Frequently Asked Questions

For authorizations, contact our 24-hour call centre on 086 77000716, +263 772 126 120 or email us at callcentre@healthzim.com.

Pre-authorization is required so that the call centre can verify with the service provider that:

• The member is a paid-up contributor
• The member has the available benefit
• The charges levied by the service provider are appropriate for the condition being treated

You will need to seek pre-authorization for diagnostics, surgery and admission to the hospital.

Pre-authorization is an important fraud protection mechanism. It ensures that claims cannot be inflated by medical service providers.

A claim is only valid for 3 months from date of treatment after which it is considered "expired" and cannot be presented for payment from the fund.

Claim forms should be signed on the day of receiving treatment by both the member and service provider. A claim form should never be signed in advance of treatment. For example, if you are booked for 10 therapy sessions, you must sign a claim form for each session on the day or the claim will be rejected.

A shortfall is the difference between the amount a medical service provider charges for treatment, and the stipulated amount that the fund pays for that specific treatment.

Minimize shortfalls by selecting a healthcare provider in our network.

This means you have reached the set annual benefit limits before your policy year has lapsed.

A shortfall is the difference between the service provider's fee and the amount awarded for the service on your scheme whereas a co-payment is an administration cost required by some service providers as a standard of their practice, regardless of what the funder pays.

These are conditions or treatments that are not covered by your medical aid.

While medical aid gives you cover for medical treatment, there are instances when you may need to settle bills out of your pocket. These instances are:

• When you have exhausted your benefit. This is when you have used up your benefits for the policy year.
• When you seek and receive treatment during your waiting period.
• When there is a shortfall, a service provider charges above your scheme award rates.
• When there is a co-payment, some service providers charge in-house administration costs not related to your medical treatment.
• When there are exclusions, your medical aid would not cover anything excluded in your policy agreement.

You are free to use any service provider of your choice. The Alliance Health cards are widely accepted by service providers all over the country.

Contact our 24-hour call centre for assistance or visit your nearest emergency rooms.

Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. It is therefore prudent to find cost-effective solutions to stretch the benefits on your medical plan.

If you are taking chronic medication, or need medication contact Meds@68 Family Pharmacy, situated at 68 Ridgeway North, Borrowdale. You can get in touch by: phone: 0242 884232, WhatsApp: 0783555202 or email at: info@meds68pharmacy.com