The Commission considered investigations initiated in March, 2025 against Horizon Health Limited following two complaints that were received.
The First Complainant alleged that beginning early 2024, she observed that hospitals had started rejecting claims under Horizon Health’s scheme, forcing her to pay out of pocket for medical treatment. For instance, the Complainant paid a bill amounting MK473,630 to Blantyre Adventist Hospital.
The Second Complainant submitted that her mother was denied medical care on grounds that the hospital had suspended acceptance of Horizon Health patients due to the Company’s failure to settle outstanding payments. The Complainant contacted the Respondent’s premiums department for assistance and was advised to obtain a quotation from the hospital and submit it for processing but was never assisted. As a result, the Complainant was forced to make cash payments for the service rendered at the hospital.
This conduct appeared to be a contravention under section 51(g) of the Competition and Fair Trading Act.
Having considered the matter, the Commission found that the Respondent failed its duty to make timely settlement of claims under its medical insurance scheme. This resulted in the disruption of healthcare services to the Complainants (and other subscribed customers).
Emanating from this unfair conduct by the Respondent, the Complainants (and other subscribed customers) were compelled to pay out-of-pocket for medical services that ought to have been covered under the medical insurance schemes.
Furthermore, considering the lapse of time (since 2024), the Respondent had demonstrated lack of seriousness to provide an effective redress to the Complainants, as evidenced in the continued failure to effect the reimbursements.
In view of the above, considering that the nature of the subscribed-for product was much needed and time-bound health/medical services, the conduct by the Respondent was grossly unfair, inconsiderate and without conscience. The Commission therefore found that the conduct by the Respondent amounts to unconscionable conduct which is in contravention of section 51 (g) of the CFTA.
Nevertheless, the Commission took consideration of the fact that, upon issuance of the investigation report, the Respondent undertook to refund the First Complainant the outstanding amount of K473,630; and the Second Complainant the outstanding amount of MK175,000; though it took too long.
Following deliberations, the Commission oordered the Respondent to pay a monetary penalty of Two Million Kwacha (MK2,000,000.00) for engaging in unconscionable conduct, contrary to section 51 (g) of the CFTA.