Primary Care Benefit |
Medical Savings Account (MSA) - Standard amount of ZMK 60 000 per month included in premium.
Funds available in advance and any unused funds will be returned at the end of the year.
Funds are used to pay for primary care needs only, as required by member. |
| Consultations (incl GP, dentist, optometrist) | Medical Savings Account (MSA) |
| Specialist consultation | Medical Savings Account (MSA) |
| Acute medicine | Medical Savings Account (MSA) |
| Chronic benefit | Medical Savings Account (MSA) |
| Procedures | Medical Savings Account (MSA) |
| Dentistry | Medical Savings Account (MSA) |
| Optometry | Medical Savings Account (MSA) |
| Radiology | Medical Savings Account (MSA) |
| Pathology | Medical Savings Account (MSA) |
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Hospital Benefit |
Hospital annual limit - ZMK 320 000 000 per beneficiary
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 80 000 000 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 | 10 days per admission |
| Psychiatric hospitalisation | 7 days per annum |
| Internal prosthesis | ZMK 14 000 000 per prosthesis |
| External medical appliances | ZMK 3 200 000 per family per annum |
| MRI/CT scans | 1 body region per beneficiary per annum |
| Secondary / Step down facilities | ZMK 14 000 000 per family per annum |
| Organ transplants | ZMK 40 000 000 per family per annum |
| Renal dialysis | ZMK 44 000 000 per family per annum |
| Oncology / Chemotherapy | Subject to enrolment on oncology program |
| Medicine to take home (TTO) | 7 days' supply |
