Chronicle Editor
Online Reporter
THE Association of Healthcare Funders of Zimbabwe (AHFoZ) has encouraged citizens to take up medical aid cover to insure themselves against ill-health as well as ensure they stay healthy and productive to the economy.
In statement, AHFoZ said medical aid coverage is crucial in people’s lives. There are over 30 medical aid societies in the country.
Concern has been raised that people prefer to take up funeral cover but without medical aid cover which would enhance good health and prevent death due to illness.
In most cases people die because of lack of medical attention as they will be having no money to seek health services.
This can be addressed through health insurance.
AHFoZ said medical aid is a form of insurance where members pay a monthly fee, contribution or premium in return for financial cover for medical treatment or related medical expenses when the need arises.
Medical aid members contribute money into a pool on a regular basis to cover health related expenses for any one of the contributing members as and when the need arises.
“It is important to have a financial fall back plan when emergency health situations arise, rather than to be caught unaware and not financially prepared.
“It is important for people to value investing in healthy and productive lives instead of only focusing and investing in death and burial,” said the organisation.
The medical aid concept operates on the principle of cross subsidy.
The well subsidise the sick, and the young subsidise the old.
Due to the nature of healthcare interventions often required, a contributing member may easily exhaust their own contributions and they go onto benefit from contributions made by others contributing into the pool.
There are different medical aid schemes to choose from in Zimbabwe and people can choose cover that suits their needs and budget.
Medical aid societies impose waiting periods for various healthcare services when a new member joins.
This is a period during which a member will pay monthly subscriptions but will not be entitled to claim any benefits.
“Waiting periods in Zimbabwe normally depend on the kind of services to be rendered with three months being the common minimum period for one to start receiving treatment while other high value services such as specialist services, hospitalization, maternity services, spectacles, haemodialysis, chemotherapy and orthodontic have longer waiting periods.
“These are put in place to allow new members time to contribute to the pool before benefitting. It would be unfair to existing members for a new member to join and immediately start benefitting. It’s important to “sow before reaping.”
Waiting periods vary with schemes taken and society used.
New-born babies are not affected by waiting period provided they join within the period stipulated by the concerned medical aid society.
Issues of shortfalls have been contentious and one of the reasons some don’t take up medical cover.
AHFoZ explained shortfall as the difference between the cost that a healthcare service provider charges a medical aid patient for services rendered and what the member’s medical aid society pays in terms of its rules and agreed fees or tariff structure.
If the service provider’s cost is greater than the fee of the medical aid society, the excess becomes a shortfall which the service provider may collect from the patient or may choose to waiver.
Some shortfalls can also be due to waiting periods, where members may not be eligible to access funds for certain procedures or services at the time, even after the general waiting period therefore the need for them to settle the difference, AHFoZ explained.
Shortfalls may also arise when members exhaust their benefit limits for a given year. Different packages have different limits, and some benefits are subject to yearly limits therefore when exhausted, a shortfall will arise.
“Members are encouraged to know their waiting periods and benefit limits for some procedures and also to enquire from their medical aid societies on where they can get healthcare service at minimal or no shortfalls.”
AHFoZ said taking up medical aid lessens the financial burden on healthcare service costs which are extremely high, helps members to get early treatment and regular health checks, than waiting for one to get sick and gives members the preference of going to an institution of choice.
AHFoZ urged citizens to choose living a productive life before death.
Online Reporter