Terms and Conditions

Last updated: June 23, 2021

Please read these terms and conditions carefully before using Our Service.

1.Book of Rules

1. A copy of the Membership Rules will be supplied to each principal member upon commencement of the membership. Furthermore, any amendments will be supplied to any member(s) by the Society, upon request.
2. These Membership Rules may be cited as the Emerald Medical Aid Rules and shall be binding to all members and member firms of the Society. All previous membership and scheme rules specially repealed
3. The Board may, at its discretion, develop additional Rules or amend existing Rules.

2.Membership

1. Membership is open to individuals, families and organisations, who are approved and admitted by the board.
2. The Board shall have complete and absolute discretion to accept or decline:
   • Any application of membership.
   • Membership of a dependant person,And the decision of the Board shall be binding and it shall not be required to furnish or substantiate the reason for its decision.
3. Prior to accepting or rejecting any applications for the membership, the Board reserves the right to request any individual or his/her dependant(s) to submit to a medical examination either by his/her own doctor or a medical practitioner nominated by the Board and such costs shall be for individuals’ own account.
4. Membership shall commence on the 1st calendar date of the month following receipt of contribution and admission of the member(s) to the Society.
5. All standard waiting periods will be applicable to new applicants, unless agreed otherwise by the Board.
6. Membership of the newly born child may be back- dated to its date of birth if the relevant application form and contributions are received by the Society on or before the tenth (10) day of the second month following that, in which the child is born
7. In all cases the benefits flowing from the membership of the Society shall only accrue to a member and his/her dependant(s) from the date on which such member or dependant(s) is deemed to be admitted to membership. For avoidance of any doubt, any waiting periods set out in the Rules shall apply on the admission of membership.

3.Individual Membership

1. Admission of membership to the Society shall be open to all persons who are under the Retirement Age of 65 years.
2. No Principal member shall be admitted into the Society below the age of 18 years.
3. The Board may, at its discretion, admit to membership persons who are above the retirement age on the set terms and conditions.

4.Corporate Membership

1. Corporate members are required to provide a monthly declaration of all covered employees. This declaration should accompany the monthly payment to enable the Society to match funds received and covered employees.
2. Corporate members are responsible for notifying the Society of all terminations, additions and adjustments to the declared number of covered employees.
3. Corporate members are required to send changes to the declared covered member listing in writing, Failure to notify the Society in writing will render the Corporate Member liable for the contributions for the individuals who may have left employment.
4. At the end of a covered member’s employment with the Corporate Member, the Corporate Member is required to take back the membership card for the departing employee to ensure that the employee does not continue to use the card once membership has been terminated.
5. Claims incurred by the former employee will be for the account of the former employer or Corporate Member should the card be used after the period of coverage has ended.

5.Termination of Membership

1. A member and his/her dependant(s) shall cease to be a member(s) of Emerald Medical Aid Society:
   • on death,
   • on resignation,
   • If the membership of the member firm under which he/she is registered is terminated in terms of these Rules and the member has not applied for the individual membership in terms hereof;
   • If he/she is expelled from the Society.
2. A member or dependant(s) may be expelled from the Society:
   • for the breach or attempted breach of the Rules;
   • for any act attributable to the member which is detrimental to the interest of the Society;
   • for non-payment of the contributions for three (3) consecutive months;
   • for any reason adjudged by the Board as good and sufficient for such action. In such an event the Board will not be obliged to disclose the reasons for its discretion.
3. Membership of the Society shall be terminated on one (1) calendar months’ notice, in writing by either a member, member firm, or the Society. The Board, at its discretion may agree to terminate such membership with immediate effect.

6. Contributions

1. Every member shall pay Emerald Medical Aid Society, in respect of himself/ herself and his/ her dependants(s), the monthly contribution in advance, as prescribed by the Board.
2. All contributions are due and payable to the Society in advance by the 30th day of each month.
3. Failure to pay contributions by the due date, may render the member or member form liable to expulsion from the Society or suspension of benefits.
4. The Board shall give all members and member firms one (1) full calendar months written notice of any intended alteration in the basis or scale of contributions.
5. It is the responsibility of the member or member firm to ensure proof of payment is forwarded to the Society within 7 working days where payment has been effected by the bank transfer and/or direct deposits, etc.
6. Any member or member firm who is not prepared to accept this alteration in the basis or scale of contributions shall:
   • Within fourteen days from the date of receiving notice thereof, notify the Society in writing of such non-acceptance and;
   • On the date on which the altered basis or scale becomes effective, cease to be a member or member firm as the case may be, of the Society.

