MAISHA CARE PACKAGES TERMS AND CONDITIONS

This document sets out the terms and conditions of Maisha Care packages offered by Maisha Health Fund (Private)
Limited (“Company”) to its Customers. Please read and fully understand each clause set out in these terms and
conditions.

These terms and conditions can be changed at the Company’s sole discretion without notice to Customers. The
Company will notify Customers by SMS of amendments to these terms and conditions and ensure that they are available
at the official website. When a Customer registers for the Maisha Care packages, the Customer must know and fully
understand the terms and conditions set out in this document. Any Customer who does not accept the changes to the
terms and conditions of this agreement shall notify the Company in writing within thirty days of posting of the
amendments at the customer touch points, and such notification shall be deemed to constitute termination of the
insurance policy with effect from the date on which the new amendments take effect.

Confirmation of registration means that the Customer agrees to abide and be bound by these Terms and Conditions, in
respect to Maisha Care packages.

1.0 DEFINITION

1.1 AHFOZ means Association of Healthcare Funders of Zimbabwe which is a voluntary membership association that represents
and furthers the common interest of medical aid societies of which Maisha Health Fund is a member.

1.2 Antiretroviral drugs means drugs used to treat Human Immunodeficiency Virus.

1.3 Beneficiary means the person and/or entity who will receive the benefit.

1.4 Claim means a request for a benefit pay-out done by or on behalf of the Member.

1.5 Claim Form means an official document from an entity duly registered under and in accordance to the Health Professions
Act detailing the services supplied to a Member and the respective costs.

1.6 Claimant a person making the Claim.

1.7 Cover means a promise by the Company to pay up to a specified amount of money and/or benefits under Maisha Care
packages, in return for Premium.

1.8 Customer means the individual applying for cover under Maisha Care.

1.9 Mobile Wallet means an electronic wallet held with Mobile Network Operator in the name of the Insured, Sponsor, and/ or
Beneficiary.

1.10 Exclusions means instances where the Company will not be obliged to pay out a claim as set out in these Terms and
Conditions

1.11 ID means any official document accepted by the national registry department.

1.12 Illness means a human health condition or disease or an internal malfunction of the body not directly influenced by external
forces such as accident, but excluding the Exclusions set out in these terms and conditions.

1.13 Independent Medical Officer means a qualified and experienced medical practitioner who is not in a treating relationship
with the Member who is engaged by the Company to review any repudiated claim, conflict or dispute.
1.14 Member means a person covered under Maisha Care packages.

1.15 Company means Maisha Health Fund (Pvt) Limited, the company offering Maisha Care packages.

1.16 Suspended means that cover is no longer available due to not meeting the Premium or withdrawal of the cover by the
Company.

1.17 Subscription Date means the date on which the Customer selects to be eligible for the Cover by completing the registration
process as set out in these Terms and Conditions.

1.18 Material Fact means information which the Company would consider in determining the terms and conditions of offering
Maisha Care packages.

1.19 Pharmacy is a facility duly registered with the Medicines Control Authority of Zimbabwe allowed to dispense pharmaceutical
drugs.

1.20 Policy means the Maisha Care packages contract between the Company and the Member, which determines the claims which
the Company is legally required to pay.

1.21 Policy Cancellation means the withdrawal and/or termination of a Policy by the Company or by the Member.

1.22 Policy Term or Duration means the period of time for which the Policy is valid and the Cover is active.

1.23 Pre-Existing Condition means an illness or health condition suffered by the Member of which they were or should have
been aware of before taking the Policy.

1.24 Maisha Care packages means medical insurance products that entitle a promised amount and/or benefit to be paid out as
set out in these terms and conditions.

1.25 Premium means the monthly value of money as determined by the Company from time to time which allows qualification to
the Cover.

1.26 Hospital Cash Back (HCB) means a medical insurance product that entitles a promised amount and/or benefit to be paid
out in the event of hospitalization of the Insured.

1.27 Hospital is a health care institution, licensed in accordance with the laws of the Republic of Zimbabwe, providing patient
treatment with suitably qualified staff and equipment.

