employment being terminated by his Employer on account of age, ill-health or other disability, or on losing his employment through retrenchment or, on resignation from the employment of an Employer; provided that such member had been, at the date of his retirement or termination of employment, a Member for a continuous period of not less than five years or has paid to the Fund Contributions to cover any period lacking in order to qualify; provided further that he does not join another fund and he is able and continues to pay subscriptions due.
7.4 Dependants of a deceased Member
The Dependant of a deceased Member, who is registered with the Fund as his dependant at the time of such Member's death, shall be admitted as a Member, provided that the deceased Member at the time of his death had been a Member of the Fund for a continuous period of not less than five years or has paid to the Fund contributions to cover any period lacking in order to qualify, provided further that the deceased Member's membership of any other registered medical fund shall also be taken into account when such period is being determined. Such Dependant shall be notified by the Fund of his rights and of the contributions payable. His membership shall terminate if he elects, in writing, not to become a Member.
7.5 Movement from another medical aid Fund
If the members of a medical aid fund who are members of that medical fund by virtue of their employment by a particular employer terminate their membership of the said medical aid fund with the object of obtaining membership of the Fund, the Fund shall admit as a Member, without a waiting period or imposition of new restrictions on account of the state of his health or the health of any of his Dependants, any member of such first mentioned medical aid fund who:-
7.5.1 is a Pensioner; or
7.5.2 has continued as a member thereof after the death of the member of whom he or she was a dependant
7.6 Interchangeability
The Fund shall admit in membership, from the date of receipt of an application, subject to the terms and conditions applicable to the admission of other Members, but without a waiting period or the imposition of new restrictions on account of the state of his health or the health of any of his dependants, any person who:-
7.6.1 has been a member of another medical aid fund for a continuous period of at least 2 years and whose membership has been terminated because of a change of employment; or
7.6.2 has been a dependant of a member of another medical aid fund for a continuous period of at least 2 years and whose status as a dependant has been terminated because of a change of employment of the member in question;
7.6.3 applies for membership of the Fund within 3 months after the date on which he ceased to be a member of such other medical aid fund or a dependant of a member of medical aid fund or such other medical aid fund as the case may be.
7.7 Readmission
7.7.1 A Member or Dependant who has voluntarily terminated his or her membership, shall not be re-admitted within a period of 12 months calculated from the date of termination of membership of the Fund.
7.7.2 The Fund shall in no circumstances be obliged to re-establish membership consequent upon an application made by or on behalf of a Member or Dependant whose membership has been terminated in terms of Rule 11.3.
8.0 APPLICATION FOR MEMBERSHIP
8.1 Duly completed application forms containing the information required from time to time by the Fund shall be submitted by or on behalf of prospective Members and shall constitute a warranty provided by the prospective Member to the Fund that the contents of the form/forms is/are true and correct and an acknowledgement that such contents are material to the Fund.
8.2 The Employer shall, in the case of Employees, submit the forms referred to in Rule 8.1.
Evidence of Health, Exclusions and Limitations
8.3 Subject to the provision of Rules 7.5 and 7.6:-
8.3.1 A prospective Member may be required to submit satisfactory evidence of age, state of his health and the health of his or her Dependants and a medical report of any condition present at the time of application for which any medical advice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which application to the Fund was made;
8.3.2 the fund in addition thereto or in place thereof may require such person to undergo a medical examination at his own expense;
8.3.3 after consideration of the information the Fund may at its absolute discretion impose a condition - for membership waiting period as provided in Annexure "B" hereto;
8.3.4 The Fund shall be entitled to decline to accept a person as Member where such person cannot or does not furnish evidence of his health.
8.4 Every Member shall, in respect of himself and his Dependants, supply the Fund with such information and evidence as the Fund may from time to time require.
Undesirable business practices
8.5 The Fund shall be entitled to decline any application for membership or for the admission of a person as a Dependant if, in the opinion of the Board, such application is a consequence of, or will result in:-
8.5.1 splitting an employer group by moving the low risk members to a new medical aid fund and leaving the higher risk members behind;
8.5.2 any undesirable business practice.
9.0 DEPENDANTS
Eligibility
9.1 No person shall be admitted as a Dependant of more than one Member of the Fund; or
9.2 Subject to Rule 9.3 no person shall be admitted as a Dependant if he or she, not being the spouse or partner of the Member, is not a person in respect of whom the Member is liable for family care and support.
Special cases
9.3 The Fund may, on application and subject to such terms and conditions as the Rules may determine, accept as a Dependant for a period or periods ending on the last day of each Financial Year:-
9.3.1 a child, step child or adopted child of a Member, who is over the age of 18 years, who was registered as a Dependant until attaining majority, and has applied to become a student Member immediately on attaining majority, who also is unmarried and who is a full-time student at a tertiary educational institution recognised by the Fund;
9.3.2 A child, step child or adopted child of a Member, who is over the age of 18 years, who was a Dependant of a Member before obtaining majority, who is unmarried and, in the opinion of the Fund, is precluded by mental or physical defect from being self-supporting;
9.3.3 The parent of a Member or of his spouse (provided such spouse is a Dependant), including an adoptive or step-parent, who lives with the Member and who is not in receipt of a regular income.
Application for Registration
9.4 Duly completed application forms containing the information required from time to time by the Fund shall be submitted on behalf of prospective Dependants and shall constitute a warranty provided by the prospective Member or Member (as the case may be) to the Fund that the contents of the form/forms are true and correct and an acknowledgement that such contents are material to the Fund.
9.5 The Employer shall, in the case of the Dependants of Employees, submit the forms referred to in Rule 9.4
Evidence of health, exclusions and limitations
9.6 Subject to the provisions of Rules 7.5 and 7.6:-
9.6.1 a Member who is applying for the registration of a Dependant may be required to submit satisfactory evidence of such Dependant's age, income, state of health and a medical report of any condition present at the time of application for which any medical advice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which application for registration was made;
9.6.2 the Fund in addition thereto or in place thereof may require such Dependant to undergo a medical examination at the expense of the Member;
9.6.3 After consideration of the information the Fund may at its absolute discretion impose a condition - specific waiting period as provided in Annexure "C" hereto provided that no such waiting period shall be imposed on a child whose date of registration as a Dependant is, in terms of Rule 9.7, the first day of the months of his birth.
9.6.4 the Fund shall not be bound to provide any Benefits to the Member in respect of a Dependant until and unless the Member has complied with the provisions of Rule 9.6.1 and, where applicable, Rule 9.6.2.