7.Medical Benefit

1. The Society will only refund treatment undertaken by registered Medical Professionals and / or Institutions who are registered with the Association of Healthcare Funders of Zimbabwe
2. The Society refunds in line with the ZRVS/ AHFoZ tariffs and up to the members yearly medical maxima as set out in the Benefits Table and in the current Terms and Conditions.
3. Treatment undertaken by a Medical Professional will be paid in line with the AHFoZ tariffs. Where the service provider(s) charge above the ZRVS rates, the member shall be responsible for any or all shortfalls
4. The Board shall in its absolute discretion, have the power to reject the claim in full or pay such amount as it may consider appropriate, having regard to the circumstances of each individual case and without having to assign any reason thereof.

8.Pre- Authorisation

1. Expenses incurred as a result of non pre authorisation, shall not be honoured by Emerald Medical Aid Society and shall be for member(s) account
2. Members are required to obtain approval for any procedure. Should members not obtain pre authorisation, from the Society, the Society reserves the right to reject any claims arising from such procedures and these expenses will be for member(s) account.
3. Emerald Medical Aid Society will issue a unique pre authorisation number for all procedures.
4. Emerald Medical Aid Society reserves the right to reject any claims received without such a specified pre authorisation number (s).
5. Members must contact Emerald Medical Aid Society no more than 72 hours after seeking emergency treatment. Should EMAS not be notified within the specified 72 hours, the Society reserves the right to reject any claims arising from such emergency treatment and this will be to the members own account

9.Submission of Claims

1. No claim shall be considered by Emerald Medical Aid Society unless the provisions of these Rules have been complied with.
2. Any claims not received within three (3) months from the date on which the service was rendered, shall not be honoured.

10.Non Claimable/ Exclusions

1. Expenses incurred as a result of the following items listed below shall not be accepted by the Society
2. Fertility, hormonal imbalances or problems of sexual nature (i.e IVF, impotence, HRT)
3. The cost of treatment which, is recoverable at law from any other party, body, source or in terms of a policy.
4. Illness or injury arising from an act of war, terrorism or rebellion.
5. Vaccinations, and/or inoculations
6. Illness or injury arising from unlawful act
7. Illness and injury arising from any wilful or deliberate self-inflicted act
8. Cost incurred for the treatment of or arising from the misuse/ abuse of drugs, substances, alcohol and/or solvents
9. Injury or illness arising from participation in what is regarded by the Society as a hazardous sport
10. Operations or treatment, which in the opinion of the Society, are not essential including operations or treatment of a cosmetic nature, whether or not such operation or treatment have been advised on psychiatric grounds
11. Any activity undertaken against the advice of a medical professional, that may result in the member requiring additional treatment for such activity.
12. Weight control treatment and/or medication whether it be on psychiatric or medical grounds
13. Any and all treatment and/ or medication for the control or prevention of smoking addictions and any habit forming substances.
14. Purchase of disability hardware.
15. Any treatment that the Board, at its discretion, deems is not medically necessary
16. Any pre-existing medical conditions and/or related complications that the Board deems as not covered
17. Treatment of any illness or injury which is the responsibility of any other medical benefit scheme, Workmen’s Compensation Commission or Insurance Company
18. Holidays for recuperative purpose.
19. Travelling expenses

10.Claim Refunds

1. The Society will endeavour to settle all reasonable and eligible claims within 30 days of submission to the Society.
2. The Society will endeavour to pay foreign claims that are considered reasonable and eligible within 90 days of submission to the Society

11.Payment of Debt

1. In the event that any payment is made in excess of a member(s) and or his/her dependant(s) entitlement, under these Rules, or any other reason whatsoever, the above shall become indebted to the Society, and fail to refund such excess payment or settle his/her indebtedness within a period of thirty days of notification thereof, the Society shall, in addition to any other lawful remedies, have the right to:
   • Deduct the overpayment or other debit for any amounts thereafter becoming due under these Rules in respect of any claims accepted from that member, or
   • Where applicable, request the members employer to deduct the amounts due, either in full or by monthly instalments, from the members salary