1.28 Hospitalisation means being placed under medical care in a hospital.

1.29 Acute medicine refers to the medication used to treat short-term illness and prescribed by a doctor for example
painkillers, antibiotics.

1.30 Emergency refers to life and limb threatening scenarios due to an unforeseen event or sudden illness.

1.31 Accident means an unforeseeable and unintentional event that occurs after the Commencement Date and which, in an
external and visible manner, independently of any other cause, directly results in the death of the Insured.

1.32 Pre-existing Condition means an illness, sickness or disease that a person applying for cover under this insurance knew
about, or was awaiting diagnosis of, in the 24 months immediately prior to the day your insurance starts. Hospitalisation due
to pre-existing conditions is not covered under this policy.

2.0 REGISTRATION
2.1 Maisha Care packages pay out benefits as detailed in Annexure 1 for medical services obtained while the policy was paid up.
2.2 To register for Maisha Care packages, the Customer must be aged at least 18 years and below 65 years.

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2.3 Persons 65 years and above will not be eligible for cover.
2.4 The Customer will register through their mobile phone or any other means availed by the Company.
2.5 Before a Policy can be issued the Customer has to complete the registration process.
2.6 By completing the registration process a Customer confirms acceptance of these terms and conditions.
2.7 The Customer is allowed to add other beneficiaries onto their policy as long as those beneficiaries are under the age of 65.
2.8 By default premiums will be collected automatically from the Customer’s Mobile Wallet when registration was completed using
the Customer’s mobile phone.
2.9 The Company reserves the right to reject an application made by a Prospective Member.
2.10 A Customer will have the option to add Dependants.
2.11 A Dependant can be any member of the immediate family members i.e. (spouse, children, parents, grandparents, mother in-
law & father in-law) below the ages of 65 years.
2.12 The Premium is paid per head is the same irrespective of the Dependants age.
2.13 Dependants are transferable amongst the Insured person such as between husband or wife for minors.
2.14 Dependants above 16 should have an active Econet line.
2.15 To add a Dependant, a Customer will be requested to provide the following information:
i. Full name and surname;
ii. Identity number;
iii. Gender;
iv. Date of birth;
v. Relationship; and
vi. Mobile number (where applicable)

1.0 POLICY COMMENCEMENT DATE AND DURATION

1.1 The Maisha Care packages policy is effective as follows:
1.1.1 the 1st of the current month if registration is completed by the 10 th; or
1.1.2 the 1st of the subsequent month if registration is completed after the 10th.

1.2 Registration is completed by payment of the Premium.

1.3 The Policy is valid for a month and renewed with the payment for the subsequent month’s premium
1.4 A Member may cancel the Policy by unsubscribing and will not be entitled to a refund of premium under any conditions
except for advance premium payments.
1.5 The Policy is terminated on the death of the Member, cancellation by the Member and/ or any other arrangement agreed
between the Member and the Company.

2.0 QUALIFYING FOR MAISHA CARE PACKAGES

2.1 Benefits will be paid provided the minimum qualifying requirements are achieved in accordance with the rules below:
i. Payment of all premium due.
ii. Observance of waiting periods as detailed in Annexure 1.
iii. There will be no Claim settlement if the Policy has lapsed or is Suspended.

3.0 SUSPENSION, LAPSE AND REVIVAL OF COVER

3.1 The grounds for suspension are as follows:

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 a) Failure to pay premiums by the 1st of each month
b) When a member obtains improper advantage for the purposes of this Rule, “improper advantage” means any advantage,
monetary or otherwise, to which a beneficiary is not entitled under the Terms and Conditions.
3.2 The Policy shall be suspended up to a maximum of three (3) months. In this case, membership shall be reinstated subject to a
request by the Member, settlement of outstanding dues and any other requirements stipulated by the Company at that time.
3.3 When the policy is suspended, the entitlement to benefits from the Scheme is also suspended, meaning that a claim incurred
by the member in such instances will not be honoured or paid.
3.4 The totality of a continuous claim: where admission falls within the dates when membership was suspended will not be
honoured outrightly.
3.5 Failure to reinstate the policy within three (3) months will result in membership becoming lapsed or terminated.
3.6 A cancelled/lapsed Policy can never be reinstated. An applicant will have to make a fresh application for a new Policy.
3.7 The Policy shall not have a surrender value.

