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Standard Scheme: Balanced Healthcare Coverage for Skilled Personnel
The Standard Scheme is designed for skilled professionals, offering a balanced healthcare plan that bridges the gap between premium and basic schemes. With extensive coverage for routine and critical care needs, it provides excellent value for skilled individuals and their families.
Key Features and Benefits:
Hospitalization Benefits:
- Coverage for up to 10 days per illness in private hospitals (three-bedded ward) for surgeries.
- After 10 days, MASCA covers 50% of additional hospital costs upon a specialist’s appeal for extended admission due to serious conditions, up to the annual benefit limit.
- Full coverage for hospital stays in public hospitals and municipal clinics, subject to annual awards.
Diagnostic and Specialist Services:
- Payments to service providers are based on USD tariffs, with potential shortfalls on specialist and anesthetist claims.
- One MRI scan per year and routine diagnostic procedures (pathology, X-rays, ultrasound scans, and allergy tests) are covered on pre-authorization with a specialist’s appeal.
Prescription Drug Coverage:
- MASCA covers 90% of acute and chronic medication costs, with members contributing 10%, up to two separate annual benefit limits.
- 75% coverage for cancer treatments and high-cost essential medications with pre-authorization, within the annual benefit cap.
Emergency and International Coverage:
- Emergency road or air evacuations to the nearest referral center (Harare) are covered up to specific limits.
- Access to healthcare during worldwide holiday travel is supported through MASCA’s contracted travel agents. Costs for minor injuries and ailments are reimbursed on submission of receipted accounts.
Grant-In-Aid Benefits:
- Coverage includes dental, optical, nebulizers, colostomy bags, and other appliances, up to specified limits.
The Standard Scheme ensures skilled personnel receive reliable and balanced healthcare coverage, addressing both routine and specialized medical needs with affordability and flexibility.