CIMAS Medical Aid Society, the country’s second-largest health insurance business, is on a collision course with Government after defying a directive to reverse its action to place clients from medial institution – Corporate 24 – on cash payment.
Cimas has been directing clients seeking services of Corporate 24 to pay cash and claim a refund from the medical aid society.
The Ministry of Health and Child Care – the industry’s regulator – was forced to intervene in order to protect clients who were being prejudiced from the year-long tiff between the two business units.
It has since emerged that in February this year, Secretary for Health and Child Care Brigadier General Dr Gerald Gwinji wrote to feuding parties imploring them to solve the issue which was prejudicing paid up members.
“The Ministry has considered your submissions and concerns regarding the above-mentioned matter (Corporate 24 – Cimas relationship). We have noted that the continuation of the status quo has prejudiced members.
“It is in this regard that we have arrived to the following conclusion and way forward. Lift up the cash placement with immediate effect to allow your members to access the service using their valid cards.
“You are obliged to inform your members about the lift of the ban to allow them easy access,” read part of the communication.
The Society was also directed to settle outstanding claims that had accrued as stipulated by Statutory Instrument (SI) 330 of 2000.
However, in an information bulletin circulated by Cimas on April 21, 2016, the Society’s managing director Mr Rodrick Takawira insisted that subscribers visiting Corporate 24 had to pay cash upfront.
“Please note that the current position is that Corporate 24 is still on cash. Cimas has however committed to paying Corporate 24 in respect to all outstanding valid claims as at 28 March 2016.
“As per our communication in August 2015, the decision to put Corporate 24 on cash was prompted by operational challenges that Cimas Medical Aid Society was experiencing with Corporate 24. Direct payment to Corporate 24 will be reviewed upon the conclusion of a forensic audit that is underway.
“We would like to advice you that as our valued members of Cimas you are free to access services from Corporate 24, but please note that you will be required to pay cash upfront and then claim from Cimas after being attended to,” said Mr Takawira.
It is understood that move will affect more than 30 000 subscribers.
SI 330 of 2000 and SI 35 of 2004 make it illegal for medical aid societies to direct their members to particular service providers.
Last week Deputy Minister in the Ministry of Health Mr Aldrin Musiiwa said Government was willing to resolve the matter.
“We have successfully mediated the Cimas-Corporate 24 wrangle and no one has the right to backtrack from the decision we reached earlier (agreement) as they may be consequences in doing so.
“However, if they have the case they have to come through us (mediators) again, we will be keen to resolve the impasse but I can’t pre-empt what we are going to do next as far as the case is concerned,” he said.
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.
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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