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Pro Health Terms and Condtions

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

  1. DEFINITIONS:

 

1.1. “Adult” means a member who is 18 years or older, excluding full-time students who are younger than 25 and dependants who are permanently physically and

mentally disabled.

1.2. “Benefit start date” means the date from which a member becomes entitled to benefits.

1.3. “Chronic medicine” means medicine that meets all the following requirements:

 

1.3.1. Is within formulary and prescribed by a network medical practitioner for an uninterrupted period of at least 6 (six) months;

1.3.2. Is for a condition appearing on the list of approved chronic conditions, as amended from time to time;

1.3.3. Which has been applied for in the manner and at the frequency prescribed and which application has been approved and accepted.

 

1.4. “Dependant” means the following persons for whom the principal applicant is liable for care and support and that are duly registered as dependants.

 

1.4.1. A spouse and/or partner,

1.4.2. A child – including an adopted child (including a child adopted under a tradition practiced by the people of Zimbabwe, provided that the child’s natural

parents are both deceased), a stepchild, biological or foster child; and /or

1.4.3 Any other person approved by ProHealth.

1.4.4. NB: You will be requested to send proof of relationship where the child is not your biological child.

1.5. “Family” means the Principal member (being a natural person) in whose name this option is effected and includes the principal member’s spouse and dependant children under the age of 18 (eighteen) years which form part of the Principal members household and who are resident in the Republic of Zimbabwe.

1.6. “Inception date” means the date on which the registration of the option becomes effective.

1.7. “Member” means each individual under cover, including a dependant.

1.8. “Medicine” means a substance registered under the Medicines Control Act, as amended or replaced from time to time and within the ProHealth formulary.

1.9. “Option” means a product registered under ProHealth, which offers a specific structure of benefits.

1.10. “Main member” means a person who has been registered as the principal applicant.

1.11. “Minor” means a dependant who is not yet 18 years old, and a dependant who is over the age of 18 but not over the age of 25 years, who is studying full time

at a recognised institution.

1.12. “Service Provider” means a registered provider of health services.

1.13. “Spouse” means a person to whom a member is married under a system recognised by Zimbabwean law.

1.14. “Waiting period” means the number of months you have to wait from inception before you can access your benefits.

1.15. “Year” means a 12 month period beginning from January 1st and ending on December 31st.

1.16. “Membership year” means a period of 12 months from the date of joining ProHealth.

 

  1. MEMBERSHIP REQUIREMENTS:

 

2.1. Unless otherwise provided for herein, the main member and spouse to be covered should be above the age of 18 years at the time of application;

2.2. Unless otherwise provided for within, the main member to be covered should be above the age of 18 at the time of application;

2.3. All dependants will be covered up to the age of 18, unless otherwise provided for herein;

2.4. Cover will cease automatically once any dependant reaches the maximum age of 18, or 25 in the case of a dependant studying at a recognized institution.

Annual proof of registration at a recognized educational institution will be required where a dependant over the age of 18 is to be covered.

2.5 Certified copies of birth certificates and identity documents are required as proof of family relationship between members and minor dependants upon

registration.

2.6 Members who join ProHealth, having been existing members of another registered Medical Aid Society, without a break in membership, may in certain instances be entitled to a waiver of waiting periods for Primary Care services subject to the rules and conditions contained herein. Members transferring from another medical aid society, which is a member of the Association of Health Funders of Zimbabwe (AFHoZ), must provide proof of membership to benefit from a waiver of any waiting periods.

 

  1. WAITING PERIODS:

 

Waiting periods will apply for all members and their dependants before they can claim any benefits as follows:

3.1. General Medical Practitioner and primary care benefits are subject to a 3 (three) month waiting period from the inception date, unless otherwise stated herein;

3.2. (Six) 6 month waiting period will apply should you choose to upgrade your health plan. During the 6 (six) month period, members and dependants will retain the benefits of their existing health plan until the 6 (six) month waiting period has lapsed.