Date of registration
9.7 Where the Fund accept the application of a Dependant for registration, the date of registration of such Dependant shall be (as the case may be):-
9.7.1 The appropriate date in the cases contemplated in Rules 7.5 and 7.6;
9.7.2 in the case of a newly-wed spouse, from the first day of the month during which the marriage took place;
9.7.3 in the case of a newly-born child in respect of whom the application for registration was made within one month of the child's date of birth, the first day of the month of birth;
9.7.4 in the case of an adopted child in respect of whom the application for registration has been made within one month of the date of adoption, the first day of the month during which adoption take place; and
9.7.5 In all other cases, the actual date of registration in the records of the Fund.
Contributions in respect of Dependants
9.8 Contributions shall be payable by the Member in respect of Dependants from the Dependant's date of registration.
9.9 The obligation to pay contributions in respect of a Dependant shall cease on the last day of the month during which such person ceases to be a Dependant.
10.0 DEPENDANTS BENEFITS
10.1 The registered Dependants of a Member shall be obliged to participate in the same Plan as the Member provided that such Benefits shall be payable to the Member and not to the Member's Dependants
10.2 No Dependant shall be entitled to any Benefits nor shall the Member be entitled to such Benefits unless and until:-
10.2.1 such Dependant is registered as a Dependant in terms of these Rules; and
10.2.2 the Member himself or herself qualifies for Benefits
10.3 A Member shall immediately inform the Fund of any circumstance which alters the eligibility of any Dependant, and should such Dependant no longer qualify to be a Dependant in terms of these Rules, his registration as Dependant shall be cancelled and no further Benefits shall be payable in respect of such Dependant.
11.0 TERMINATION OF MEMBERSHIP
Resignation
11.1 A member who is not an Employee shall be entitled to resign from the Fund by giving the Fund three calendar months notice in writing of such resignation.
11.2 Subject to the provisions of Rule 7.2.2 and Rule 7.2.3, no Member shall be entitled to resign while he remains an Employee of his Employer save to become a dependant of a member of another medical aid fund.
Exclusion from benefits and termination of Membership
11.3 The Fund shall be entitled to suspend Benefits or terminate the membership of a Member or Dependant forthwith on the grounds of:-
11.3.1 Failure to pay Contributions within three days after payment thereof becomes due;
11.3.2 Failure to pay any debt due to the Fund within three days after payment thereof becomes due;
11.3.3 Submission of fraudulent claims to the Fund;
11.3.4 the committing of any fraudulent act;
11.3.5 the non-disclosure of any material information or fact to the Fund.
11.4 Fraudulent acts referred to in 11.3.4 shall include but not limited to:-
11.4.1 the use of a membership card by any person other than the Member or his registered Dependants, where such use occurs with the knowledge of a Member or Dependant;
11.4.2 Where the Member or Dependant makes or causes to be made any claim for the payment of any Benefit allegedly due in terms of the Rules, knowing such claim to be false;
11.4.3 Where the Member or Dependant, knowingly makes or causes to be made a false representation of any material fact to the Fund, for use in determining any right to a Benefit allegedly due in terms of the Rules;
11.4.4 Where the Member or Dependant , having knowledge of any fact or occurrence of any event affecting his or her right to receive any Benefit, fails to disclose such fact or event to the Fund with the intent to obtain from the Fund a Benefit to which he or she is not entitled or a larger Benefit than that to which he is entitled;
11.4.5 Where the Member or Dependant renders a statement, account or invoice to the Fund, knowing that such statement, account or invoice is false; and
11.4.6 any other act or omission which, in the circumstances, amounts to a fraudulent act or omission.
11.5 In the event that a Dependant is guilty of an act or omission referred to in Rule 11.3.3, 11.3.4 or 11.3.5 and the Board is of the opinion that the Member knew or ought to have known or ought to have prevented such act or omission the Fund shall be entitled to exclude from Benefits or terminate the membership of the Member forthwith.
11.6 If an Employer does not timeously pay Contributions and any other amounts due to the Fund, the membership of all Members within such Employer's Group may be terminated.
Employees
11.7 Subject to any provision to the contrary contained in the Rules:-
11.7.1 a Member who ceases to be an Employee as provided under Rule 7.3 shall on the date of such termination cease to be a Member, and all rights to Benefits shall thereupon cease, except for claims in respect of Relevant Health Services rendered prior to the said termination;
11.7.2 the membership of every Member of a Group shall terminate on the date on which their Employer's contract with the Fund terminates; and
Dependants
11.8 Subject to the provision of Rule 7.4, a Dependant shall automatically cease to be registered as such when:-
11.8.1 the Member of whom he or she is a Dependant ceases for any reason to be a Member; or
11.8.2 he or she ceases to be a spouse or partner of the Member in question; or
11.8.3 he or she, being a child of the Member in question, ceases to be a Dependant of such Member; or
11.8.4 he or she, being a member of the Member's immediate family in respect of whom the Member is liable for family care and support, ceases to be a member of the Member's immediate family or ceases to be in need of family care and support; or
11.8.5 he or she is a Dependant by virtue of the provisions of Rule 5.12.2, he or she ceases to be eligible for Benefits in terms of the Rules.
11.9 A person shall automatically cease to be a Dependant in the following circumstances but the Member responsible for such person shall be entitled to re-apply for such person to be registered as a Dependant upon proof to the satisfaction of the Fund that the person in question is in fact eligible in terms of these Rules to be a Dependant:-
11.9.1 Where such person reaches the age of 18 years, it being presumed in the circumstances that he or she is capable of supporting him or herself;
11.9.2 Where such a person being a member of the Member's immediate family in respect of whom the Member is liable for family care and support and has been registered as a Dependant for a period of 1 year or takes up employment.
12.0 CONTRIBUTIONS AND CLAIMS
Introduction
12.1 Contributions shall be determined by the Board on a basis determined by the Board from time to time.
12.2 Limitations and waiting periods, minimum and maximum Benefits, the various categories of Members and Dependents, the scales and specific directives relating to the payment of Benefits, the Contributions payable and, the amount of such Contributions are set out in the plans and annexures to these rules.
Contributions
12.3 The Fund shall send out to the Employer or self-paying Member monthly invoices in respect of Contributions and other amounts due to the Fund.
12.4 The Employer or self-paying Member (as the case may be) shall, make payment of the amount due under the invoice referred to in Rule 12.3 to the Fund to reach the Fund's offices by not later than the 3rd day of the month for which such amount is due.
