Medical Aid in Zimbabwe: What You Need to Know and Why it Matters?

September 22, 2021

Health is a gift that we tend to take for granted. We do not value it until sickness strikes or when an unfortunate accident happens.

Many people hide under the famous phrase “I never get sick.” Guilty as charged? The reality is, it may not always be you who needs medical attention. It can be your parents, your significant other or a child who lands in the hospital due to unforeseen road accidents, sports injuries or stress.

When most Zimbabweans are faced with an unexpected illness, condition or accident they depend solely on cash to fund treatment. According to the last statistics released, a small fraction of the population, 10%, can turn to their medical aid to cover treatment. This is despite the majority of the population having funeral insurance.

Uptake of medical aid has further been affected by the Covid 19 pandemic. The pandemic has impacted businesses and individual in terms of revenues and disposable incomes standings. This has led to a continued decline in people subscribing or taking up medical aid.

While most still see medical aid as an unnecessary expense, it remains a necessity.

“With the escalation in both cost of medical care and complexity of diseases, medical aid is a must for that unfortunate event,” says Albert Musakwa, Managing Director at Generation Health.

What is medical aid, and why does it matter?

In essence, medical aid is a type of insurance that protects you financially should you require medical or health care. It covers medical expenses incurred while in hospital, receiving treatment from a specialist, GP or when seeking medication from a pharmacy.

Picking a good, reputable medical aid is now an essential part of alleviating the stress of worrying that provides you with the necessary financial cover when you need it. Accidents can happen, and your health, as well as your family, is unpredictable.

How do I choose the best Medical Aid?

When choosing an ideal plan, it is best to assess your life and understand the implications if you needed medical treatment. According to Mr. Musakwa, the best medical aid interacts and engages with bonafide medical practitioners who believe in improved health outcomes for their clients.

First, ask these questions:

How long has a Medical Aid been in business? 

It is imperative to ensure if the scheme is well established and financially stable. The market and medical practitioners prefer established brands with a sound track record.

What do other people say about the Medical Aid?

The word-of mouth phenomenon is vital as it helps you get a better idea about the product and is key in decision making. For example, some Medical Aid schemes are notorious for delaying payments, and most practitioners avoid them – leaving you as a member on the lurch.

What is the level of shortfalls/out of pocket expenses?

It is not standard that schemes cover all expenses. Some medical aid only cover a percentage of their tariffs for the hospital. In that case, members would have to cover the shortfall if doctors or specialists charge more than the schemes rates.

What is medical aid card acceptability by many provider networks?

Members should look at the acceptability of cards by service networks. These service networks include a pharmacy, GP, specialist or hospital network. Medical schemes are also increasingly introducing service provider networks to contain costs. A member should decide with the listed service providers in mind.

How flexible are the products?

For example, medical aid schemes may exclude you from claiming for conditions for a limited time. Be aware of these possible exclusions before signing on the dotted line.

What are the benefits? 

Most medical aid schemes pay claims depending on the benefit option.  The benefits can be in hospital and out of hospital benefits. These will financially protect you and have a flexible day to day benefits, among others.

What are the rules of joining and the applicability of waiting periods?

Medical aids are entitled to 3 months general waiting period at the medical aid’s discretion. The waiting periods are not always automatically applied. It depends on the health risk profile presented to the medical scheme.

What do I need to join/register for medical aid?

When you come in, remember to bring these:

  • ID, Birth certificate for children.
  • Membership certificate if leaving another Fund.
  • Medical Report on request from Funder.