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Re- launch Hospital Cash Plan Insurance Benefit (HCP) Processes and Procedures . Areas to cover. HCP Definitions. HCP Benefits. HCP Terms and conditions. HCP Interpretations HCP Registration. HCP cancellation. Edgars Club Subscription/Premiums Billing & payments. HCP claims process.
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Hospital Cash Plan Insurance Benefit (HCP) Processes and Procedures .
Edgars Stores Limitedwill pay the Insured Person the Benefits Listed below if during the Period of Insurance any Insured Person suffers Sickness or Bodily Injury which results in any Sick or Injured Person's Hospitalization, provided:
• Hospitalizationoccurs within 30 (thirty) days of any injury or sickness;
• The sickness or injury was suffered during the currency of the Policy;
• The sickness or injury falls within the policy terms and conditions included herein.
HOSPITAL CASH PLAN BENEFITS.
Also the Edgars Club Subscriber can add beneficiaries. The following conditions apply
A child refers to a male or female dependant below the age of eighteen years.
This refers to a period of 24 (twenty-four) consecutive hours of hospitalization.LIMITATION OF STAY.
Means sickness or disease contracted and commencing during the currency of this Policy.
INSURED PERSON / LIFE INSURED
Means the person(s) who proposed or applied for The Club Membership and subsequently paid the membership subscription who is/are a resident(s) of the Republic of Zimbabwe, residing in Zimbabwe and in possession of a valid Zimbabwean identity document
Means a medical practitioner duly qualified, registered, licensed and practicing within the scope of his/her license pursuant to the laws of the Republic of Zimbabwe. Physician shall not include the Insured Person whose Hospitalisation is the basis of a claim hereunder, or a relative by blood or marriage of such Insured Person unless approved by The Company.
PRE-EXISTING MEDICAL CONDITION
Means the person married (whether by civil, customary, tribal or religious union) to the Insured. Cover is limited to one nominated spouse where a person has more than one.
LIMITATION OF STAY.
Registration on Edgars Club can be done using the following methods
DIRECT DEBIT BY EDGARS.
Billing of subscriptions.
Club subscriptions as well as HCP beneficiary fees are billed at the beginning of each trading month and they become due and payable at the end of the same trading month.
The subscriptions and the beneficiary fees are added to the monthly instalment together with funeral Insurance for those that have insurance.
Payments of subscription fee and beneficiary premiums.
These are paid in full at the close of trading period being an additional $3 plus any beneficiary premiums on the customer’s normal instalment. The order in which payments are deducted per month are funeral Insurance (for those covered), the Edgars Club subscription and instalment including LPC andinterest (if applicable).
Failure to pay Subscription fees.
The following are legally accepted ways of notifying claims. When a claim is notified through any of the following methods, take the necessary steps to gather and verify information.
Letter, fax, Email from Insured.
CLAIMS REPUDIATIONS AND EX-GRATIA PAYMENTS
Claims repudiation should be done when
Write to the Section manager stating clearly why ex-gratia should be granted
Conditions for ex-gratia justification
After the all documents have been collected and the claims documents completed, these will be sent to Eagles Insurance Claims department. It is Eagles Insurance Company Limited’s claim department who will give the final word as to whether Edgars must pay or not pay the claim.
Q1. Can I be covered if I have any of the following conditions, HIV, Diabetes, Hypertension, Kidney problems, cancer, Asthma?
Q2. Are medicals required before I join?
Q3. Can I be covered if I am on a work permit and I am not Zimbabwean?
Q4. Can I still claim if I am hospitalised outside of Zimbabwe?
Q5. How long does a claim take to settle?
Q6. Are there any documents required for payment to be settled?
Q7. Is there a maximum number of dependents?
Q8. Is there an age limit?
Q9.What happens when I reach that age after I have been contributing?
Q10.What if my injuries are internal?
Q11. What if I am being monitored and I stay in hospital for 3 days? i.e. my condition is being assessed either illness or accident?
Q12.What happens when the principal member dies?
Q13. What if a patient dies whilst they are hospitalised?
Q14. If I pay annually, do I still have to adhere to the waiting period?
Q15. If I have an instalment shortfall and I am hospitalised do I get anything?
Q16. Does it lapse?