Product ESSENTIAL OPTION

Overall Limit ZMW 22 160 pbpa

Overall Limit In Patient (IP) ZMW 17 370 pbpa

Hospitalisation
(General medical and surgical wards) Subject to IP limit
Hospitalisation
(Executive/Private Ward)) Not Covered

Not Covered
High Care and ICU Currently not reflecting on Brochure
Simon M indicated that sometimes paid
Specialists and General Practitioners Subject to IP limit
Theatre Costs Subject to IP limit
Ward and Theatre medicines Subject to IP limit
Major Disease Benefit (MDB) Subject to IP limit
Oncology Subject to MDB Subject to enrolment on oncology programme
Organ Transplants *D Subject to MDB Not Covered
Organ Transplants *D2 - donor Not Covered
Renal Dialysis Subject to MDB Subject to IP limit
HIV Programme Subject to IP limit
Motor Vehicle Accident Subject to MDB Subject to IP limit
Step Down/Rehabilitation*P Not Covered
Medicines to take home Subject to IP limit
Appliances Subject to IP limit
Subject to IP limit (MRI/CT Scan subject to medical
Specialised Radiology (Including MRI/CT Scans) motivation required)
Pathology Subject to IP limit
Radiology Subject to IP limit
Maxillofacial Surgery Subject to IP limit
Dental Surgery (subject to conditions) Subject to IP limit
Maternity Subject to IP limit

Neonatal, including neonatal ICU and related costs Subject to IP limit

Internal and external prosthesis Subject to IP limit
Physiotherapy *R Subject to IP limit
Psychiatric hospitalisations Subject to IP limit
Addictive conditions & disorders *L Not Covered
Circumcision (per ben) ZMW 1 030 pb
Ambulance Services (In Country Only) Subject to IP limit
Air/Cross Borders Evacuation Not Covered
Compassionate travel for one parent accompanying
the minor Not Covered
Emergency Foreign cover *C Not Covered
Emergency Medication Not Covered
GP Visits Not Covered
Specialist Visits Not Covered
Product ESSENTIAL OPTION
Overall limit Out Patient (OP) ZMW 4 790 pbpa
MSA N/A
Out-of-network benefits N/A
Consultations Limit Subject to OP limit
GP Consultations Subject to OP limit
Specialists Consultations Subject to OP limit
Antenatal Benefit* Subject to OP limit
Antenatal Consultations Subject to OP limit
Ultrasounds Subject to OP limit
Pathology Subject to OP limit
Procedures Subject to OP limit
Pathology Subject to OP limit
Radiology Subject to OP limit

HIV / AIDS Benefit *E

Anti-retroviral therapy
Pathology Tests Subject to OP limit
Basic Dentistry ZMW 1 080 pbpa
Advanced Dentistry*P
Orthodontics not covered for age > 18 Subject to OP limit
Physiotherapy *R ZMW 1 090 pbpa
Appliances Subject to OP limit
Auxiliary services *R
ZMW 1 090 pbpa
Psychology Subject to Auxiliary Services limit
Acute Medicines Subject to OP limit
Doctors Dispensed Acute Medicines Subject to OP limit

OTC including supplements

(Supplements only covered provided valid clinical
motivation is given) ZMW 370 pbpa
Chronic Medicines *E ZMW 4 190 pbpa

Chronic Benefits *E 1 Glucometer per

Glucometer and Strips for Insulin Dependant Chronic Insulin dependent chronic member
Members Max 300 Gluco-Sticks per annum
Optical Limit - per beneficiary every 24 months ZMW 1 080 per beneficiary every 24 months
Mono- / Bi- / Multifocal lenses
Every 24 months Within optometry benefit (every two years)
Frames
Every 24 months Within optometry benefit
Eye Test
Every 24 months Within optometry benefit
Refractive surgery
Every 24 months Within optometry benefit

SPECIAL BENEFITS
Repatriation of mortal remains Included
Funeral Included
Accidental Death Benefit (Main Member Only) ZMW 5 000
 Contributions for 12 months from date of death of a
Health Premium Waiver PRINCIPAL MEMBER
24-hour health advice line Not Covered
Hello Dr Digital Doctor included
Personal Health Assessment Not Covered

Beyond Life benefit

Main Member ZMW 5 000
Adult Dependant ZMW 5 000
Child Dependant ZMW 2 000

Antenatal Benefit*
Members have to register on a maternity program to qualify for these
benefits
*E = Enrolment Required
*P = Pre-Authorisation Required
*R = Referral by GP or Specialist required
*D = Donor not covered
ESSENTIAL PLUS OPTION EXTENDER OPTION

ZMW 35 050 pbpa ZMW 115 180 pbpa

ZMW 26 960 pbpa ZMW 104 840 pbpa

Subject to IP limit Subject to IP limit

Not Covered Not Covered

Not Covered
Currently not reflecting on Brochure
Simon M indicated that sometimes paid 3 days per hospital episode
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to enrolment on oncology programme Subject to enrolment on oncology programme
Not Covered Not Covered
Not Covered Not Covered
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Not Covered Not Covered
Subject to IP limit Subject to IP limit
Subject to IP limit ZMW 5 510 per family per annum
Subject to IP limit (MRI/CT Scan subject to medical Subject to IP limit (MRI/CT Scan subject to medical
motivation required) motivation required)
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit

Subject to IP limit 3 days per hospital episode

Subject to IP limit ZMW 11 140 per prosthesis
Subject to IP limit Subject to IP limit
Subject to IP limit 3 days per annum
Not Covered Not Covered
ZMW 1 120 pb ZMW 5 250 pb
Subject to IP limit Subject to IP limit
Not Covered Not Covered

Not Covered Not Covered

Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
ESSENTIAL PLUS OPTION EXTENDER OPTION
ZMW 8 090 pbpa ZMW 10 340 pbpa
N/A N/A
N/A N/A
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit

Subject to OP limit Subject to OP limit

ZMW 1 800 pbpa ZMW 2 130 pbpa

Subject to OP limit Subject to OP limit

ZMW 1 360 pbpa ZMW 1 800 pbpa
Subject to OP limit Subject to OP limit

ZMW 1 360 pbpa ZMW 1 800 pbpa

Subject to Auxiliary Services limit Subject to Auxiliary Services limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit

ZMW 560 pbpa ZMW 840 pbpa

Subject to OP limit Subject to OP limit

1 Glucometer per 1 Glucometer per

Insulin dependent chronic member Insulin dependent chronic member
Max 300 Gluco-Sticks per annum Max 300 Gluco-Sticks per annum
ZMW 1 800 per beneficiary every 24 months ZMW 2 130 per beneficiary every 24 months

Within optometry benefit (every two years) Within optometry benefit (every two years)

Within optometry benefit Within optometry benefit

Within optometry benefit Within optometry benefit

Within optometry benefit Within optometry benefit

Included Included
Included Included
ZMW 6 500 ZMW 7 000
Contributions for 12 months from date of death of a Contributions for 12 months from date of death of a
PRINCIPAL MEMBER PRINCIPAL MEMBER
Not Covered Not Covered
Digital Doctor included Digital Doctor included
Not Covered Not Covered

ZMW 6 500 ZMW 7 000

ZMW 6 500 ZMW 7 000
ZMW 2 600 ZMW 2 800
PREMIER OPTION ADVANCED OPTION

ZMW 1008 860 pbpa Annual limit - Unlimited per beneficiary per annum

ZMW 988 490 pbpa Hospital limit - Unlimited per beneficiary per annum

Subject to IP limit Subject to IP limit

Not Covered Not Covered

10 days per hospital episode 10 days per hospital episode

Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to enrolment on oncology programme Subject to enrolment on oncology programme
Not Covered Not Covered
Not Covered Not Covered
ZMW 106 400 per family per annum Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
ZMW 33 430 per family per annum ZMW 50 630 per family per annum
Subject to IP limit Subject to IP limit
ZMW 7 790 per family per annum ZMW 10 130 per family per annum
Subject to IP limit (MRI/CT Scan subject to medical Subject to IP limit (MRI/CT Scan subject to medical
motivation required) motivation required)
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
10 days per hospital episode - subject to a limit of 10 days per hospital episode - subject to a limit of
ZMW 92 980 pbpa ZMW 139 470 pbpa
ZMW 33 130 per prosthesis ZMW 40 500 per prosthesis
Subject to IP limit Subject to IP limit
7 days per annum 10 days per admission
Not Covered Not Covered
ZMW 6 740 pb ZMW 7 050 pb
Subject to IP limit Subject to IP limit
Subject to IP limit Subject to IP limit
Return economy class ticket and US 120 allowance per Return economy class ticket and US 120 allowance per
day (max 14 days) day (max 14 days)
Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
PREMIER OPTION ADVANCED OPTION
ZMW 20 370 pbpa ZMW 40 930 pbpa
N/a N/a
N/a N/a
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit
ZMW 5 370 pbpa ZMW 14 330 pbpa
ZMW 5 370 pbpa ZMW 14 330 pbpa
Subject to Pathology limit Subject to Pathology limit

Subject to OP limit Subject to OP limit

ZMW 2 760 pbpa ZMW 4 910 pbpa

Subject to OP limit Subject to OP limit

Subject to OP limit Subject to OP limit
Subject to OP limit Subject to OP limit

Subject to OP limit Subject to OP limit

Subject to OP limit Subject to OP limit
ZMW 3 060 pbpa ZMW 6 090 pbpa
Subject to OP limit Subject to OP limit

ZMW 1 260 pbpa ZMW 1 900 pbpa

Subject to OP limit Subject to OP limit

1 Glucometer per 1 Glucometer per

Insulin dependent chronic member Insulin dependent chronic member
Max 300 Gluco-Sticks per annum Max 300 Gluco-Sticks per annum
ZMW 2 740 per beneficiary every 24 months ZMW 4 140 per beneficiary every 24 months

Within optometry benefit (every two years) Within optometry benefit (every two years)

Within optometry benefit Within optometry benefit

Within optometry benefit Within optometry benefit

Within optometry benefit Within optometry benefit

Included Included
Included Included
ZMW 10 000 ZMW 10 000
Contributions for 12 months from date of death of a Contributions for 12 months from date of death of a
PRINCIPAL MEMBER PRINCIPAL MEMBER
Not Covered Not Covered
Digital Doctor included Digital Doctor included
ZMW 2 000 pbpa ZMW 2 500 pbpa

ZMW 10 000 ZMW 10 000

ZMW 10 000 ZMW 10 000
ZMW 4 000 ZMW 4 000