Membership to Acacia Health Insurance Scheme is open to corporate bodies, organisations or any group of people. Dependants of the individual applying for membership.

You can join the Acacia Health Insurance Scheme through your employer. Firms/Organisations seeking membership on behalf of their employees are required to complete the Acacia Health Insurance Membership Registration Form.

Individuals seeking membership through their employers or on their own should complete Acacia Health Insurance Membership Registration Form on behalf of themselves and their dependants. Applications are approved upon a thorough review by Acacia Health Insurance.

When filling the Acacia Health Insurance Membership Registration Form, applicants are requested to:

• Declare their medical history and that of their dependants.
• Sign the medical history declaration form.
• Supply authentic information.
• Provide all relevant information.

Members of Acacia Health Insurance Scheme are expected to fill and sign a Schedule or Claim Form for only consultation/treatment they have received from their chosen healthcare service providers (HSPs).

• Each member is required to attend to any of the service providers (hospital, clinic, or pharmacy) from Acacia Health Insurance’s list of accredited service providers (Not all plans can access certain providers eg Nyaho, Akai house, Finney etc). The plan you choose, determines the hospitals you can access.
• You may consult your doctor at pre-arranged times or during working hours.
• You will be required to sign a Claims Form each time you visit a Service Provider to certify the amount charged and the service received.
• You do not have to submit the claims form to Acacia Health Insurance because your Service Provider will do that for you.
• You can also visit an Acacia Health Insurance Accredited Specialists direct without going through a General Practitioner.
• Any drug included on the essential drug list that is prescribed by your chosen doctor or referred specialist obtained from Acacia Health Insurance accredited pharmacies will be paid for.

• Acacia Health Insurance defines an emergency as a sudden or unexpected onset of a condition requiring medical or surgical care which the member secures after the onset of such condition (or as soon thereafter as care can be made available but which in any case is not later than 24 hours after onset) and in the absence of such care the member could reasonably be expected to suffer serious physical impairment or death. Examples include but are not limited to heart attacks, severe chest pain, cardiovascular accidents, haemorrhaging, poisoning, major burns, loss of consciousness, serious breathing difficulties, spinal injuries, shock and other acute conditions as Acacia Health Insurance shall determine are emergencies.
• Any service provider can attend to you.
• You are required to pay if consultation/treatment is NOT given by your chosen service provider. Insist on a receipt and a report of the treatment from the service provider.
• Submit the receipt and report to Acacia Health Insurance for reimbursement.
• Acacia Health Insurance will adjudicate the situation thoroughly before reimbursing you.

• You are allowed to move up packages if you feel that your present package do not cover you adequately. However, you will have to wait for a period of six (6) months before benefiting from a higher package when transferred from a lower package.
• Acacia Health Insurance will accept downward movement of packages only under special circumstances.
• A new Acacia Health Insurance Membership Card will be issued to you to reflect your new status.

• Premiums shall be payable in advance by members (firms) to Acacia Health Insurance on a payment plan as agreed between the parties.
• Premiums for any particular month, must reach Acacia Health Insurance before 25th of previous month. If full premium has not been received by the due date, membership shall cease and no benefits shall be available for periods for which no premium has been received.
• Acacia Health Insurance shall determine from time to time, the rate of premium payable, and provide reasonable notice of amendments to members.

• Each eligible member will be issued with an Acacia Health Insurance card that serves as a proof of membership.
• The Acacia Health Insurance Card acts as an identification when you visit your chosen healthcare service provider and this card must be displayed at the request of your service provider.
• The Acacia Health Insurance Card bears the following features and information:
  • Name of the Member.
  • Photograph
  • Acacia Health Insurance Membership Number.
  • Type of Benefit Package or Plan.
  • DOB
  • Expiry Date
  • Employer
  • Commencement Date
  • Hotline
  • Scannable Barcode
• Use of Acacia Health Insurance Membership Card is subject to premiums having been paid.

• Acacia Health Insurance pays claims on behalf of all members to healthcare service providers for the appropriate medical expenses incurred.
• Acacia Health Insurance submits quarterly utilisation reports to all member companies providing details of all services which have been rendered on behalf of members during the period under review.

• When a service provider charge on a claim exceeds Acacia Health Insurance’s award for the member.
• Where the maximum benefit limit has been exceeded.
• Where a member has received treatment not covered under the scheme.
• Where a member is required to pay a proportion of the cost. Where this shortfall occurs on a claim for treatment, the member shall settle it with Acacia Health Insurance.

To check or minimise the frequency and prevalence of abuse and misuse of membership facilities and benefits, Acacia Health Insurance has put in place the following measures:

• Members are encouraged to restrict medical expenses wherever possible to reasonable limits, so as to build up good reserves for high cost of medical needs.
• The supply of fraudulent information during submission of claims will lead to termination of membership.
• When a claim is inadmissible in terms of the stated rules, Acacia Health Insurance shall return the claim to the member, together with an explanation as to why the claim was inadmissible.
• Acacia Health Insurance will use the claims information of its members to improve the overall provision of health care by means of appropriate managed care interventions.
• A beneficiary who has or may have a right in law to recover from some other person or party any medical expenses claimed from or paid by Acacia Health Insurance on his behalf, shall be bound to recover such expenses and account to Acacia Health Insurance or to cede his rights of recovery to Acacia Health Insurance on demand and give Acacia Health Insurance on demand every assistance in the exercise of those rights.
• Claims for treatment incurred shall be acceptable for adjudication and payment, if the provider giving the treatment or service currently appears on the appropriate register of the Ghana Medical Association or is a practitioner recognised by Acacia Health Insurance.
• Any member may request Acacia Health Insurance to consider a further award on a claim payment or a rejected claim by report. After consideration of such a request, any decision made by Acacia Health Insurance shall be final.
• Acacia Health Insurance shall not disclose the nature of illness or treatment of any member and or his dependants other than to its service providers when necessary.

• Your premium has not been received thirty (30) days after the due date.
• You engage in fraud or abuse of the scheme.

If you have any queries about membership, service providers or client relations, do not hesitate to contact ACACIA HEALTH INSURANCE (AHI) by either telephone or e-mail. For any Challenges / Difficulties with Healthcare Services Providers (HSPs) and/or scheme, please contact our Call Center: 0233 008 821 / 0233 008 810 / 0233 009 926 / 0233 009 913.

For Client Service and Enquiries call 0233 008 860 / 0233 008 826 / 0233 009 927.

For general enquiries, contact 0302 543 734 / 0302 543 738 or via info@acaciahealthinsurance.com