12.5 An Employer or a self-paying Member shall, if so required by the Fund, make payment of Contributions and other amounts due to the Fund by Automated Clearing Bureau, stop order or any form of electronic bank transfer which the Fund may reasonably require.
12.6 A Member may change from one Plan to another subject to the following conditions :-
12.6.1 The change may be made only with effect from 1 January of any Financial Year. The Board may, in its absolute discretion, permit a Member to change from one to another Plan on any other date;
12.6.2 The Application to change must be in writing and lodged with the Fund by not later than 30 September prior to the Financial Year in which it is intended that the change will take place; and
12.6.3 In the case of the Fund introducing a new Plan, a Member may change to such new Plan by giving written notice to the Fund within three months of the introduction of the said new Plan.
Change in contributions, fees, subscriptions, benefits and membership conditions:-
- Members shall be entitled to at least 30 days advance notice of any change in subscriptions, membership fees or subscriptions and benefits or any other condition affecting their membership.
Refunds
12.7 A Member shall forthwith refund to the Fund any amount disbursed by the Fund on his behalf or on behalf of his Dependants which exceeds the Benefits to which such Member or his Dependants are entitled.
12.8 Such amounts may be recouped from his income by arrangement between the Employer and such Member.
12.9 No refund of any portion of a Contribution shall be due to any Member or other person where such Member's membership (or that of any of his Dependants) terminates during the course of a month.
Claims
12.10 Subject to the limitations imposed by these Rules, Members and their Dependants shall be entitled to the Benefits set out in the appropriate Plan.
12.11 No benefit or right in respect of a Benefit shall be capable of being assigned or transferred or otherwise ceded or of being pledged or hypothecated or be liable to be attached or subjected to any form of execution under a judgement or order of a court of law and the Fund shall be entitled to withhold, suspend or discontinue the payment of a Benefit to which a Member is entitled or any right in respect of such Benefit or payment of such Benefit to such Member, if a Member attempts to assign or transfer or otherwise cede or to pledge or hypothecate such Benefit.
12.12 Unless the Fund decides otherwise and subject to Rule 12.14, the Fund shall process benefit refunds to the Member and not to any other person.
12.13 No Benefits shall be payable to a Member by the Fund unless such Benefit relates to a Relevant Health Service.
Payment of Account
12.14 The Fund may, by mutual agreement with any Supplier or group of Suppliers, pay the account in respect of a Relevant Health Service or the Benefits to which the Member is entitled, direct to such Supplier or group of such Suppliers or person who organises or co-ordinates or represents any Supplier or group of Suppliers.
12.15 The Fund shall under no circumstances be liable to pay any Benefit, whether to the Supplier or the Member, where the Member is in breach of his obligations in terms of these Rules and, in particular, where any Contribution or part thereof is in arrear. Where any such account has been paid by the Fund, the Member shall be liable to repay the Fund the amount so paid.
12.16 The Fund shall not be obliged to pay any Benefit to a Supplier or a Member unless the Fund has been furnished with a copy of the Supplier's bank account number.
12.17 Where any account has been paid by a Member he shall, in support of his claim, submit a receipt with the account referred to in 12.16.
12.18 The Fund shall be entitled in the Fund's discretion, to refuse payment of any benefit to a member for any Relevant Health Service where the claim relating to such Relevant Service has not been submitted to the Fund before the last day of the third month in respect of local claims and fourth month in respect of foreign claims following the month during which the Relevant Health Service was rendered.
12.19 Notwithstanding the provisions of Rule 12.18, where a claim is received by the Fund within the said period of 4 months and the Fund is of the opinion that the said claim is erroneous or unacceptable for payment, the Fund shall notify the Member within 30 days of the member submitting such claim, that such claim is erroneous or unacceptable for payment and the Fund shall state the reasons why such claim is erroneous or unacceptable. Thereupon the Member shall be allowed until the last day of the fourth month following the date when such reasons are received, to return such claim in corrected or acceptable form.
12.20 No Benefits shall be payable in the event of a Member whose membership has terminated and who submits an account later than the period specified in Rule 12.18, and if the Fund is legally compelled to pay a Supplier for such an account, the Member will be debited with the full account.
12.21 Subject to these Rules and the Law, the Fund shall pay any Benefit owing to the Member within 30 days after the day of receipt of the claim pertaining to such Benefit.
12.22 The Fund shall not be bound to pay any claim made by a Member or by a Supplier unless such claim contains the Supplier's Practice Code Number.
12.23 The Member shall use the Member's best endeavours to ensure that the Supplier furnishes the Member with an account or statement complying with the provisions of these rules.
12.24 There shall be recoverable by the Fund from a Member or Supplier any amount which has been paid to which the Member or Supplier is not entitled or the amount of any loss which has been sustained by the Fund through theft, fraud negligence or any misconduct and the Fund shall be entitled to deduct such amount from any benefit payable to the Member or Supplier.
12.25 Accounts for Relevant Health Services rendered in respect of injuries to a Beneficiary shall, when required by the Fund, be supported by a statement setting out such particulars of the circumstances in which the injury was sustained as are adequate to enable the Fund to assess its liability in terms of the relevant Plan. The Fund shall be entitled to call for such further information and evidence as it may deem necessary in the circumstances.
12.26 The Fund may require that, where possible, a claim be certified by the Member in order to qualify for benefits.
12.27 The Fund may as a condition precedent to the payment of any Benefit or any future Benefits require that a member or Dependant shall undergo an examination by a medical practitioner appointed by the Medical Assessor.
12.28 When an examination has been required in terms of Rule 12.27 the Fund's obligation, if any, to pay any such Benefit or future benefits shall be suspended until the Member/Dependant has been so examined and the Fund has had the opportunity of considering the Medical Assessor's report.
General
12.30 The Employer shall be the agent of the Member and not of the Fund in all dealings between an Employee and the Fund.
13.0 THE BOARD
Numbers
13.1 The affairs of the Fund shall be directed by a Board consisting of a maximum of 12 and a minimum of 6 trustees of whom:-
13.1.1 At least 50% of the Trustees shall be elected from amongst Members.
13.1.2 Not more than 4 shall be co-opted annually as provided in Rule 15.1
13.2 Not more than 8 shall be nominated and elected in accordance with the provisions of these Rules; and
13.3 In the event that, for whatever reason, the provisions of Rule 13.2 are not complied with, the longest serving Trustee co-opted in terms of Rule 13.1.2 shall resign and so on until the correct proportion as required by Rule 13.2 has been achieved. Where persons became Trustees on the same day, the person or persons to resign shall, unless they agree among themselves, be determined by lot. Any dispute or uncertainty concerning the identity of the longest serving Trustee or Trustees or as to the procedure to be followed shall be resolved by the Chairman of the Board, whose decision shall be final and binding.
