Terms & Conditions
TERMS AND CONDITIONS
1. Cosmopolitan Health Insurance and Vodafone Ghana reserves the right to increase or decrease the policy cover levels with notification to the Policyholder and the right to adjust Premium(s) at a 1 (one) days’ notice.
2. Cosmopolitan Health Insurance reserves the right to restrict/decline cover allocation to a Policyholder at any time.
3. Cosmopolitan Health Insurance shall verify the eligibility of all claims and may request documentary proof of hospitalization and other information from the hospital or clinics.
4. Cosmopolitan Health Insurance reserves the right to direct client to a specific hospital when clients give prior notice or if there is a need to change facilities base on the treatment and cost to the client and the scheme.
5. For a particular Policyholder, Cosmopolitan Health Insurance will not pay more than three nights within a month of client hospitalization.
6. A claim will only be paid out on Vodafone Cash Account per claimable plan through clients mobile cash number.
7. In the event that the time of admission to hospitalization is more than three days from the day of the admission, Cosmopolitan Health Insurance reserves the right to scrutinize and reject the claim if it believes client has connived with the hospital or a doctor to defraud the scheme.
8. Beneficiaries must be residents in Ghana and no claim shall be payable if the Beneficiary changes country of residence.
9. Beneficiaries must be Vodafone Subscribers with active and valid Vodafone Cash Accounts.
10. Policy benefits are not transferable.
11. Claims will NOT be paid under the following circumstances:
a. Any expenses incurred in connection with injury or illness caused or contributed to by war, invasion, riots, civil commotion or whilst engaging or taking part in military, naval or air force services or operation.
b. Reconstructive procedures, cosmetic surgeries and procedures for aesthetic purposes e.g. after burns, ligament/tendon repair or reconstruction.
c. Medical devices for secondary management (e.g. Hearing aids, Crutches, braces, elastic stockings, Zimmer frames, wheel chairs etc.), Self-use medical devices (e.g. monitors, glucometers, glucometer strips etc.) and orthodontics
d. Treatment overseas or treatment available as free public health services e.g. Immunization, TB, Buruli Ulcer, Mental health/psychiatric conditions, Trachoma etc.
12. If a claim is in any respect fraudulent, intentionally exaggerated or misrepresented in any manner, all benefits under the policy shall be forfeited and Cosmopolitan Health Insurance may terminate the policy without the obligation to refund any of the premiums already paid under the policy.
13. The Policyholder can cancel the policy at any time. Should a Policyholder wish not to discontinue with the policy
14. The policy cover cannot be sold or exchanged for cash.
15. A 30 (thirty) days waiting period applies to the following benefits:
16. Cosmopolitan Health Insurance and Vodafone will, in relevant cases, disclose your personal information to each other, our service providers and business partners and by accepting the Cosmopolitan Health Insurance and Conditions, you agree and consent that we may process, record and/or disclose your personal information, including details of your transactions on your Vodafone account with Cosmo.
17. Enquiries on product, service, plan and claims can be referred to: www.cosmopolitanmhi.com, the help option on the Vodafone USSD menu or the following Cosmopolitan health Insurance Call Centre which will be available to answer general questions: number
18. Policyholders may also refer to the section on Frequently Asked Question (FAQs) on the Cosmopolitan health Insurance website: www.cosmopolitanmhi.com
19. All Policyholders and Additional Insureds must be natural persons.
20. Policyholders shall have to contribute a whole more than six months before one can enjoy breast cancer and prostate cancer benefit.
21. Cosmopolitan Health Insurance only cover breast cancer and prostate cancer and not all other Cancer and cancer related treatments
22. Any treatment outside the shores of Ghana will not be covered by the scheme.
23. Cosmopolitan Health Insurance will pay benefit for 40 nights to any client who has contributed 12 months’ period.
24. Cosmopolitan Health Insurance reserve the right to decline any claim submitted if the policyholder refuse to declare the preexisting condition
25. Cosmopolitan Health Insurance will not cover Intentional self-injury or illness resulting from alcoholism and drunkenness, drug addiction or the use of drugs not medically prescribed.
26. Cosmopolitan Health Insurance will not cover transplant and dialysis and kidney replacement.
27. Cosmopolitan Health Insurance will not cover pregnancy and delivery treatment.
28. Cosmopolitan Health Insurance will not cover Home nursing/care, Spas and Rehabilitation treatments and physiotherapy.
29. Cosmopolitan Health Insurance will not cover Management of obesity and immune stimulant
30. Cosmopolitan Health Insurance will not cover Alternative medical treatments e.g. Chiropractic, homeopathy, Traditional medicine etc.
31. Cosmopolitan Health Insurance will not cover Myomectomies, Caesarean sections and termination of pregnancies..
32. Cosmopolitan Health Insurance will not cover Mortuary services and blood products.
33. Cosmopolitan Health Insurance will not cover MRI, CT scans, X-rays and Endoscopy.
34. Cosmopolitan Health Insurance will not cover for Investigations and examinations except the client has been on the scheme for a year and has continuously no claim.
35. Cosmopolitan Health Insurance and Vodafone Ghana reserves the right to decline payment of any claim if the facility is not license by HIFRA.
36. Cosmopolitan Health Insurance and Vodafone Ghana reserves the right to decline payment if the facility the policy holder access HIFRA license has expired.
37. Cosmopolitan Health Insurance and Vodafone Ghana reserves the right to decline payment if policy holder refuse to provide enough information of his or her treatment.
38. Policyholder is required by the scheme to send in treatment information to Cosmopolitan Health Insurance within 30 days of leaving the hospital.
39. Cosmopolitan Health Insurance and Vodafone Ghana reserves the right to decline payment if the policyholder sends treatment information after three months of hospitalization.
40. Premium: Amount payable by the Policyholder in order to purchase insurance cover on remittances to be insured under Cosmo Vodafone Mobile health through Vodafone Cash.
Cosmo 3rd Party Admin
Third party administration of medical services for corporate bodies and associations with large membership. Management of Top up medical service for NHIS member.