TERMS AND CONDITIONS

1.0 Commencement of services

Services shall commence after the employer has; signed Employer Registration Contract, paid
monthly contribution and upon issuance of membership identity cards to beneficiaries.

2.0 Registrable members

a. Eligible members under this arrangement include an employee, his/her spouse, children
below 21 years of age (biological, adopted or step children), biological/step parent of the
employee and/or parents of the spouse;

b. An employer is required to submit data of their employees in format prescribed by the

Fund;

c. An employer is required to ensure all the employees enrolled to the Fund have all
necessary qualities of employee including payment of their salary through bank and
complies with all statutory deductions;

d. An employer is required to notify the Fund within five working days for any change in
employment status of the employee like termination, new employment or retirement;

3.0 Contribution remittance

a. An employer shall remit a monthly contribution to the Fund of an equivalence of three (3)
per centum of his employees salary together with another three (3) per centum
contribution from the employer to the Fund;

b. Contribution shall be remitted within 30 days after the last day of the contribution month
failure of which shall attract a penalty equals to 5% simple interest per annum for each
delay month

c. An employer shall notify the Fund of changes on number of employees and employees’
basic salary;

d. Changes on number of employees and employees’ basic salary communicated after the
15th day of every month shall be considered in employer’s invoice of the following month.

4.0 The Benefit Package

The Fund shall provide the following benefit package to its beneficiaries through Accredited
Health Facilities as follows:

a. Registration and consultation;

b. Medicines and medical supplies;
c. Investigations and Diagnostic test;
d. Surgical Services – Includes Minor, Major and Specialized surgical services;
e. Inpatient Care Services including ICU and HDU;
f. Physiotherapy and rehabilitation services;

1
 g. Eye and Optical Services;
h. Spectacles;
i. Dental and Oral health Services;

j. Medical/Orthopedic Appliances;

The Fund shall not provide the following benefit package to its beneficiaries:

a. Illness or injuries arising from attempted suicide for self-destruction while the person
is not insane or of unsound mind;

b. Purchase of wheel chairs or prosthetic appliances;

c. Illegal abortions;
d. Illness arising from abuse of drugs and alcoholism;
e. Cosmetic or traditional circumcision;
f. Cosmetic surgery;

g. Transportation of corpse(s);
h. Burial expenses;
i. Mortuary services.

5.0 Fraudulent Acts

An employer:

a. Shall not engage in any fraudulent practices;

b. Submits false employee and dependents details regarding his employees to the Fund;
c. Register ghost employees ;
d. Does any other act or omission which is against the provision of this agreement. 3.2.4
In event where the employer has proven to engage in fraudulent practices, the Fund shall:

e. Reimburse itself the defrauded amount and all the costs incurred in provision of health
care services;

f. Cancel the employer from the benefits of the scheme ; and

g. Take any other action as the Fund shall consider appropriate.

6.0 Confidentiality

a. Each party shall treat all the information obtained in the course of execution as
confidential;

b. An employer shall use or disclose any confidential Information of the other party,
including information of beneficiaries under this Agreement without the written consent of
the other Party

2
 c. A party receiving confidential Information from the other party shall use the highest
reasonable degree of care to protect that confidential Information.

d. The duty to protect confidential information through non- disclosure of such information
shall continue indefinitely.

7.0 Right to Inspection

Fund shall have right to enter into the employers premises and inspect inspection the premises at
any reasonable time and manner, with or without notice.

8.0 Cessation of services

The Fund shall terminate services to employees and employer upon occurance of the following
acts:

a. Submission of false information with regard to a member by the Employer;

b. Inclusion of any person who is not an employee of the Employer among the list of
employees of the Employer;

c. Failure to remit contributions for three months consecutively;

d. Submission of false information concerning the Employer;
e. breach of any terms or conditions stated in the Employer registration form as provided
under the National Health Insurance Fund Regulations

9.0 Laws Applicable

This Agreement shall be construed, governed and take effect in accordance with the laws of
Tanzania