4.0 NOTICE PERIOD FOR PREMIUM INCREASE

4.1 Increases in Premium will be communicated in the preceding month in which the change becomes effective.

5.0 MISREPRESENTION AND FRAUD

5.1 Any misrepresentation or non-disclosure of a Material Fact by the Customer may result in the Policy being cancelled, a claim
rejected or the policy being voided from inception without any refunds of Premiums paid.
5.2 Any fraudulent act used to obtain any benefit under any Policy may render the Policy cancelled or void from inception and
in such event any claim will be forfeited without any refunds of Premiums paid.

6.0 CHANGES IN THE POLICY

6.1 Any changes to the personal details for the Policy holder must be done to the Mobile Wallet details first and then
communicated to Maisha Health Fund.
6.2 Such changes are limited to:
i. Change of contact details
ii. Corrections of any personal details of the Policy.
6.3 There can be no change in the identity of the Member on a given Policy other than official changes in name in accordance
with Zimbabwean registration laws.

7.0 INDEMNITY
7.1 Upon purchase of medical services by the Member, the Company will pay the amounts stated in Annexure 1 to the
Member/Beneficiary but subject to the Exclusions and Conditions contained herein.
7.2 If the Company claims that the payment is not due and payable by virtue of the Exclusions or non-compliance with any of
the terms and conditions stated herein, onus shall be on the Member or beneficiary to prove the contrary.

8.0 CLAIMS
8.1 All Claims are submitted to the Company.
8.2 The Claims will be paid into Claimant’s bank account.

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8.3 Claims must be submitted to the Company within 90 days of receiving medical services following which they will be deemed
stale and will not be honoured.
8.4 The following documents should be supplied at the claiming stage.
8.4.1 The service provider's name, registration number and address;
8.4.2 The patient's full name and address;
8.4.3 The date of service;
8.4.4 Doctor’s prescription/request form;
8.4.5 The description of the service;
8.4.6 The amount(s) charged;
8.4.7 Claim form;
8.4.8 Receipts for all cash payments;
8.4.9 Any other information that the Company may reasonably request.
8.5 A full medical history may be requested together with reports by the regular and attending doctors to validate any claim.
8.6 Claims will be processed within 60 days.
8.7 The Company reserves the right to call for any additional documentation as may be required from time-to-time to validate
the information provided and the Member or Beneficiary shall supply in writing at his/her own cost any information that
the Company may request.
8.8 By use of the Cover, the Member irrevocably authorises, and requests any doctor, medical institution or other person who
may be in possession of or hereafter acquire any information concerning their health up to the present time, to disclose such
information to the Company and agree that such authority and request shall remain in force after their death as prior thereto.
8.9 Should a member happen to pay cash at any service provider, the member shall be entitled to a refund within thirty
(30)working days of receipt of the claim subject to availability of the member’s benefit limits and subject to the Company’s
tariff award regime for the service received.
8.10 For a claim to be eligible for refund, the claim should be stamped by the Service Provider and should be accompanied by a
receipt for the cash paid and bank details for the principal member. The claim should be submitted and received by the
Company within 90 days of treatment. The member should also fill in the Company’s Claim Refund form and provide the
requisite details for payment of the refund. After 90 days, such a claim will be stale and will not be accepted for payment.
8.11 To claim for the Hospital Cash Back Plan, the following original documents should be supplied:
i. Patient card;
ii. Other Medical records from the hospital;
iii. Other Medical Aid Cards used;
iv. Receipts for all cash payments;
v. Letter of admission and discharge; and
vi. Copy of ID of claimant.
claims must be notified within 30 days of discharge.
Hospitalization related to any chronic illness will be limited to a maximum of 5 days per event, and a maximum of 10 days per
Policy per year.
The next of kin of the principal can claim on behalf of him/her that is if, he/she dies after being admitted in hospital. However,
he/she will be required to provide all the required documents to make a claim including the death certificate. A proof of the
relationship in the form of marriage certificate or birth certificate should accompany the documents listed in item 13.3 above. Two
witnesses may also be requested if there is no spousal relationship.