3.3. (Twelve) 12 month waiting period will apply should you choose to downgrade your health Plan. During the 12 (Twelve) month waiting period members will be required to continue paying the tariff rates for their existing health plan, before the tariff applicable to the chosen downgrade takes effect.

3.4. (Six) 6 month waiting period will apply for access to chronic medication benefits, (12 months) for Anti-Retroviral therapy programs, specialist treatment, CT and MRI scans, spectacles and contact lenses, special appliances such as nebulizers, glucometers and hearing aids.

3.5. (Twelve) 12 months for maternity benefits, and Maternity notification should be made immediately after confirmation of pregnancy.

3.6. (Twenty Four) 24 month waiting period will apply for access to orthodontics and internal prosthesis.

3.7. (Twenty Four) 24 month waiting period will apply for Haemodialysis, Chemotherapy and Radiotherapy.

3.8. (Twelve) 12 month waiting period will apply for dental care, optical benefits, wellness benefits and access to health services that are not available locally such as foreign hospital treatment.

3.9. (Six) 6 month waiting period for hospitalisation.

3.10. (Twelve) 12 month waiting period from the inception date for planned or elective surgery, unless otherwise stated herein;

 

  1. AMENDMENT / UPGRADE PROCEDURE

 

4.1. Should you wish to change your personal details, amend any option or add dependants on to your existing product, please contact our office directly with your membership number.

4.2. The addition or removal of a product option may result in a change of premium, equivalent to the current rates applicable to the options and members covered.

 

NB: STANDARD WAITING PERIODS ON UPGRADED OR DOWNGRADED BENEFITS WILL APPLY ONCE THE SPECIFIED POLICY WAITING PERIODS FOR UPGRADES AND DOWNGRADES HAVE LAPSED.

 

  1. PRODUCT PREMIUM PAYMENTS

 

5.1. Product premiums are payable monthly in advance. If the product premium is not received in time, all option benefits will be suspended. There is an extended grace period to receive premium up to the 15th of the month for which the premium is due. If your contributions fall in arrears for more than 1month without alternative arrangements being made, your membership will be terminated immediately without further notice. The Society understands the needs of its members; therefore various payment methods are accepted to suit everyone’s needs. The use of mobile banking platforms to make contribution payments is encouraged.

5.2. Premiums are due on the 25th of each month, unless otherwise agreed.

5.4. If your membership lapses due to non-payment, you may reinstate the product within the first two months of such lapsing by paying the missed contributions.

5.4.1. If missed premium contributions are not paid upon re-instatement, the inception date will be changed to the date of re-instatement, and standard waiting periods will apply from this date.

5.5. At retirement age, those members who have enjoyed 25 years of continuous subscription will continue to receive medical cover, at a discount of up to 100%.

The length of the contribution period and claims experience of the member will determine the level of retirement cover.

 

  1. MEMBERSHIP CANCELLATIONS

 

6.1. You may cancel your membership by giving written notice. You will, however still be covered for the remainder of the month for which the last premium was collected.

6.1.1. No premiums will be refunded in instances where benefits are not utilised by a member.

6.2. Should you wish to re-instate your product after cancellation, you may do so within 2 months from the cancellation becoming effective. However, the  inception date of the product will change to that of reinstatement, and the standard waiting periods mentioned herein will apply if the contributions are not paid.

6.3. ProHealth reserves the right to cancel your membership or that of any of your dependants by giving a 30 day written notification, where possible, if you or any of your dependants:

 

6.3.1. Provide false information, or fail to disclose pre-existing conditions when applying for any option or product; 6.3.2. Provide false information upon submission of a claim;

6.3.3. Allow any other person to use your membership card;

6.3.4. Commit any other fraudulent act;

6.3.5. Fail to pay premiums.

 

  1. GENERAL EXCLUSIONS AND LIMITATIONS

 

ProHealth shall not be held liable for any claims or compensation, in respect of any of the following:

