Terms of Service

1. Acceptance of Terms

Welcome to TeleMedhin Insurance Share Company. By accessing or using our website, mobile application, or services, you agree to be bound by these Terms of Service (“Terms”). If you do not agree to these Terms, please do not use our services.

These Terms constitute a legally binding agreement between you and TeleMedhin Insurance Share Company (“TeleMedhin,” “we,” “us,” or “our”), a company registered under Ethiopian law.

2. Definitions

• “Member” or “You” refers to any individual or entity that has enrolled in a TeleMedhin insurance plan.
• “Policy” refers to the insurance contract between TeleMedhin and the Member.
• “Premium” refers to the payment required to maintain active insurance coverage.
• “Network Provider” refers to healthcare facilities and professionals that have agreements with TeleMedhin.
• “Dependent” refers to family members covered under a Member's policy.
• “Claim” refers to a request for payment of benefits under a Policy.

3. Eligibility

To enroll in TeleMedhin insurance, you must:

• Be at least 18 years of age
• Be a resident of Ethiopia or hold valid Ethiopian residency documentation
• Provide accurate and complete information during enrollment
• Have a valid Ethiopian National ID or Passport
• Have the legal capacity to enter into binding contracts

4. Enrollment and Coverage

4.1 Application Process

All applications are subject to review and acceptance by TeleMedhin. We reserve the right to reject any application at our sole discretion. Approval is not guaranteed until you receive written confirmation and payment has been processed.

4.2 Coverage Effective Date

Coverage begins immediately after payment verification for most benefits. Pre-existing conditions have a 12-month waiting period before coverage becomes effective.

4.3 Accurate Information

You agree to provide accurate, complete, and current information during enrollment. Providing false or misleading information may result in policy cancellation and denial of claims.

5. Premium Payments

5.1 Payment Obligation

You agree to pay all premiums when due according to your chosen payment schedule (monthly, quarterly, semi-annual, or annual). Premiums are non-refundable except as specifically stated in these Terms or required by law.

5.2 Grace Period

A 15-day grace period is provided for premium payments. Coverage continues during the grace period. If payment is not received within 15 days of the due date, your policy will be suspended.

5.3 Payment Methods

We accept payments via mobile money (telebirr, CBE Birr, Awash Birr, Amole), bank transfer, direct debit, and cash at our offices. All payment processing is subject to verification.

5.4 Premium Changes

TeleMedhin reserves the right to adjust premium rates annually. You will be notified at least 30 days before any rate change takes effect.

6. Claims Process

6.1 Filing Claims

Claims must be filed within 30 days of receiving medical services. Required documentation includes original receipts, medical reports, and any other documents specified by TeleMedhin.

6.2 Claim Verification

All claims are subject to verification. TeleMedhin reserves the right to request additional documentation, conduct investigations, or seek independent medical opinions.

6.3 Payment Timeline

Approved claims are typically processed within 7 business days. Complex claims may take up to 14 days. Payment will be made to your registered bank account or mobile wallet.

6.4 Claim Denials and Appeals

If a claim is denied, you will receive written explanation. You may appeal the decision within 30 days by providing additional documentation or clarification.

7. Coverage Exclusions

The following are not covered under TeleMedhin insurance policies:

• Cosmetic procedures and treatments (unless medically necessary)
• Experimental or investigational treatments
• Injuries sustained during criminal activities
• Self-inflicted injuries
• War, terrorism, or civil unrest-related injuries
• Pre-existing conditions during the 12-month waiting period
• Routine dental and vision care (unless specified in your plan)
• Alternative medicine not recognized by Ethiopian medical standards

8. Cancellation and Termination

8.1 Voluntary Cancellation

You may cancel your policy at any time by providing written notice. A pro-rated refund for the remaining coverage period will be provided, minus any applicable processing fees.

8.2 Termination by TeleMedhin

TeleMedhin may terminate your policy for non-payment, fraud, misrepresentation, or violation of these Terms. In such cases, no refund will be provided.

9. Privacy and Data Protection

Your privacy is important to us. Our collection, use, and protection of your personal information is governed by our Privacy Policy, which is incorporated into these Terms by reference.

By using our services, you consent to the collection and use of your information as described in our Privacy Policy.

10. Limitation of Liability

TeleMedhin's liability is limited to the benefits specified in your insurance policy. We are not liable for:

• The quality of medical services provided by network or non-network providers
• Medical outcomes or treatment decisions made by healthcare providers
• Delays in claim processing due to incomplete documentation
• Service interruptions or technical issues with our website or app

11. Governing Law and Dispute Resolution

These Terms are governed by the laws of the Federal Democratic Republic of Ethiopia. Any disputes arising from these Terms or your use of TeleMedhin services shall be resolved through:

1. Good faith negotiations between the parties
2. Mediation, if negotiations fail
3. Arbitration or litigation in Ethiopian courts as a last resort

12. Changes to These Terms

TeleMedhin reserves the right to modify these Terms at any time. We will notify you of material changes via email or through our website at least 30 days before they take effect.

Continued use of our services after changes take effect constitutes acceptance of the modified Terms.

13. Contact Information

If you have questions about these Terms of Service, please contact us: