Procurement of Group Medical Insurance Services

Mandatory Scheme Requirements

• Provide inpatient and outpatient cover as a single package under one underwriter.
• Cover the principal member, spouse and up to four child dependants.
• Apply an age limit of 18–65 years for the principal member and spouse.
• Cover children from birth to 25 years.
• Continue covering children with disabilities for as long as they remain dependent on the principal member.
• Cover chronic, congenital and pre-existing conditions.
• Cover HIV/AIDS.
• Include ambulance and air evacuation.
• Include maternity, dental and optical cover.
• Include mental health and psychiatric treatment.
• Include pandemics.
• Provide biometric identification systems at no additional premium.
• Allow direct access to service providers rather than requiring use of insurer-owned clinics.
• Provide a 60-day cancellation notice.