The Health and Child Care Ministry has ordered Cimas to lift a ban on Corporate 24, settle all outstanding claims within the stipulated time and advise members that their claims would be honoured.
Government said mediating the dispute was helped by the fact that Cimas and Corporate 24 were willing to negotiate and had reduced the points of contention by the time the State intervened.
Medical aid society Cimas and health services firm Corporate 24 had been feuding for 10 months, threatening to prejudice more than 30 000 of the former’s subscribers.
The stand-off started in June 2015 when Cimas removed Corporate 24 from its direct payment system after alleging that the latter had some “irregular” claims.
This meant Cimas subscribers who used Corporate 24’s services had to pay cash upfront and then apply for reimbursement.
Corporate 24, which maintains a database of over 24 000 members and their beneficiaries, reported the matter to the State regulator in July 2015 and challenged Cimas to prove its allegations of fraudulent claims.
It was alleged that Cimas, in turn, notified its members to use cash when using competitors’ services as a means of getting subscribers to use in-house facilities.
Cimas has denied the allegations.
Statutory Instrument 330 of 2000 and SI 35 of 2004 make it illegal for medical aid societies to direct their members to particular service providers.
Sources familiar with the case say Corporate 24 could have lost millions of US dollars through the fued as Cimas was not processing its claims for payment.
Deputy Health Minister Mr Aldrin Musiiwa last week said, “We have successfully mediated the Cimas-Corporate 24 wrangle, but by the time we came, the two had already narrowed their differences to come up with long lasting solutions.
“Both sides were forthcoming in terms of bringing the solution to the matter. Cimas relaxed its stance to make the negotiations smoother.
“Our job as regulators was made easier by both parties as we came to strengthen the agreements they made together since they didn’t want to disadvantage the clients.
“Going forward, both parties have assured us that they are going to work peacefully for the good of the clients and the industry.”
A system where medical aid subscribers are forced to pay cash upfront is largely discouraged in the sector as it goes against the essence of medical insurance.
Corporate 24 CEO Dr Mike Joka said, “We want to thank Honourable Deputy Minister Musiiwa for the final resolution on the matter.
“The law has taken its course and we have been vindicated.
“We look into the future with hope and we look forward to improved relationships with Cimas going forward.”
Cimas MD Mr Rodrick Takawira referred this paper to the company’s lawyers, who could not be reached for comment by the time of going to print.
Cimas is Zimbabwe’s second-largest medical aid society after Premier Service Medical Aid Society.
Last year, Cimas also had run-ins with the National Physicians Association of Zimbabwe, the Zimbabwe Hospital Doctors’ Association and the Retail Pharmacists Association of Zimbabwe over various matters.
In 2000, Cimas was locked in a similar dispute with leading laboratory group Lancet and the matter spilled into the courts.
It took Government intervention to break the impasse.
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