Eligibility
13.4 A minor shall not be eligible to be a Trustee.
13.5 A person shall not be eligible to be a trustee and if he is already a Trustee, shall automatically cease to hold office if:-
13.5.1 he is not a fit and proper person to participate in the management of the business of the Fund; or
13.5.2 he is declared mentally certifiable or incapable of managing his affairs or
13.5.3 He is a director, shareholder, member, trustee, representative, agent or employee of, or a partner in, the Administrator; or
13.5.4 He is declared insolvent or is an unrehabilitated insolvent; or
13.5.5 He is or has been convicted, whether in Zimbabwe or elsewhere, of any crime of which dishonesty is an element; or
13.5.6 He is removed by any court from any office or trust on account of misconduct; or
13.5.7 He is or becomes the Auditor or a member of the business entity which is the Auditor.
13.6 An elected Trustee shall automatically cease to be a Trustee if he ceases to be a Member.
13.7 A Trustee shall automatically cease to be a Trustee if he absents himself from three consecutive meetings of the Board without the Chairman's Approval.
Resignation
13.8 A Trustee may resign at any time by giving written notice to that effect to the Fund.
Remuneration
13.9 Trustees shall be remunerated as determined from time to time at a general meeting of the Fund.
14.0 ELECTED TRUSTEES
14.1 The Trustees referred to in Rule 13.1.1 shall be elected by the Members;
14.1.1 Not more than 4 thereof shall represent Employers; and
14.1.2 Not more than 4 thereof shall represent Members.
14.2 Not more than one Employee from any one Employer may be elected to the Board. For the purposes of this sub-rule and Rule 41.2, an Employer shall mean any Employer together with all employers who are associated or affiliated with that Employer, as part of the same group.
14.3 No Member who is a Group employee of an Employer (as defined in the second sentence of Rule14.2) shall hold office as a trustees at the same time as a representative of such Employer and vice versa). Should such a Member and a representative be nominated/proposed and seconded in terms of Rule 16.2 the nomination/proposal first received by the Fund shall stand and all subsequent nominations/proposals shall not be put forward for election as Trustees.
14.4 No Member who is also an Employer shall become a Trustee in the category referred to in Rule 14.1.2.
14.5 At the annual general meeting every year half of the Trustees for the time being, in each category referred to in Rule 14.1, shall retire from office provided that if that ends in fraction of half then the next whole number above half.
14.6 The Trustees to retire in every year shall be those who have been longest in office, but as between persons who became Trustees on the same day, those to retire shall, unless they otherwise agree among themselves, be determined by lot.
14.7 A retiring Trustee shall be eligible for re-election.
15.0 CO-OPTED TRUSTEES
15.1 The Board shall, at the first Board Meeting held after the annual general meeting each Financial Year co-opt not more than four Trustees in terms of Rule 13.1.2 and having regard to Rule 13.2:-
15.1.1 The previously co-opted Trustees then remaining on the Board shall forthwith and ipso facto be deemed to have resigned from the Board;
15.1.2 The said co-opted Trustees shall remain in office until replaced by the Board following the same procedure in the following Financial Year;
15.1.3 An existing Trustee may be co-opted as aforesaid.
16.0 ELECTIONS
16.1 The Fund shall annually call for the names of persons who wish to be elected as Trustees by publishing a notice at least once in each of two Sunday newspapers circulating in Zimbabwe, the date of last publication to be not later than the 10th March in each year. Such names must be submitted to the Fund prior to 31st March of each year.
16.2 All candidates for election must:-
16.2.1 In the case of Employer's representatives, be nominated in a written document, signed by the Employer and by the candidate; and
16.2.2 In the case of Members' representatives, be proposed and seconded by Members in a written document, signed by the proposer, the seconder and the candidate.
16.3 Where the number of vacancies in a particular category is equivalent to or less than the number of eligible candidates for election in such category, all candidates shall be deemed to have been elected and the Chairman of the annual general meeting shall so advise that meeting.
16.4 Where the number of eligible candidates for election in a category exceeds the number of vacancies in such category, voting papers shall be prepared, the form of which shall be determined by the Board, showing the number of vacancies to be filled and the names of the candidates. Each Member who attends the annual general meeting shall be given a voting paper at the annual general meeting in order to record his vote thereon in the manner determined by the Board. The Auditors to the Fund shall act as scrutineers at the annual general meeting and count the votes so cast, and the election shall be decided upon such votes. The results of the election shall be declared at the Annual General Meeting by the Chairman.
17.0 VACANCIES
17.1 The Board shall be entitled to co-opt an eligible person to fill any vacancy in the number of co-opted trustees and/or to bring the number of co-opted trustees up to 4 (but always subject to the provisions of Rule 13.2) at any time, and such co-opted Trustees shall be deemed to have been co-opted in terms of Rule 15.1.
18.0 REMOVAL OF TRUSTEES
18.1 The Members shall be entitled at a special general meeting called for that purpose to remove from office an elected or nominated Trustee.
18.2 Provided a quorum is present the vote required to exercise the rights given by Rule 18.1 shall be that of at least three quarters of the Members present at the Special General Meeting.
19.0 QUORUM AT BOARD MEETINGS
19.1 One half of the number of Trustees shall constitute a quorum for meetings of the Board
19.2 Notwithstanding any vacancy on the Board, the remaining Trustees may continue to act : provided that if and, for so long as their numbers are reduced below the quorum the Trustees may act only for the purpose of:-
19.2.1 Co-opting further Trustees to increase their numbers to at least the number required for a quorum; or
19.2.2 Summoning a special general meeting of members to ensure compliance with Rule 13.2.
20.0 PRESIDING OFFICER
20.1 The Board shall, at its first meeting after the annual general meeting, appoint from its number a Chairman to preside over meetings of the Board.
20.2 In the absence of the Chairman at any meeting the Trustees present shall elect one of their number to preside over the meeting.
21.0 VOTING IN THE BOARD
21.1 All matters before the Board shall be decided by a majority vote. In the event of an equality of votes the presiding officer shall have a casting vote in addition to his deliberative vote.
22.0 MEETINGS OF THE BOARD
22.1 The Board may meet for the despatch of business, adjourn and otherwise regulate its meetings as it thinks fit, but shall meet at least twice annually.
