J.

Consultation(Limitedtooneconsultationperdaypercondition) 3 4 5 i ii 6 LocalPrivateSpecialists. 100%subjecttotariff& Referral. 70%subjecttotariff. MASMEXCLUSIONS TheMedicalAidSocietyofMalawishallnotbeliableforpaymentof thefollowing: ADMISSIONS AdmittingMASMmemberswithoutPreauthorization PrivatewardswhichcostmorethantheSocietystariffrate. Costoffoodandlodgingforguardians. Mealsifchargedseparatelyforthepatients. Admissioncostsincurredduringthefirstthreemonthsfromdate ofregistration. Admissioncostswheretreatmenthasa12monthwaitperiod Privatenursingserviceschargesin&outofhospitalorhomebasedcare Guardiansfees. TREATMENTBYGENERALPRACTITIONER TreatmentprovidedtomemberbyaPanelDoctorwhomhe/sheis notregisteredwith. MEMBERSHIP Anypersonabovetheageof55yearscannotberegisteredonany ofourschemes. SPECIALISTTREATMENTRESIDENT TreatmentgiventoVIPandExecutiveSchemememberswithout referralfromaGPoranyothermedicalinstitution. Minorormajorproceduresrenderedwithoutpreauthorization TreatmentprovidedtoEconoplanSchememembersatprivatespecialists. Wherereferralletterisprovidedonmembersrequest. SPECIALISTTREATMENTVISITING&FOREIGN Treatment rendered to a VIP or EXE Scheme member who have beenonMASMforlessthantwelveconsecutivemonths. Treatment rendered to VIP or EXE Scheme member without a referralletterfromaGP/Specialistandwhereamemberdoesnot havealetterofguaranteefromMASM. TreatmentprovidedtoEconoplan,MlimiUmoyo,KabwafuSchememembers. Wherereferralletterisprovidedonmembersrequest. MATERNITYSERVICES AccessingmaternityserviceswithoutpriorapprovalfromMASM. Incaseswherematernitylimithasbeenexhausted. Where member/dependent has not been on MASM for 12 consecutivemonths. Wheremember/dependentconceivesanddeliverswithin2years. ForeignMaternityServices DENTALTREATMENT Inlays,CrownsandBridges DentalflossandMouthwashes OrthodontictreatmentprovidedwithoutpreauthorizationbyMASM ForeignDentalServices MEDICINES/DRUGS DrugsusedfortreatmentofAIDSe.g.Mariandina,AZT,(MASM coversfirstlinetreatmentrecommendedbyNAC) Prophylactic treatment e.g. contraceptives, anti malarials, Vaccinescoveredbygovernmentforfree Slimmingtablets. Infertilitydrugs. Antiseptics Foodse.g.Isomil,Lucozade,SanatogenWinesetc. Cosmetics. Overthecounterdrugse.g.vitamins. Food Supplements e.g. Herbal remedies, Immune boosters Transshipproducts,Tianshietc ORTHOPAEDICAPPLIANCES Noawardswillbemadeinrespectof: Repairsoradjustments. Labourchargesandtechniciansfees. Salestax. Footwearofanytypeincludingsurgicalboots,footwearraises, inserts,wedgespads,toetipsandcaps. Walkingsticks,wheelchairs,bathaids,etc. Toiletraisers. GENERALEXCLUSIONS Treatment of cosmetic nature e.g. faces lifts, breast reductionsorimplants,Keloidremoval,Lipodostripyetc. Health Check or any expense in respect of medical examinations for employment, insurance, education, immigrationortravelpurposesandvaccinations. Treatment for which cost is recoverable in law from any body,partyoranInsurancePolicy. Treatmentarisingfromanywillfulordeliberateselfinflicted injury or any attempt thereat, negligence, suicide, abuse of alcoholordrugs. Participation in any hazardous sport or any sport for monitorygain. Serviceswhichareavailablefreeoratanominalchargee.g. familyplanningservices,underfiveclinicservices,Vaccines. Treatment or services for which Limit of Benefit in a specifiedperiodhasbeenexhaustedbythebeneficiary. Treatmentorserviceswhichhavebeenspecificallyexcluded asabenefitunderthescheme. Local treatment rendered by a service provider who is not registeredwiththeSociety. Purchaseofspectacles,frames,lensesforEconoplanScheme members. Privatenursingservices. Treatmentofinfertility. OrgantransplantsandImplantsofanynature AirTickets Treatment of services given by hypnotic, herbalists, traditional healers, homeopaths, naturopaths, osteopaths, acupuncturistsetc. Treatmentbyfamilymemberoranyautotherapy. Treatment related to birth defects and congenital illness includingheredityconditions. Treatmentforpreexistingconditions. Accommodation or treatment received at health/slimming orsimilarclinics. Salestax. MISCELLANEOUSEXPENSES Funeralservices. Birthreports. Telephonecharges. Deathreports. Laborchargesandtechniciansfees. MedicalReports Salestax Tel:01820298/543 Fax:01820217 Cell:0888707100 Email:management@masmw.com