7.1.1. Suicide, or self-injury or intentional exposure to obvious risk of Injury (unless in an attempt to save human life);

7.1.2. Claims from individuals that are not recognised members, subject to the terms herein;

7.1.3. Any harm or injury caused by or as a result of the influence of alcohol, drugs or narcotics upon such insured;

7.1.4. Any injury caused by or arising from exposure to or contamination by atomic energy and/or nuclear fission or reaction;

7.1.5. Injuries sustained whilst participating in any riot or civil commotion or public disorder or active involvement in war, acts of terrorism, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or political risk of any kind;

7.1.6. Injuries sustained whilst participating in any Professional Sport.

 

DISPUTE RESOLUTION

 

7.2. Should any dispute, disagreement or claim arise between the parties concerning this or any other Product option (“the Dispute”), the parties shall endeavour

to resolve the Dispute referring the Dispute to Arbitration.

7.3. Unless otherwise agreed in writing by the parties, any such arbitration shall be held in Harare.

7.4. Each party to this Product option irrevocably: option and shall, notwithstanding the termination of this Product option, remain in full force and

7.4.1. Consents to any arbitration in terms of the aforesaid rules being conducted as a matter of urgency; and

7.4.2. Authorises the others to apply, on behalf of the parties to such Dispute, in writing to the arbitrator in terms of the aforesaid rules for any such arbitration

to be conducted as a matter of urgency, provided that the party which intends so applying first notifies the other parties in writing of its intension to do so.

7.4.3. The provisions of this clause 8 shall not preclude a party from seeking urgent interim relief from the appropriate court of law.

7.4.4. For the purposes of clause 8 and for the purposes of having any award made by the arbitrator(s) being made an order of court, each of the parties

hereby submits itself to the High Court of Zimbabwe or its successor in title.

7.4.5. This clause 8 constitutes an irrevocable consent by each of the parties to any proceedings in terms hereof, is severable from the rest of the Product option and shall, notwithstanding the termination of this Product option, remain in full force and effect.

 

  1. DOMICILIUM

 

9.1. The domicilium citandi et executandi address of a Principal Member shall be the address set out in the application form or such later address as notified in

writing.

9.2. For purposes of this product, ProHealth’s address shall be 11 Routledge Street Milton Park: Attention Compliance Officer.

9.3. Any notification given in terms of this product shall be in writing and shall -9.3.1. If delivered by hand be deemed to have been duly received by the addressee on the date of delivery;

9.3.2. if posted by prepaid registered post be deemed to have been received by the addressee on the 8th (eighth) day following the date of such a posting; 9.3.3. if transmitted by facsimile or email, be deemed to have been received by the addressee on the day following the date of dispatch, unless the contrary is

proved;

9.3.4. Notwithstanding anything to the contrary contained or implied in this agreement, a written notice or communication actually received by ProHealth or

a member from the other as the case may be, including by way of facsimile or email transmission, shall be adequate written notice or communication to such party.

 

  1. GENERAL

 

10.1. This product option constitutes the entire Day to day product and that no other conditions, stipulations, warranties and representations whatsoever have

been made by any party or that party’s agent, other than as specifically included herein.

10.2. No latitude, extension of time or other indulgence which may be given or allowed by either party to the other in respect of any payment provided for or the performance of any other obligation shall under any circumstances be construed to be an implied consent by such party or operate as a waiver or a novation of or otherwise affect any of the third party’s rights in terms of or arising from the Product, or prevent such party from importing, at any time and without notice, strict and punctual compliance with each and every provision or term thereof.

10.3. No amendment or cancellation of the Product option shall be of any force and effect unless such amendment or cancellation is in writing and signed by

ProHealth.

10.4. ProHealth specifically determines that no loans will be allowed in terms of the product.

10.5. Statements made by the Principal Member relating to the Product option will be deemed to be true and incontestable.

10.6. The parties consent to the jurisdiction of the High Court of Zimbabwe, to hear and determine and action or proceeding which may result from or arises from the Product option.

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