22.2 The Chairman or any two Trustees may at any time summon a meeting of the Board.
22.3 A resolution signed by not less than the number of Trustees required for a quorum at a Board meeting shall be as valid and effective as if it had been passed at a meeting of the Board duly called and constituted.
23.0 SUB-COMMITTEES
23.1 The Board may delegate any of its powers to a sub-committee consisting of such Trustees and/or experts as it may nominate.
23.2 A sub-committee shall in the exercise of its powers conform to these Rules and any instructions that may from time to time be issued by the Board.
23.3 The Chairman shall be an ex-officio member of all sub-committees, but shall not be taken into account in calculating whether a quorum of sub-committee members is present at any meeting of the sub-committee.
24.0 MINUTES
24.1 The Board shall cause the proceedings of all Annual and Special General Meetings to be properly minuted and the minutes of such meetings shall be laid before the next annual general meeting.
24.2 The Board shall cause the proceedings of all Board Meetings to be properly minuted and the minutes of such meetings shall be laid before the next Board meeting.
24.3 If the minutes of any such meetings are accepted and confirmed as correct by a majority of Trustees present they shall be signed as correct by the Chairman.
25.0 DUTIES AND POWERS OF BOARD
25.1 It shall be the duty of the Board to oversee the business of the Fund so that the Fund at all times maintains its business in a financially sound condition and, in particular by :-
25.1.1 Ensuring that all Fund assets are registered in the name of the Fund;
25.1.2 Having assets (not taking into account any encumbered asset to the extent that it is encumbered), the aggregate value of which on any day is not less than the aggregate value on that day of the Fund's liabilities;
25.1.3 Providing for the Fund's liabilities;
25.1.4 Generally conducting the Fund's business so as to be in a position to meet its liabilities at all times;
25.1.5 Causing audited annual financial statements to be prepared in respect of every Financial Year and furnishing copies of the statements concerned together with the report of the Board to AHFoZ and to the Commissioner of Taxes;
25.1.6 Ensuring that the Board's report referred to in Sub-Rule 25.1.5 deals with every matter which is material for the appreciation by Members of the state of affairs and the business of the Fund and the results thereof and contains relevant information indicating whether or not the resources of the Fund have been applied economically, efficiently and effectively;
25.1.7 Appointing a Principal Officer who shall be a fit and proper person to hold such office;
25.1.8 Ensuring that proper registers, books and records of all operations of the Fund are kept and that proper minutes are kept of all resolutions passed by the Board;
25.1.9 Ensuring that proper control systems are employed by or on behalf of the Fund;
25.1.10 Ensuring that adequate and appropriate information is communicated to the Members concerning their rights, Benefits, Contributions and duties in terms of the Rules;
25.1.11 Taking all reasonable steps to ensure that Contributions are paid timeously to the Fund in accordance with the Rules;
25.1.12 Taking out and maintaining professional indemnity insurance and fidelity guarantee insurance from and up to such amount as the Auditor, may determine;
25.1.13 Obtaining expert advice on legal, accounting and business matters as required or on any other matter of which the Trustees may lack sufficient expertise;
25.1.14 Ensuring that the Rules, operation and administration of the Fund comply with the law;
25.1.15 Taking all reasonable steps to protect the confidentiality of medical records concerning any Member's state of health;
25.1.16 Taking all reasonable steps to ensure that the interest of Members in terms of the Rules are protected at all times;
25.1.17 Acting with due care, diligence, skill and good faith;
25.1.18 Taking all reasonable steps to avoid conflicts of interest;
25.1.19 Acting with impartiality in respect of all Members;
25.1.20 Ensuring that the Fund has a sufficient number of Members who contribute or, are likely to contribute to the Fund;
25.1.21 The Board shall have regard to, revise and introduce the business policies of the Fund, the benefits, the Scale of Benefits, Plans and Contributions;
25.1.22 The Board shall see to the appointment of a Manager (which may be the Administrator) or other officer for the management of the business contemplated by the Fund;
25.1.23 Keeping all money and assets belonging to the Fund and (unless the obligation has been delegated to the Administrator) maintaining such books of accounts and other records as may be necessary for the purposes of the Fund.
25.2 The Board shall have all the powers given to it in terms of these Rules and in addition the power:-
25.2.1 To purchase movable and immovable property for the use of the Fund or otherwise and to sell the same;
25.2.2 To let or hire movable or immovable property;
25.2.3 In respect of any moneys not immediately required to meet current charges upon the Fund, to lend, invest or otherwise to deal with such moneys upon such security (if any) and in such manner as the Board may from time to time decide and to realise, vary, re-invest or otherwise deal with such moneys and investments in such manner as it may from time to time determine;
25.2.4 To grant loans secured by first mortgage bonds over immovable property: provided that such mortgage bonds shall in no case exceed seventy five percent of the market value of such immovable property;
25.2.5 Subject to the provisions of any law to cause the Fund, whether on its own or in association with any person, to establish or operate any pharmacy, hospital, clinic, maternity home, nursing home, infirmary, home for aged persons or any similar institutions;
25.2.6 To make donations to any hospital, clinic, nursing home, maternity home, infirmary or home for aged persons in the interests of all or any of the Members;
25.2.7 To grant loans to any Members or to make ex-gratia payments on behalf of or to Members to assist such Members to meet commitments in regard to any matter specified in Rule 6.1.1, 6.1.2 or 6.1.3.
25.2.8 To contribute to, and join, any association instituted for the benefit of medical funds;
25.2.9 To contribute towards any fund of any kind whatsoever which is conducted for the benefit of the Officers and take out and pay for insurance policies on the lives of Officers for the benefit of such Officers or their dependants;
25.2.10 To arrange reinsurance of the Fund's obligation to assume liability for and guarantee the benefits;
25.2.11 To authorise such Trustees or Officers as it may decide from time to time, and upon such terms and conditions as the Board may decide, to sign any contract or other document binding or relating to the Fund or any document authorising the performance of any act on behalf of the Fund;
25.2.12 To enter into contracts with any person for the provision of Relevant Health Services and to charge the cost thereof to the appropriate Plan or the Fund as the case may be;
25.2.13 To enter into contracts for the compensation of any person (a broker), in cash or otherwise, for the introduction or admission of a Member and/or rendering services over a period exceeding one year by such broker provided such person has been granted accreditation by the Administrator.
25.2.14 To enter into a transaction or transactions involving the amalgamation of the business of the Fund with another medical Fund or the transfer of any business from the Fund to another medical Fund or the transfer of any business from any other person to the Fund;
25.2.15 To appoint, remove from office and fix the powers and remuneration of any Manager, Principal Officer, Treasurer, Clerk or other employee of the Fund;
25.2.16 To create and manage a Plan, available to Members, for the purpose of allocating personal medical savings accounts to Members, to be used for the payment of any Relevant Health Service provided to the Member in question or his Dependants;
25.2.17 To introduce Plans from time to time for the benefits of the Fund and the Members, to apply to the relevant authorities for the approval of such Plans and to manage them in accordance with the Rules.
25.2.18 To apply to the High Court for an order that an investigation be made or that the Fund be placed under judicial management or that the whole or any part of the business of the Fund be wound up;
25.2.19 To do whatever is necessary to effect or oppose a compromise or arrangement between the Fund and its creditors or any class of them or between the Fund and its Members or any group of them;
25.2.20 To provide administration services to other medical aid funds and any other employee benefit funds.
26.0 QUALIFIED POWERS OF THE BOARD
26.1 The Fund, through the Board, shall be entitled:-
26.1.1 To encumber the Fund's assets;
26.1.2 To allow the Fund's assets to be held by another person on behalf of the Fund;
26.1.3 To borrow money and to pledge the Fund's assets as security therefor; or
26.1.4 To give security in relation to obligations between other persons whether by means of suretyship or any other form of personal security, whether under a primary or accessory obligation.
27.0 PROHIBITED TRANSACTIONS
27.1 The Fund shall not invest any of its assets in the business of or grant loans to:-
27.1.1 An Employer;
27.1.2 Any other Medical Fund;
27.1.3 Any Administrator; nor to
27.1.4 Any person associated with any of the above mentioned.
27.2 The Fund shall make no payment, in whatever form, directly or indirectly, to any person as a dividend, rebate or bonus of any kind;
27.3 The Fund shall not knowingly permit any person other than an Employer to receive, hold or in any manner deal with a Contribution.
28.0 DISCRETIONARY POWERS OF THE BOARD
28.1 In addition to powers expressly conferred upon the Board in terms of these Rules, the Board shall have the power to do anything lawful and consistent with the objects of the Fund as expressed in Rule 6.
29.0 PRINCIPAL OFFICER
29.1 The Board shall appoint a Principal Officer who is a fit and proper person to hold such office.
29.2 The Principal Officer shall assume such duties and responsibilities, commensurate with his status, as the Board may from time to time direct.
30.0 ADMINISTRATOR
30.1 The Board may appoint an Administrator for the proper execution of the business of the Fund.
30.2 The agreement between the Fund and the Administrator must:-
30.2.1 Stipulate the scope and duties of the Administrator;
30.2.2 Provide that the Administrator must, on behalf of the Fund, administer the business of the Fund in compliance with the Rules and shall provide the Commissioner General of the Zimbabwe Revenue Authority with an audited copy of the Fund's annual accounts;
30.2.3 Stipulate the basis on which the Administrator is to be remunerated for conducting the administration;
30.2.4 Empower each party to the agreement to terminate the agreement after notice, in writing by one party to the other, of a period of not less than 90 days and not more than 180 days; and
30.2.5 Provide that all registers, minute books, records and all other data pertaining to the Fund, must at all times remain the sole property of the Fund.
30.3 Any amendment to the agreement referred to in Rule 30.2 must be in writing and must be affected by way of an addendum to the existing agreement or a new agreement between the Administrator and the Fund.
31.0 MANAGERIAL STAFF
31.1 Subject to the provisions of any agreement entered into between the Fund and the Administrator the Board shall have the power on behalf of the Fund:-
31.1.1 To appoint Managers, a Principal Officer, Treasurers, Clerks or other agents or Employees, all for the proper execution of the business of the Fund;
31.1.2 To fix the terms on which the said staff may be removed from office, the said staff's powers and their remuneration;
31.1.3 To determine the said staff's rights to pension and insurance cover;
31.1. To take all necessary steps and to sign and execute all necessary documents to ensure the due fulfilment of the Fund's obligations to such staff.
32.0 INDEMNITY AND FIDELITY INSURANCE
32.1 All Officers shall be indemnified by the Fund against all claims, costs and expenses to the extent to which they arise out of the exercise or purported exercise of any power or right in terms of these Rules: provided that such indemnity shall not extend to any claim, cost or expense arising from or occasioned by the personal dishonesty or wilful misconduct or gross negligence of the person involved or by the personal dishonesty or wilful misconduct or gross negligence of any other person which the person involved knowingly allowed or to which he was an accessory.
32.2 The Board shall ensure that the Fund is adequately insured against loss resulting from the dishonesty or negligence of any Officers or the Auditor.
33.0 BOOKS OF ACCOUNT AND FINANCIAL STATEMENTS
33.1 The Fund shall keep proper registers, books and records of all its operations and as are necessary for the proper working of the Fund.
33.2 The Board shall in respect of every Financial year cause to be prepared annual financial statements and shall within 4 months after the end of a Financial Year furnish a copy of the statements concerned together with the Board's report to the Registrar of ……………..
34.0 BANKING ACCOUNT
34.1 The Fund shall establish and maintain a bank account under the Fund's direct control with a registered commercial bank into which shall be paid every amount:-
34.1.1 Received as a Contribution; and
34.1.2 Received as income, discount, interest, accrual or payment of whatsoever kind.
34.2 All payments made by the Fund shall be made by cheque under the joint signature of not less than 2 persons nominated by the Board, by electronic transfer or by tape exchange.
34.3 Notwithstanding the provisions of Rules 34.1 and 34.2 the Fund may maintain a petty cash float in such sum as the Board may from time to time decide from which to make minor disbursements relating to the running expenses of the Fund.
34.4 No amount shall be debited to the above mentioned bank account save:-
34.4.1 Payments by the Fund of any benefit or ex gratia payments;
34.4.2 Costs incurred by the Fund in carrying on the Fund's business;
34.4. Amounts invested by the Board in accordance with the provisions of the Rules.
35.0 AUTHORITY FOR PAYMENTS
35.1 All disbursements shall be approved by the Board: provided that such authority may be delegated to the Administrator, Principal Officer or such other persons as the Board may approve.
36.0 SAFE CUSTODY OF SECURITIES
36.1 Any mortgage bond, title deed or other security belonging to or held by the Fund shall, except when in the temporary custody of any other person for the purpose of the Fund, be kept in safe custody in a safe or strong room at the registered office of the Fund or with any attorney, accountant, bank or building society approved by the Board.