K.

Privatehospital/ClinicIn Patient. Privatehospital/ClinicOutPatient. NormalHours Afterhours(excluding additionalcharges). VisitingForeignSpecialist12 monthswaitperiod. 1stK200,000.00 AboveK200,000.00 GovernmentHospitals& MissionHospitals RealignedMissionHospitals. GovernmentHospitals& MissionHospitals RealignedMissionHospitals. PrivateHospitals. GovernmentHospitals& MissionHospitals RealignedMissionHospitals. PrivateHospitalsNormal Hours. PrivateHospitalsAfter Hours. ForeignlabtestsLabTests doneabroad. CT&Obstetricscan

70%subjecttotariff. 70%subjecttotariff.
50%subjecttotariff,referral, 12monthswaitperiod&letter ofguaranteefromMASM.
50%subjecttotariff,referral,12 monthswaitperiod&letterof guaranteefromMASM

7 8 1 2 3 1 2 3 4 5 6

100%subjecttotariff. 90%subjecttotariff. 100%subjecttotariff& Referral. 90%subjecttotariff&Referral. 70%subjecttotariff&Referral. 100%subjecttotariff. 90%subjecttotariff. 70%subjecttotariff. 70%subjecttotariff. 25%subjecttotariff&12 monthswaitperiod. 70%Subjecttotariff,prior approvalbyMASM, 12monthswaitperiod 40%subjecttotariff12 monthswaitperiod& approvalbyMASM.
100%subjecttotariff,annual limit&12monthswaitperiod. Accordingtostipulatedco payments,subjecttotariff& sublimit12monthswait period 50%subjecttotariffandsub limit12monthswaitperiod

Physiotherapy

L.

Lab&Xrays(Afterhourchargestobecoveredatnormalhourscoverage)

M.

MRIScanApprovalby MASM&12monthswait period HearingAids(Onceevery5years). 1 2

GovernmentHospitals& MissionHospitals PrivateHospitals

N.

VisitingForeignSpecialist 12mothswaitperiod. ElectiveTreatment(ifoutsidecountry ofresidence.Includeshospital admissions,intensivecare,outpatient care,laboratorytests,xrays, specialisttreatmentanddrugs.

Nil 40%subjecttotariff,12monthswait period&approvalbyMASM

O.

Dialysis

Youdonotneedtotellusyournamewhenyouwritetous.Makeupyour ownfivedigitnumber,whichyoumustputattheendofthereport,e.g. numberslike51230or64387.Pleaserememberthisnumber.Ifyouphone, rememberthereferencenumberouroperatorprovidesyouwith. Youridentitywillalwaysbeprotected. TollFreeLines:80000847MTL847AIRTEL&TNM Fax:01821229/Email:reportsqm@tipoffs.com/FreePost:P.O.Box1726,Blantyre

MakeaReportsafelyandanonymouslytoan independentandprofessionalcompany concerningissuesoftheft,fraud,scamsand corruptionoccurringwithinMASM. RewardsAnonymous:AfterTipOffsAnonymousreceivesrewardmoney fromMASMitwillmakeapaymenttothepersonwhomadethetipoff

TipOffs Anonymous

Deloitte.

EXECUTIVEScheme

BenefitsSummary

www.masmw.com

2013

EXECUTIVESCHEME
AnnualCover
MonthlyContribution Executive Executive(O)

D.