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9.0 EXCLUSIONS
The Company will not be liable in respect of any Claim which is directly or indirectly caused by, arising from, contributed to,
aggravated by, connected with or resulting from any of the following:
9.1 War, invasion by a foreign country, acts of foreign enemies, hostilities (whether war is declared or not), civil war, riots, labour
disturbances, active participation in strikes or the activities of locked-out workers, rebellion, revolution insurrection or
military or usurped power, or the Member engaging in military duty or military exercises with any armed force of any country
or international authority.
9.2 Intentionally self-inflicted injury or attempted suicide, while sane or insane.
9.3 Engaging in (or practicing for or taking part in training peculiar to) underwater activities necessitating the use of artificial
breathing apparatus, climbing or mountaineering necessitating the use of ropes or guides, potholing, parachuting, hang-
gliding, winter sports involving snow and ice, professional sports or racing other than on foot.
9.4 Engaging in aviation, other than as a fare-paying passenger in a fixed-wing aircraft provided and operated by an airline or
air charter company which is duly licensed for the regular transportation of fare-paying passengers, or in a helicopter
provided and operated by an airline which is duly licensed for the regular transportation of fare-paying passengers provided
such helicopter is operating only between established commercial airports and/or licensed commercial heliports.
9.5 The actions of any Member or the Member personal representatives contrary to the law.
9.6 Driving a motor vehicle while the blood alcohol level of the Member is higher than that permitted by law, irrespective of
whether such action causes an accident or not.
9.7 Medical Services where there are no objective indications or impairment in normal health.
9.8 The Member having taken a drug, unless it is proved that the drug was taken in accordance with proper medical prescription
and not for the treatment of a drug addiction.
9.9 Operations, treatments and examinations for obesity, cosmetic purposes or of the Member’s own choosing which has no
connection with any Illness.
9.10 Treatment of infertility or the artificial insemination of a person.
9.11 Services as a consequence of breast reduction or enlargement, penis enlargement or sex change operations.
9.12 Any treatment not recommended or administered by a qualified medical professional.
9.13 Treatment due to cosmetic or plastic surgery except in the case of bodily reconstruction after Injury.
9.14 Alcohol or drug dependence syndrome including treatment of any medical condition which, in the opinion of the Company,
is considered to be either an underlying cause of, or directly attributable to, alcohol or drug dependence syndrome.
9.15 Medication that is not on the Essential Drugs List of Zimbabwe
9.16 Claims as a result of expenses incurred out of the Republic of Zimbabwe.
9.17 Over the counter drugs.
9.18 Obesity, weight control medication and any other products that are purchased without a doctor’s prescription.
9.19 Recreational devices and drugs such as condoms and Viagra, Contraceptives.
9.20 Lodgers’ fees.
9.21 Vaccinations-yellow fever etc.
9.22 Treatment by a medical practitioner who is in any way related to the member.
9.23 Illegal termination of pregnancy.
9.24 Any service not detailed in Annexure 1

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 10.0 REPUDIATION OF CLAIMS, CONFLICT & DISPUTE
10.1 In the event of a repudiation by the Company of a Claim or portion of a Claim hereunder, (and after receiving a written
objection from the Beneficiary within thirty (30) days after such repudiation) the decision shall be reviewed by an
Independent Medical Officer. The Independent Medical Officer’s view will not be binding on the Company, but may serve
as a basis for a reappraisal of the decision to repudiate.
10.2 In the event of the Beneficiary not agreeing with the Company’s reappraisal, the Beneficiary will notify the Company in
writing within thirty (30) days.
10.3 Thereafter the matter shall be referred to arbitration by the Company in terms of the relevant legislation, within a period of
60 (sixty) days.

11.0 COMMUNICATIONS
11.1 The Company is entitled to address any written communication in the manner it deems most expedient including e-mail and
through other means such as the website (www.maishahealth.co.zw), Maisha Care toll free line - 149, Ambulance Toll Free
line – 186 and Telemedicine Toll free line - 147.