36.2 The Board shall make such provision as it deems desirable for the safe custody of the books, papers and other effects of the Fund.
37.0 AUDITOR
37.1 An Auditor shall be appointed at each Annual General Meeting to hold office from the conclusion of that meeting to the conclusion of the next Annual General Meeting. At any Annual General Meeting a retiring Auditor, however, appointed, shall be deem to be re-appointed, without any resolution being passed unless:-
37.1.1 He is not qualified for re-appointment; or
37.1.2 A resolution is passed by at least 75% of the Members present at such meeting appointing another Auditor in his stead or providing expressly that he shall not be re-appointed; or
37.1.3 He has given the Fund notice in writing of his unwillingness to be re-appointed.
37.2 The Auditor shall not be appointed, and shall cease to act as Auditor, if:-
37.2.1 The Auditor is a member of the Board;
37.2.2 The Auditor is a person who is not engaged in public practice as an Auditor;
37.2.3 The Auditor is a person who is disqualified from acting as an Auditor in terms of the Public Accounts and Auditors Act, Chapter 27 : 2.
37.2.4 He or she is an Officer, Member or Dependant of the Fund.
37.3 Whenever for any reason the Auditor vacates his office prior to the expiration of the period for which he has been appointed, the Board shall within 30 days appoint an Auditor to fill the vacancy for the unexpired period.
37.4 If the Members at a general meeting fail to appoint an Auditor as required in terms of the Rules, the Board shall within 30 days make such appointment.
37.5 The Auditor of the Fund shall have the right of access at all times to the books and accounts and vouchers of the Fund, and shall be entitled to request from the Officers of the Fund such information as he may require.
37.6 The Fund shall instruct the Auditor to conduct an audit and to prepare the Annual Financial Statements of the Fund in accordance with any legal requirements.
38.0 AUDIT COMMITTEE
38.1 The Board shall appoint an audit committee of at least five Members of whom at least two shall be members of the Board.
38.2 The majority of the members of the audit committee, including the Chairman thereof, shall be persons who are neither Officers nor officers of the Administrator, the controlling company of the Administrator or any subsidiary of that controlling company.
38.3 The objects of the audit committee shall, inter alia, be to:-
38.3.1 Assist the Board in its evaluation of the adequacy and efficiency of the internal control systems, accounting practices, information systems and auditing processes applied by the Fund or the Administrator to the day to day management of the Fund's business;
38.3.2 Facilitate and promote communication and liaison regarding the matters referred to in Rule 38.3.1 or a related matter, between the Board, Principal Officer, Administrator and, where applicable, the internal audit staff of the Fund;
38.3.3 Recommend the introduction of measures which the audit committee believes may enhance the credibility and objectivity of financial statements and reports concerning the affairs of the Fund.
38.3.4 Advise on any matter referred to the audit committee by the Board.
39.0 ANNUAL GENERAL MEETING
39.1 The Annual General Meeting of Members shall be held before the 30th of June of each year.
39.2 The notice convening the Annual General Meeting shall contain the agenda and shall be given to all Members at least 10 days before the date of the meeting. The non-receipt of such notice by a Member shall not invalidate the proceedings at such a meeting
39.3 Attached to the notice convening the Annual General Meeting shall be lists showing in alphabetical order the names of candidates for the position of elected Trustees.
39.4 If any special business is to be debated at the Annual General Meeting the precise nature of the business shall be stated in the notice convening the meeting or in an annexure thereto.
39.5 Audited annual financial statements together with a copy of the Auditor's and the Board's reports shall be laid before the meeting.
40.0 QUORUM AT ANNUAL GENERAL MEETINGS
40.1 Twenty-five persons who are members shall form a quorum at an Annual General Meeting. If a quorum is not present at the time fixed for the commencement of the meeting, the Chairman shall adjourn such meeting for 15 minutes. The Members present at such adjourned meeting shall be a quorum.
41.0 SPECIAL GENERAL MEETING
41.1 A special general meeting of Members may be called at any time by the Board.
41.2 On the requisition of at least one hundred Members, (not more than ten Members who are Employees of the same Group Employer as set out in Rule 14.2 may sign such requisition), the Board shall cause a Special General Meeting to be called within twenty-one days of the date of receipt of the requisition. The requisition shall state clearly the matters to be discussed at the meeting and shall be signed by all the Members requisitioning the same. It shall be delivered to the registered office of the Fund. Only those matters stated in the requisition may be discussed at the meeting.
41.3 Notice of a special general meeting shall be given to the Members and Trustees in the manner provided in Rules 39.2 and 49.9. The non-receipt of such notice by a Member shall not invalidate the proceedings at such a meeting.
42.0 QUORUM AT SPECIAL GENERAL MEETINGS
42.1 Fifty persons who are members shall form a quorum at a special general meeting.
42.2 If a quorum is not present at the time fixed for the commencement of the meeting, at a special general meeting called by the Board, the Chairman shall adjourn such meeting for 15 minutes. The Members present at such adjourned meeting shall be a quorum.
42.3 If a quorum is not present at the time fixed for the commencement of the meeting at a special general meeting convened on the requisition of Members, the meeting shall be cancelled.
43.0 VOTING AT GENERAL MEETINGS
43.1 Every Member who is present at a general meeting of the Fund and whose Contributions are not in arrears shall have the right to vote.
43.2 The Chairman of the Board shall be Chairman at all general meetings; provided that, if he is absent, the meeting shall commence business by electing a Chairman from the Members present.
43.3 The Chairman of the meeting shall determine whether voting on any issue is to be by ballot or by a show of hands: provided that a ballot shall be held if it is demanded by not less than five Members present.
43.4 In the event of the votes on a ballot being equal the Chairman (provided he is a Member) shall have a casting vote in addition to a deliberative vote.
43.5 Resolutions adopted at all general meetings shall be binding on the Fund and all the Members, provided that such resolutions are not inconsistent with the Rules.
44.0 COMPLAINTS AND DISPUTES
44.1 Members shall lodge their complaints in writing with the Fund.
44.2 Such written complaints shall be administered by the Fund's Complaints Officer, appointed for that purpose.
44.3 Where the solution of such complaint is primarily dependant on medical considerations, the Complaints Officer shall refer the same to the Medical Assessor.
