Terms & Conditions

1. Definitions & Interpretation

Key Definitions:

"UTANO" or "We": UTANO Health Care Plan, a healthcare service provider operating in South Africa and Zimbabwe

"Member" or "You": Any individual who has registered for and maintains an active UTANO membership

"Services": All healthcare services, benefits, and support provided through the UTANO platform

"Partner Clinics": Healthcare facilities and providers contracted with UTANO to deliver services to members

"Platform": UTANO's website, mobile application, and related digital services

"Membership Fee": The monthly payment required to maintain active membership status

Interpretation:

References to "days" mean calendar days unless otherwise specified
Headings are for convenience only and do not affect interpretation
Singular terms include plural and vice versa where context permits
References to laws include amendments and replacements

2. Membership Eligibility

Eligible Members:

Foreign Nationals: Individuals from other countries residing in South Africa
Immigrants & Refugees: People seeking healthcare access while establishing residency
Temporary Residents: Visitors, students, and workers on temporary permits
Cross-Border Communities: Individuals frequently traveling between South Africa and neighboring countries
Age Requirement: Must be 18 years or older, or have parental/guardian consent if under 18

Required Documentation:

Valid passport or national identity document
Proof of residence or temporary accommodation in South Africa
Contact information (phone number and email address)
Emergency contact details
Immigration status documentation (where applicable)

Membership Restrictions:

UTANO reserves the right to verify eligibility and may request additional documentation
False information provided during registration may result in immediate membership termination
Members must notify UTANO of any changes to eligibility status within 30 days
Membership is non-transferable and personal to the registered individual

3. Services & Benefits

Primary Healthcare:

General practitioner consultations
Basic diagnostic tests and screenings
Preventive care and health check-ups
Prescription medication access
Emergency medical consultations

Digital Services:

Online appointment booking
Digital member card and ID
WhatsApp support and consultations
Mobile app access
Health records management

Specialist Services:

Referrals to specialist practitioners
Chronic disease management
Mental health support services
Maternal and child health services
Dental and optical care (where available)

Support Services:

24/7 customer support
Health education and resources
Language interpretation services
Care coordination assistance
Insurance and documentation support

Service Availability:

Services are subject to availability and partner clinic capacity
Some services may require additional co-payments or fees
Service levels may vary by geographic location
UTANO reserves the right to modify services with reasonable notice

4. Payment Terms

Membership Fees:

Monthly Fee: R299 per month for individual membership
Family Plans: Additional rates apply for family members (details available on request)
Payment Due: Fees are due monthly in advance on the same date each month
Grace Period: 7-day grace period for late payments before service suspension

Accepted Payment Methods:

PayFast: Secure online payment processing
MUKURU: International money transfer service
Ozow: Instant bank-to-bank transfers
Bank Transfer: Direct deposits to UTANO accounts
Mobile Payments: Where available and supported

Payment Policies:

All fees are non-refundable except as required by law
Failed payments may result in service suspension after the grace period
Members are responsible for all bank charges and transaction fees
Payment confirmations should be retained for record-keeping
Disputed payments must be reported within 30 days

Fee Changes:

UTANO may adjust membership fees with:

60 days written notice to all affected members
Justification for fee increases (inflation, service improvements, etc.)
Option for members to cancel membership before increases take effect
No more than one fee increase per 12-month period

5. Member Responsibilities

General Obligations:

Accurate Information: Provide truthful and complete information during registration and updates
Timely Payments: Ensure membership fees are paid on time to maintain active status
Proper Use: Use UTANO services appropriately and in accordance with these terms
Respectful Conduct: Treat UTANO staff and partner clinic personnel with respect and courtesy
Compliance: Follow all applicable laws and regulations when using UTANO services

Health Information:

Provide accurate medical history and current health status
Inform healthcare providers of all medications and treatments
Report changes in health conditions that may affect treatment
Follow prescribed treatment plans and medical advice
Attend scheduled appointments or provide reasonable notice of cancellation

Platform Usage:

Maintain confidentiality of login credentials and member information
Report any unauthorized use of your account immediately
Use the platform only for legitimate healthcare purposes
Respect intellectual property rights and platform security measures
Provide feedback and report technical issues promptly

Prohibited Activities:

Sharing membership benefits with non-members
Providing false or misleading information to healthcare providers
Attempting to defraud or abuse UTANO services
Harassing or threatening UTANO staff or other members
Using services for illegal activities or purposes

6. Healthcare Provider Network

Partner Clinic Network:

Contracted Providers: UTANO maintains agreements with qualified healthcare facilities and practitioners
Quality Standards: All partner clinics meet UTANO's quality and service standards
Geographic Coverage: Network spans major urban and suburban areas in South Africa
Specialty Services: Access to various medical specialties through referral system
Emergency Care: 24/7 emergency services through partner facilities

Network Changes:

UTANO may add or remove providers from the network as needed
Members will be notified of significant network changes
Alternative providers will be offered when possible
Network updates are published on the UTANO platform

Out-of-Network Services:

Services from non-partner providers may not be covered
Emergency situations may allow for out-of-network coverage
Prior authorization required for out-of-network referrals
Members may be responsible for additional costs

Provider Responsibilities:

Partner clinics are independent contractors, not UTANO employees
Providers maintain their own professional licenses and insurance
Clinical decisions remain the responsibility of treating healthcare providers
UTANO facilitates access but does not direct medical treatment

7. Claims & Reimbursements

Claims Process:

Direct Billing: Most partner clinics bill UTANO directly for covered services
Member Claims: Submit receipts and documentation for reimbursable expenses
Claim Forms: Use official UTANO claim forms available on the platform
Supporting Documents: Include all required receipts, prescriptions, and medical reports
Submission Deadline: Claims must be submitted within 90 days of service date

Reimbursement Timeline:

Complete claims processed within 14 business days
Incomplete claims returned for additional information
Approved reimbursements paid via member's preferred method
Claim status updates available through member portal
Appeals process available for denied claims

Coverage Limitations:

Annual and per-service benefit limits may apply
Pre-authorization required for certain procedures
Generic medications preferred over brand names
Experimental or investigational treatments excluded
Cosmetic procedures not covered unless medically necessary

Claim Denials:

Claims may be denied for:

Services not covered under the membership plan
Incomplete or inaccurate claim documentation
Services received from non-network providers without authorization
Claims submitted after the 90-day deadline
Fraudulent or duplicate claims

8. Termination & Cancellation

Member-Initiated Cancellation:

Notice Period: 30 days written notice required for membership cancellation
Cancellation Methods: Submit requests via member portal, email, or written notice
Effective Date: Cancellation takes effect at the end of the current billing period
Final Payment: All outstanding fees must be paid before cancellation
Service Access: Services remain available until the effective cancellation date

UTANO-Initiated Termination:

UTANO may terminate membership for:

Non-payment of membership fees after grace period
Violation of terms and conditions
Fraudulent use of services or false information
Abusive behavior toward staff or other members
Loss of eligibility for membership

Suspension of Services:

Services may be temporarily suspended for non-payment
Suspended members can reactivate by paying outstanding fees
Suspension period limited to 90 days before automatic termination
Emergency services may still be available during suspension

Post-Termination:

All UTANO services cease immediately upon termination
Outstanding claims may still be processed if submitted before termination
Member data retained according to privacy policy requirements
Re-enrollment possible subject to eligibility verification
No refunds for unused portions of membership fees

9. Limitations & Exclusions

Service Limitations:

Geographic Limits: Services primarily available within South Africa's major metropolitan areas
Provider Availability: Services subject to partner clinic capacity and availability
Benefit Caps: Annual and lifetime maximums may apply to certain services
Waiting Periods: Some services may have waiting periods for new members
Pre-existing Conditions: Coverage limitations may apply to pre-existing medical conditions

Excluded Services:

Cosmetic and elective procedures not medically necessary
Experimental or investigational treatments
Services related to illegal activities or self-inflicted injuries
Alternative medicine not recognized by conventional medical practice
Fertility treatments and assisted reproductive technologies
Long-term care and custodial care services

Liability Limitations:

UTANO's liability limited to the value of membership fees paid
No liability for indirect, consequential, or punitive damages
Healthcare providers remain independently responsible for medical care
UTANO not liable for provider negligence or malpractice
Force majeure events may suspend service obligations

Disclaimer of Warranties:

Services provided "as is" without warranties of any kind
No guarantee of specific health outcomes or treatment success
Platform availability subject to technical limitations and maintenance
Information provided for general guidance only, not medical advice

10. Dispute Resolution

Internal Resolution Process:

First Contact: Contact UTANO customer service for initial dispute resolution
Formal Complaint: Submit written complaints through official channels
Investigation: UTANO will investigate and respond within 30 days
Escalation: Unresolved disputes escalated to senior management
Documentation: Maintain records of all dispute communications

Mediation:

Voluntary mediation available for unresolved disputes
Neutral third-party mediators from recognized institutions
Mediation costs shared equally between parties
Mediation agreements binding on both parties

Arbitration:

Binding arbitration for disputes exceeding R50,000
Arbitration conducted under South African arbitration rules
Single arbitrator appointed by mutual agreement
Arbitration awards final and enforceable

Legal Proceedings:

South African courts have exclusive jurisdiction
Legal action must be initiated within 2 years of dispute arising
Class action lawsuits prohibited under these terms
Legal costs may be awarded to the prevailing party

11. Privacy & Data Protection

Privacy Commitment:

POPIA Compliance: Full compliance with South Africa's Protection of Personal Information Act
Data Security: Industry-standard security measures protect member information
Limited Sharing: Personal information shared only as necessary for healthcare delivery
Member Rights: Members have rights to access, correct, and delete personal information
Privacy Policy: Detailed privacy practices outlined in separate Privacy Policy document

Health Information:

Medical records maintained in secure, encrypted systems
Access limited to authorized healthcare providers and UTANO staff
Health information shared with partner clinics for treatment purposes
Members can request copies of their medical records

Consent:

Membership constitutes consent for necessary data processing
Additional consent required for marketing communications
Members can withdraw consent for non-essential processing
Consent withdrawal may affect service availability

Data Breaches:

Immediate investigation and containment of any security incidents
Notification to affected members and authorities as required by law
Remedial measures implemented to prevent future breaches
Regular security audits and updates to protection measures

12. General Provisions

Governing Law:

Jurisdiction: These terms governed by South African law
Courts: South African courts have exclusive jurisdiction over disputes
Regulatory Compliance: UTANO operates in compliance with all applicable healthcare regulations
International Members: Terms apply regardless of member's country of origin

Modifications:

UTANO may modify these terms with 60 days notice to members
Significant changes communicated via email, SMS, and platform notifications
Continued membership after changes constitutes acceptance
Members may cancel membership if they disagree with modifications

Severability:

Invalid provisions do not affect the validity of remaining terms
Unenforceable clauses replaced with similar enforceable provisions
Terms interpreted to give maximum legal effect

Assignment:

UTANO may assign rights and obligations to affiliated entities
Members cannot transfer membership without UTANO consent
Assignment does not affect member rights and benefits

Entire Agreement:

These terms constitute the complete agreement between parties
Supersedes all previous agreements and understandings
Modifications must be in writing and signed by UTANO
Privacy Policy incorporated by reference

Document Information

Document Version: 1.0

Effective Date: January 2025

Last Updated: January 2025

Next Review: January 2026

Jurisdiction: South Africa & Zimbabwe

Language: English

Document Type: Terms & Conditions

Compliance: South African Healthcare Laws

By joining UTANO Health Care Plan, you acknowledge that you have read, understood, and agree to be bound by these Terms & Conditions. These terms are effective immediately upon membership registration and remain in effect throughout your membership period.

UTANO Health Care Plan