12.0 LIMIT OF INDEMINTY

12.1 Any Claim brought by the Member or Beneficiary as a result of Maisha Care packages for whatever reason shall be limited
to the benefit the Member is entitled to in terms of their Policy and these terms and conditions.
12.2 The Member may benefit from Maisha Care packages as long as the Company continues to offer Maisha Care packages to
the Member. Any Claims incurred after the discontinuance of Maisha Care packages for whatever reason shall not be valid.
The Company shall meet all Claims that meet the terms and conditions and are submitted no later than 30 days after
discontinuance of Maisha Care packages.

13.0 WHOLE AGREEMENT

13.1 These Terms and Conditions, shall constitute the sole agreement between the Company and the Member.
13.2 No contrary representations or agreement to amend the Terms and Conditions shall be of any force or effect unless reduced
to writing and signed by someone specifically authorized thereto in writing by the Company.

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ANNEXURE 1

POLICY BENEFITS AND PREMIUM

1. The Maisha Care packages are designed to provide basic medical services at selected service providers as
communicated by the Company from time to time.
2. Consultation benefit is only limited to general practitioners and the first consultation for emergencies i.e.
life or limb threatening situations. No procedures, sundries or any other costs apart from consultation tariff
fees are covered.
3. Only drugs that are on the Essential Drugs List of Zimbabwe will be covered under Maisha Care packages.
4. The benefits under the Maisha Care packages are tabulated below:

Maisha Care Category Benefit Limit

Emergency consultation 2 emergency consultations per year and emergency

stabilization for 48 hours subject to a limit of USD$300.
Non-emergency GP consultation 4 consultation a year, 1 per quarter

Prescription Drugs (only those on the Essential/Acute US$200 per year

Drugs List of Zimbabwe)
Hospital Cash Back USD$50 per day after 72 hours of continuous hospitalization
up to a maximum of 30 days per event. Annual limit of 60 days.
Health tips 14 Health tips per month

Telemedicine 4 telemedicine consultations per month and annual limit of 36

telemedicine consultations.
Ambulance services Emergency road evacuations

5. The following waiting periods will apply for the particular benefits:

Benefit Waiting
Period
General Consultation 3 months

Emergency Consultation 3 Months waiting, No waiting period for emergency

due to an accident.
Prescription drugs 3 months
Hospital Cash Back 3 months
Ambulance No waiting period
Telemedicine No waiting period
Health tips No waiting period

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6. The premiums for the Maisha Care packages will be communicated by the Company from time to time.

Monthly
Premium
Adult US$5.00

Child US$5.00

7. The Member must produce their ID and policy number/phone number when accessing medical services.
8. To access the ambulance benefit, the member will contact the toll-free line 186.
9. To access the telemedicine consultations, the member will contact the toll-free line 147.
10. For the customers joining before the 10th of the month, their policy commencement date will be the month
of joining and they will start receiving their tips from the 14 th of that month. This also applies to existing
members. For customers joining after the 10th of the month, their policy commencement date is the 1st of
the following month and they will start receiving the tips from the 14 th of the following month.
11. The applicable benefit year is equivalent to 365 days / 366 days in a leap year. This runs between 1 March to
28 February or 29 February in a leap year.
12. For those joining in the course of the benefit year, yearly benefits will be pro-rated.
13. There are basically two limits in respect of each claim. The per treatment limit and the per benefit limit. The
per treatment limit will generally be in reference to the applicable AHFOZ tariff code and limit for that
treatment, or in its absence, to the benchmark amount which is determined by the Company from time to
time. The per benefit limit, refers to the cap on the benefit category to which the treatment is defined by the
Company. For consistency and fairness, it is agreed that this classification provided by the Company is final
and members or beneficiaries will not contest this.
14. Drugs will be covered at the Company’s internal tariffs. The Member will be expected to meet the difference
between the cost of the drugs and how much the Company pays for that drug according to its internal drug
tariffs
15. The company reserves the right to recommend members to less expensive treatment options. This includes
but is not limited to requesting for three quotations on some forms of treatment or limiting quantities of a
service or product accessed even through one’s limits may generally permit.
16. In cases where a Member is in violation of the waiting periods and a claim is submitted to the Company by
a Claimant, the Company will not honour such a claim.
17. Benefits are not transferrable between members. In addition, an exhausted benefit category cannot be
subsidised by another benefit category.