Drugs(GenericDrugsOnlyorequivalentlistedprices) 1 EssentialDrugs. 100%subjecttotariff& annualcoveratnominated Doctor/InhouseClinic. 70%subjecttotariff& annualcover. 25%subjecttotariff,annual cover,priorapprovalby MASM&12monthswait period. 100%subjecttoannual coverandtariff.

E.

ForeignTreatmentSADCRegion&IndiaOnly 1 2 3 Specialistforeignmedical treatment. Travelemergencymedical treatment. Studentforeignmedical treatment. GovernmentHospitals. MissionHospitals ReAlignedMissionHospitals PrivateHospitals/Clinics. Visitingforeignspecialist.1 K200,000.00
AboveK200,000.00
st

H.

Ophthalmology(Consultation&Procedure) 90%subjecttotariff,annual limit&12monthswait period. 4 PrivateHospitals/Clinics. 70%subjecttotariff, annuallimit&12months waitperiod. 5 Spectacles,Frames&Lens. 100%subjecttotariff,prior approvalbyMASMand12 monthswaitperiod.Coveris availableonceevery2years Limitedto150registered memberspermonth. HospitalizationIntensivecare/patientcare,roomandboard, prescribedandspecialistdrugs.(Nowaitperiodsapplyon Emergencytreatment) 1 GovernmentHospitals. 100%subjecttocoverlimit &3monthswaitperiod. 2 MissionHospitals. 100%subjecttotariff, coverlimitand3months waitperiod. 3 ReAlignedMissionHospitals 90%subjecttotariff,annual limit&3monthswaitperiod. 4 PrivatereferralHospitals. 70%subjecttotariff,cover limitand3monthswait period. 5 PrivategeneralHospitals. 70%subjecttotariff,cover limitand3monthswait period. 6 ClinicsrunbyParamedics. K500perdaysubjectto24 hourobservationtime. 7 IntensiveCareUnit.(Limitedto3days) i. PrivateHospitalsGeneral ward PrivatewardonDr'srequest andapprovalbyMASM PrivateWardonMembers requestandapprovalby MASM GovernmentHospitals& missionHospitals ReAlignedMissionHospitals. 70%subjecttotariff,cover limitand3monthswait period. 70%subjecttotariff,cover limitand3monthswait period. 30%subjecttotariff,cover limitand3monthswait period. 100%subjecttotariff, coverlimitand3months waitperiod. 90%subjecttotariff,cover limitand3monthswait period. 3 ReAlignedMissionHospitals

K4,000,000.00
K4,200.00 K7,000.00
Government,Missionand Privatehospitals,andClinics RegisteredwiththeSociety. Malawi

Nil Nil Nil

2 3

LocalPrescriptions. ForeignPrescriptions.

TypeofServiceProviders TerritorialLimit A.

Major&MinorSurgicalProcedures,Theatrefee,Anestheticcharges& Surgicalsundries.(NowaitperiodsapplyonEmergencytreatment)

EmergencyEvacuation(Betweenhospitalswithintheterritorial Limit) 1 Municipal,GovernmentService 100%subjecttotariff. &MissionHospitals 2 ReAlignedMissionHospitals. 90%subjecttotariff. 3 4 PrivateAmbulanceService. MASMEMSAmbulanceswithin 30Kmradius. MASMEMSAmbulances Outsidethe30kilometre radius. EmergencyEvacuationbyroad orairtothenearestsuitable facility,prehospitalcareand treatmentforlifeorlimb threateningevents. ThirdPartyAccompaniment. 70%subjecttotariff. 100%subjecttotariff.All callsattractaMK12,000call charge 70%subjecttotariff.

6 7 8 i ii

SuppliedtoInPatientsand OutPatients(atGovernment HospitalsOnly). SuppliedtoInPatientsand 80%subjecttoannualcover OutPatients(atRealigned andtariff. MissionHospitalsOnly). SuppliedtoInPatients 70%subjecttoannualcover Privatehospitals. andtariff. SuppliedtoOutPatients 70%subjecttoannualcover Privatehospitals. andtariff. Chronicmedicines(MASMserve). Branded Generic. Nil

G.

1 2 3 4 5 6

100%Subjecttotariffand3 monthswaitperiod. 100%Subjecttotariffand3 monthswaitperiod. 90%Subjecttotariffand3 monthswaitperiod. 70%Subjecttotariffand3 monthswaitperiod.

