Source: EMF targets expanding medical aid coverage -Newsday Zimbabwe
EMF Medical Aid Society has launched a strategy to expand medical aid coverage to Zimbabwe’s informal sector, low-income earners and underserved rural communities in a bold push to drive insurance uptake in a market where penetration remains below 10%.
This comes amid growing concerns over low prioritisation of health insurance, with many Zimbabweans opting for funeral cover over medical aid due to affordability constraints, lack of clarity around benefit structure as well as limited access to healthcare providers in remote areas.
Zimbabwe’s health insurance industry has also come under pressure to adopt digital innovations and strengthen fraud control mechanisms in order to restore public confidence.
“We have noticed that most players are chasing the white- and blue-collar markets of those formally employed. But the lower end of the market remains largely neglected,” EMF chief executive Mthulisi Ncube told NewsDay in an interview.
“As a business, we have deliberately shifted our focus to the bottom of the pyramid. We are actively developing affordable, targeted products for sectors such as small-scale miners and SMEs, groups that are typically excluded from traditional medical aid structures.”
Ncube said the fund was working closely with sectoral bodies, including the Zimbabwe Miners Federation and small business associations to co-create health solutions tailored to their needs.
“We want to expand the cake. Right now, only about 10% of Zimbabwe’s population is on medical aid,” he said.
“For us to remain viable and impactful, we must bring in those who’ve been left out, especially people in rural areas who’ve never had access to formal healthcare financing.”
To support its inclusive growth strategy, EMF is building a national network of service providers beyond Zimbabwe’s major cities, aiming to increase proximity and access for rural and peri-urban members.
“We’re aligning service delivery with the communities we serve. That means securing providers not just in high-end clinics, but also in remote areas where our members live,” Ncube added.
EMF has also embraced technologies such as artificial intelligence, machine learning and data analytics to strengthen fraud detection, streamline claim processing and support predictive healthcare planning.
“We’ve developed our own in-house operating system with built-in fraud detection tools. We’re also upskilling our teams and have begun recruiting data analysts specialising in big data and machine learning to help us to manage risks more proactively,” he said.
Ncube noted that one of the major pain points in the sector is the unexpected out-of-pocket payments members face due to unclear or limited benefit structures.
EMF, he said, was addressing this by prioritising transparency, preventive care and outcome-based partnerships with healthcare providers.
“Our model goes beyond just providing medical aid, it’s about financing healthcare. When designing products, we strive to strike a balance between affordability and comprehensive coverage,” Ncube said.
“We partner providers who focus on strong health outcomes, which helps to reduce repeat visits, eliminate inefficiencies and curb fraud.”
The fund’s product roadmap includes continued support for chronic illness care, mental health services under its wellness arm and public education campaigns on non-communicable diseases.
“Our vision is to walk with our members throughout their health journey from prevention and wellness to treatment.
“Where there are shortfalls, we ensure they’re minimal so that members can still access quality care without being financially overwhelmed.”
Established in 2014, EMF Medical Aid Society is a locally-registered, member-owned health fund regulated by the Health and Child Care ministry and the Insurance and Pensions Commission.
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