44.4 The decision of the medical Assessor shall be prima facie proof of any of the following facts:-
44.4.1 The nature of any physical or mental defect, physical or mental illness, physical or mental deficiency or injury in a Beneficiary (all of which are hereinafter referred to as a "sickness condition");
44.4.2 The nature of any Relevant Health Service required to deal with a sickness condition;
44.4.3 The level, type and duration of Relevant Health Service appropriate to any sickness condition;
44.4.4 Whether the place of treatment/facility is appropriate to any particular sickness condition; and
44.4.5 The occurrence or otherwise of any fraud or other matter relevant to Rule 11.3 and/or Rule 11.4 and within the area of the Medical Assessor's area of expertise or experience.
44.5 Should the decision of the Medical Assessor not be accepted by the member, the same shall be referred by the Fund to the nominee of the President for the time being of the Zimbabwe Medical Association for settlement provided such person is not a member of the Board.
44.6 Where such complaint does not, in the opinion of the Complaints Officer, depend primarily on medical considerations, the Complaints Officer shall refer the same to any one of a panel of Complaints Adjudicators (who may not be employees of the Administrator or Officers) for decision.
44.7 The parties to any dispute referred to in Rules 44.4, 44.5 or 44.6 shall have the right to be heard either in person or through a representative.
44.8 Process in any legal proceedings against the Fund may be served by leaving it at the registered office of the Fund.
45.0 DISSOLUTION
45.1 The Fund shall be dissolved upon a resolution passed at a special General Meeting of Members at which a quorum is present in terms of Rule 42.0 and at which not less than 75% of the Members present vote in favour of the dissolution of the Fund;
45.2 Upon the passing of the said resolution the Board shall appoint a person or persons as liquidator who shall be approved by the Registrar and the liquidation shall be deemed to commence as from the date of such approval, subject to the Commissioner General of the Zimbabwe Revenue Authority approval.
46.0 DISTRIBUTION ON DISSOLUTION
46.1 In the event of the dissolution of the Fund, its funds and assets shall be subject to the approval of the Commissioner General of the Zimbabwe Revenue Authority be applied in the following sequence:-
46.1.1 In payment of Members' personal medical savings accounts;
46.1.2 In payment of any costs incurred in such dissolution;
46.1.3 In payment of the debts and liabilities of the Fund then due and payable, including but not limited to obligations to Members or Dependants prior to the date of dissolution;
46.1.4 The balance to the Members as the Board shall decide.
47.0 AMALGAMATION AND TRANSFER
47.1 The Fund may, amalgamate the business of the Fund with any business of any other person (irrespective of whether that other person is or is not a registered Fund) or transfer any business from the Fund to any other person or transfer any business from any other person to the fund.
47.2 If the Board decides that any transaction referred to in Rule 47.1 is in the interests of the Fund, the Board shall be entitled:-
47.2.1 To enter into agreements on behalf of the Fund with other persons in respect of any transaction referred to in Rule 47.1;
47.2.2 To draw up an exposition of the proposed transaction.
48.0 SIGNATURE ON BEHALF OF THE FUND
48.1 Contracts and other documents binding the Fund shall be signed by the Chairman of the Board and by one other member of the Board.
49.0 MEMBER'S ENTITLEMENT TO DOCUMENTS
Membership card
49.1 Every Member shall be given a membership card, listing any limitations or exclusions. The card must be exhibited to any Supplier when required and be returned to the Fund on termination of membership.
Certificate of Membership
49.2 The Fund must within 30 days of the termination of membership or at any time at the request of any former Member or Dependant, provide that member or Dependant with a certificate, stating the period of cover, type of cover and shall forward a copy thereof on request to any medical Fund to which the former Member or Dependant subsequently applies for membership; provided that the Fund shall not be obliged to comply with either said category of request which reaches the Fund more than 2 years after such termination.
Summary of Rules
49.3 The Fund shall provide a detailed Members' Guide or Summary of Rules, specifying the Member's rights and obligations, free of charge to every member on admission.
49.4 A Member shall be entitled without charge to inspect the documents referred to in Rule 49.5 at the registered office of the Fund and to make extracts therefrom.
49.5 The Fund shall deliver to a member on demand by such member and on payment of a sum as determined by the Board from time to time per A4 page or part thereof, copies of any of the following documents:-
40.5.1 The Rules;
49.5.2 The latest annual financial statements of the Fund;
49.5.3 The latest balance sheet dealing with the state of affairs of the Fund;
49.5.4 The Fund's latest income statement;
49.5.5 The Fund's latest cash flow statement;
49.5.6 The latest report of the Auditor of the Fund, incorporated in the latest annual financial statements;
49.5.7 The management accounts in respect of any Plan offered by the Fund, indicating the financial performance thereof and the number of Members enrolled per Plan;
49.5.8 The member's membership card.
Confidentiality
49.6 No Member or Officer of the Fund shall, except in the performance or his functions or when called upon to do so as a witness before a court of law, disclose any information relating to the affairs of the Fund or any of its members and furnished to or obtained by him or her in connection with any enquiry or investigation.
Change of address
49.7 A Member shall notify the Fund by registered or certified mail within 30 days of his change of address. Failure to notify the Fund will absolve the Fund from any liability should a Member's rights be prejudiced or forfeited.
49.8 An Employer shall notify the Fund by registered or certified mail within 30 days of such Employer's change of address. Failure to notify the Fund will absolve the Fund from any liability should such Employer or a Member's rights be prejudiced or forfeited
Notices
49.9 Any notice to a Member or an Employer shall be deemed to have been validly given if:-
49.9.1 It has been mailed to his latest known address; or it has been delivered to him personally; or
49.9.2 In the case of a member who is an Employee, it has been delivered personally or sent by post to the secretary or other appropriate officer of his Employer; or
49.9.3 It has been published in two national Sunday newspapers, at least 10 days before the date of the meeting, in which case the notice shall state that the documents required by Rules 39.2 to 39.4 are to be open for inspection at the registered office of the Fund.
49.10 Posted notices shall be deemed to have been received by the addressee on the day of their delivery to the post office for posting and notices published in terms of Rule 49.9.3 shall be deemed to have been received by all Members on the last date of publication.
49.11 Advance notice of one calendar month shall be given to Members of any change in Contributions, membership fees or subscriptions and Benefits or any other condition affecting their membership.
50.0 AMENDMENT OF RULES
50.1 the Board shall be entitled to amend or rescind any Rule or to make any additional Rule, provided that not less than 75% of the members of the Board agree to such alteration, rescission or addition subject to the Commissioner of Taxes approval of such rescission, alteration or addition.
50.2 The Board shall amend the Rules:-
50.2.1 To comply with any legal requirements; or
50.2.2 Where the High Court orders that the Rules be amended; or
50.2.3 To withdraw a Plan where it is deemed to be not financially sound.