50%Subjecttotariff,referral &approvalbyMASMand12 monthswaitperiod. 50%subjecttotariff,referral, 12monthwaitperiod&letter ofguaranteefromMASM

I.

J.

Nil

B.

7 8

Nil Nil

Repatriationofmortalremains followingmedicalemergency. BloodTransfusion 1 2 GovernmentHospitals& Mission. PrivateHospitals

10

C.

100%subjecttotariff. 100%subjecttotariff.

11

DentistrypainrelievingtreatmentincludingExtractions&Fillings. 1 2 3 4 5 6 GovernmentHospitals. MissionHospitals ReAlignedmissionHospitals SpecifiedPrivateDental hospitals&Clinics. Inlays,Crowns&Bridges. Dentures. 100%Subjecttostipulated limit&tariff. 100%Subjecttostipulated limit&tariff. 80%Subjecttostipulated limit&tariff. 80%Subjecttostipulated limit&tariff. Nil 80%Subjecttotariffand approvalbyMASM,12 monthswaitperiod. 80%Subjecttotariffand approvalbyMASM,12 monthswaitperiod. Nil

12

13 14

Orthodontictreatment Applicabletomembersupto 21yearsofage. Mouthwashes&DentalFloss

SpecificNamedDrugs,i.e., Lamisilcream,Quadriderm cream,Ampotericin,Voltaren, Biltricide,Minocyclineetc). Overthecounterdrugs (OTC's)onlypainkillers,cough syrups,andallrangesofanti acids). Nonpayabledrugse.g. Contraceptives,Antimalarial vaccines,infertilitydrugs, foodssuppliments,slimming tablets,vitamins,herbal productsandotherrangesof OTCs. ARV'sFirstlinetreatment fromapprovedservice providers. Drugssuppliedbyvisiting specialist. Vaccinesnotcoveredby Governmentincluding (HepatitisA,HepatitisA, HepatitisA&B,Measles, Mumps,Rubiella,Rotavirus,& Varicella.

50%subjecttotariff,annual cover,priorapprovalby MASM&12monthswait period. 50%subjecttariff(Generic drugsonly).12monthswait periodandpreauthorisation byMASM 50%subjecttotariff.

Nil 100%subjecttoapproved price&provider. 25%subjecttotariff&12 monthswaitperiod. 50%subjecttotariff.

MedicinessuppliedbyVisiting 50%Subjecttotariffand12 foreignspecialist. monthswaitperiod. 7 GeneralPractitioner 100%Subjecttotariffand3 (NominatedGP). monthswaitperiod. 8 HomeNursing(Postoperative Nil rehabilitation). MaternityAntenatal,Delivery,&Postnatal,limitedtoevery2 years.(Foreignmaternityservicesisnotcovered) 1 GovernmentHospitals. 100%subjecttotariff, annuallimit&12months waitperiod. 2 MissionHospitals. 100%subjecttotariff, annuallimit&12months waitperiod. 3 ReAlignedMissionHospitals. 90%subjecttotariff,annual limit&12monthswait period. 4 PrivateHospitals. 70%subjecttotariff,annual limit&12monthswait period. ii. Antenatal(3visits). 70%subjecttotariff& annuallimit. iii. Postnatal(2visits). 70%subjecttotariff& annuallimit. 5 Localspecialist(Antenatal& 100%subjecttotariff, Postnatal) annuallimit&12months waitperiod. Ophthalmology(Consultation&Procedure) 1 Government&Mission Hospitals. MissionHospitals. 100%subjecttotariff, annuallimit&12months waitperiod.
100%subjecttotariff,annual limit&12monthswaitperiod.

i.

Delivery.

ii.

iii.

H.

TreatmentforOutpatient RecoveryincludingSpecialist Nil consults,laboratory,xrays, anddrugs. Consultation(Limitedtooneconsultationperdaypercondition) 1 2 GeneralPractitioner (Nominated/Specified). Paramedics(Emergencies only). 100%subjecttotariff. 100%subjecttotariff.

Formoreinformationonthisandotherschemes,consultyourcopyofthe
MASMMembershipBookletorgetanelectronic/softcopyfromourwebsite

www.masmw.com