The Company will pay Daily Cash Benefits after spending more than 48hrs in hospital as in patient due to Sickness or Bodily Injury subject to the waiting periods outlined in this document. This means that no payment will be made in respect of the first 48 hours in hospital.

Hospital cash plan is aimed at covering incidental expenses incurred during hospitalization which are normally not covered under health insurance.

Benefits

  • A cash pay-out as per selected plan for each day spent in hospital when admitted for more than 72 hours. (See available plans and options on the table below)
  • ­The maximum pay-out per claim will depend on the selected plan (see table below for details).
  • ­ Dread disease benefit/Chronic ailments cover e.g. cancer
  • ­ Immediate accident cover
  • ­ No medical examinations are required
  • ­There is an absolute freedom of choice since one can use the cash in any way they wish to i.e. paying school fees, utility bills etc.
  • ­ Pre-existing conditions/ailments excluded (including HIV/Aids)
  • ­ Should you be diagnosed with HIV/Aids or any chronic ailment after the commencement of your policy, you will be covered
  • ­ It can cover shortfalls from medical aid
  • ­ Premiums will be paid on an annual basis and the amounts will depend on the plan selected (see table below)

Plans and Benefits

Plan No 1 2 3 4 5 6 7 8
Daily Cash Benefits 50 100 200 300 500 700 850 1000
Limit any one Hospitalization 1,500 3,000 6,000 9,000 15,000 21,000 25,500 30,000
Annual Aggregate Limit 3,000 6,000 12,000 18,000 30,000 42,000 51,000 60,000

 

Cover attaches if:

  • Hospitalisation occurs within 30 (thirty) days of any injury or sickness.
  • The sickness or injusry was suffered during the currency of the Policy.
  • ­The sickness or injury falls within the policy terms and conditions included herein.
  • Premiums are up to date

Excess/Deductible

48 hours

Covered persons

Covers people from 3 months to 64 years

Claims Processing

The policyholder has to submit the duly filled claim form with requisite documents normally within 10 days from the date of discharge to Madison General Insurance Company Zambia limited. These documents include but not limited to doctor’s report or hospital’s reference letter, discharge summary, showing date of admission, date of discharge, diagnosis and treatment summery.

The claim forms will be processed within 5 working days if all documents are attached and submitted within 10 days after discharge

Hospital Cash Back Benefits will be payable for hospitalisation at any registered hospital in the Republic of Zambia.

In the event of non-payment of Premiums, the Policy will automatically lapse.  If at the time of a claim your premiums were not paid then you will not stand to benefit from the pay-out. Your 3/6/9 month waiting period starts upon your payment of the premium.

Exclusions

  • Pregnancy and any pregnancy related illness
  • ­ Any psychological or psychiatric disease or disorder, including Post Traumatic Stress Disorder will not be covered.
  • ­ Confinement in an establishment which is not a Hospital as defined herein will not result in a valid claim and will not be covered.
  • ­ Operations, treatments and examinations for obesity, cosmetic purposes or of the Insured Person’s own choosing which has no connection with any illness, will not be covered.
  • ­ Any hospitalization for the removal of cysts and fibroids
  • Any persons below the age of three months or older than sixty four years
  • ­ The driving of a motor vehicle while the blood alcohol level of the insured Person is higher than that permitted by law,
  • ­ Intentionally self-inflicted injury or attempted suicide, while sane or insane, will not be covered

 

DEFINITIONS


Hospital : Is licensed in accordance with the applicable laws of the jurisdiction in which it is located; has proper qualified doctors, nurses, and other staff, emergency & other medical facilities and minimum of 10 beds.

Illness : Means sickness or disease contracted and commencing during the currency of this Policy

Waiting Periods:

  • Immediate cover for Accidents (no waiting period).
  • ­ Illness (natural causes) 3 months
  • ­ Pre-existing non-surgical conditions 6 months
  • ­ Pre-existing surgical conditions 9 months

Insured Person : Means the person(s) who proposed or applied for Insurance and subsequently paid the premiums who is/are a resident(s) of the Republic of Zambia, residing in Zambia and in possession of a valid Zambian identity document.

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