Primary Care Benefit |
| Consultations (incl GP, dentist, optometrist) | 6 visits per member per annum |
| Specialist consultation | 2 per annum (part of consultation limit) |
| Acute medicine | ZMK 640 000 per member per annum |
| Chronic benefit | ZMK 1 280 000 per member per annum (DSP) |
| Procedures | ZMK 1 200 000 per member per annum |
| Dentistry | ZMK 280 000 per member per annum |
| Optometry | ZMK 280 000 per member per annum |
| Radiology | Included in procedure benefit |
| Pathology | Included in procedure benefit |
| HIV/AIDS benefit | Wellness program |
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Hospital Benefit |
Annual limit ZMK 80 000 000 per member
Benefits payable at 100% of agreed tariff (Zambia Price List). Hospital benefit covers medical
expenses incurred when hospitalised, including doctors, specialists, operations, anaesthesia, etc. |
| Hospital limit | ZMK 24 000 000 per hospital episode |
| Specialists, doctors, etc in hosptal | Included in hospital limit |
| Ward fees (general ward) | Included in hospital limit |
| High care, intensive care, neonatal care | 3 days per hospital episode |
| Psychiatric hospitalisation | 3 days per annum |
| Internal prosthesis | ZMK 4 000 000 per prosthesis |
| External medical appliances | ZMK 2 000 000 per family per annum |
| MRI/CT scans | Medical motivation required |
| Medicine to take home (TTO) | 5 days' supply |
