individual & family health insurance - Mavic Insurance Agency

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WWW.JUBILEEINSURANCE.COM

Important Notes: • *(1) All inpatient hospital bills shall be paid net of National Hospital Insurance Fund (NHIF) • *(2) Fibroids, Adenoidectomy, Hemorrhoidectomy & Tonsillectomy procedures shall have a waiting period of 24 months • *(3) MRI, CT Scan on pre-authorization • All scheduled admissions must be reported to Jubilee at least 48 hours prior to admission. Members must seek Jubilee authorization before proceeding • For emergency admissions, the hospital will contact us within 48 hours for authorization • All plans are subject to a 60 days waiting period • Members must present their medical cards in order to obtain treatment on credit at the accredited panel of providers. Each member will also be required to complete and sign a claim form available at the service provider • In case of a medical emergency, members can reach us on the 24 hours emergency lines • A member on travel outside the country will be eligible for emergency medical benefits up to a period of six (6) weeks in any one visit. All medical expenses will be on reimbursement basis and will be within the acceptable guidelines of the Kenya Medical Practitioners and Dentists Board Exclusions • Treatment for pre-existing and chronic conditions (within the first 12 months) • Treatment for /AIDS and related ailments (within the first 12 months) • Treatment of Cancer (within the first 24 months) • Sexually transmitted diseases • Menopause, andropause and hormone replacement therapy • Congenital illnesses and related complications, and conditions related to genetic disorders • Cosmetic or plastic surgery unless necessitated by an accidental injury that occurs while the insured is covered under this contract; • Riding or driving in any kind of race • Participation in extreme sports • Beauty treatment or massage • Naval, military and air force operations • Stays at sanatoria, old age homes, places of rest etc • Medical check-up, general health examinations, vaccinations • Transportation other than a licensed ambulance, as provided for under the in-patient coverage of this contract • Hearing tests or cost of deaf aids unless resulting from an accidental injury • Nutritional food supplements • Prophylactic treatment e.g. yellow fever vaccines • Injury or illness resulting from insurrection or war, civil commotion or an act of terrorism, whether declared or undeclared Injury as a result of participating in riot, strike • Nervous breakdown, general debility and psycheneurosis unless resulting from accidental injury • Alternative treatment such as herbal treatment, acupuncture treatment, pain management, chiropractors etc • Expenses resulting from the insured participating in a hazardous • sports and activities • Pain management • Dental treatment including teeth extractions, fillings, teeth scaling, etc

HEAD OFFICE Jubilee Insurance House, Wabera Street P. O. Box 30376-00100 GPO, Nairobi Tel: (020) 328 1000, Fax: (020) 328 1139 Email: [email protected]

• Optical treatment relating to correction of eyesight e.g. eye glasses, contact lenses, laser eye treatment • Intentional self-injury while sane or insane, suicide or attempted suicide, treatment of acute or chronic alcoholism and drug addiction • Expenses recoverable under any other insurance e.g. NHIF • Treatment required as a result of Noncompliance, Failure or refusal to comply with medical advice • Vaccination, or any treatment undertaken or carried out as a preventative measure • Pregnancy, childbirth, maternity benefits, abortion, miscarriage, ante-or-postnatal care, caesarean operation except where purchased subject to twelve months waiting period • Family planning and fertility treatment e.g. costs of treatment related to infertility and impotence, hormonal imbalance, hormone replacement therapy (HRT) including but not limited to all consultations, examinations, evaluations, medications, laboratory, drugs • Contraceptive services and supplies including but not limited to all consultations, examinations, evaluations, medications, laboratory, drugs and complications arising from the use of the same • Any injury, illness or disease specified as an exclusion and complications caused by a condition that is excluded • Birth defects, Congenital illness and related complications, conditions and illnesses related to genetic disorders • Psychiatric illness, mental disorders and/or insanity expenses within the first 12 months • Any claim for expenses occasioned by or through or in consequence, directly or indirectly caused by acts of God (natural causes) • Services primarily for weight reduction or Treatment of obesity and slimming preparations or any care which involves weight reduction as a main method of treatment • Epidemics or unknown diseases • Experimental treatment and drugs not scientifically recognized or not proven to be effective based on established medical practice • Food supplements or replacements • Costs of treatment for, or related to, Menopause, andropause, ageing, puberty and pre-menstrual tension syndrome • Organ transplant within the first 12 months) • Treatment of Hemorrhoids, Fibroids, Hernia (except congenital), Adenoidectomy within the first 24 months • Any treatment arising from an accident or event because the member or dependant was under the influence of alcohol or drugs, unless prescribed and taken according to the instructions of a medical practitioner • Medical expense directly or indirectly resulting from or in connection with any act of terrorism (“declared or undeclared”), regardless of any other cause contributing concurrently or in any other sequence to the medical expense • All expenses in respect of illnesses/conditions that were subject to waiting periods when the member and dependant joined the scheme • Treatment required as a result of Injuries or complications sustained as a result of domestic violence

Vision: Enabling people overcome uncertainties Mission: To provide solutions to protect the future of our customers Core Values: Integrity, Passion, Excellence, Team work

Mombasa Branch Jubilee Insurance Building, Moi Avenue P. O. Box 90220-80100 Mombasa Tel: (041) 222 4286/ 231 4019/ 231 6760 Fax: (041) 231 6796

Kisumu Branch Jubilee Insurance House, Oginga Odinga Road P. O. Box 378 – 40100, Kisumu Tel: (057) 202 0836/ 202 0845 Fax: (057) 202 0532

INDIVIDUAL & FAMILY HEALTH INSURANCE

J-CARE - JUBILEE MEDICAL INSURANCE

J-CARE - JUBILEE MEDICAL INSURANCE

02

J-CARE JUBILEE MEDICAL INSURANCE An Individual and Family Medical Product from Jubilee Insurance – East Africa No. 1 Insurer In this day and age, it is paramount to have a valid medical insurance cover in place, with the escalating cost of medical services.

Enhanced Benefits We offer enhanced cover options that cater for the following conditions after the first policy period. • Cover for pre-existing and chronic conditions • Cover for HIV/AIDS and ARV therapy

Our J-Care cover provides peace of mind and financial buffer in critical time of need, a wise risk management decision for the protection of the family income and assets.

Who is eligible for the cover? • Adults between the age of 18 years and 60 years • Children between the age of 3 months and 18 years

The Team Jubilee aim at walking with you to ensure that you have timely help when you need it, with Jubilee you...Live Free indeed!

NB: Members above 50 years will be required to undergo a medical examination at specific providers before membership and eligibility of cover can be confirmed. Please note that this will be at the applicant’s cost.

A little bit about Jubilee Jubilee was incorporated on 3rd August 1937, in a small office in Mombasa and is one of the pioneers in the establishment of a local composite insurance company. In Keeping with our Mission of contributing to the economic growth of the region, Jubilee took the bold step of converting itself into an public Company in 1984, to broaden its ownership base locally which now consists of over 5,000 shareholders. Today more than sixty eight years since inception Jubilee is a leading Insurance company in East Africa with the largest shareholders’ funds and solid emphasis on security for policyholders, information technology, committed, knowledgeable & professional staff, and a reputation for superior customer service. Currently, the Jubilee group is the largest medical insurance underwriter in East Africa. Our products Main Products Inpatient cover

Optional Benefits Outpatient cover Maternity cover

Last expense cover Personal expense cover

Maternity Cover This caters for: • Normal delivery including professional fees, labour and recovery wards up to Kshs.80,000 under the Royal plan and Kshs.60,000 under the Executive Plan • Costs of delivery, and other related ailments and complications including ectopic pregnancies, miscarriage, etc • Caesarean section delivery including professional fees, labour and recovery wards up to Kshs. 150,000 under the Royal plan and Kshs.120,000 under the Executive Plan Please note maternity has a 12 months waiting period of continued coverage with Jubilee. Last Expense Benefit Members will be required to nominate a beneficiary on the application form. The death notification and death certificate must be presented for the benefit to be paid out. Personal Accident Benefit The benefit of Kshs. 500,000 is payable to the nominated beneficiary in the event of accidental death. Members are required to nominate a beneficiary on the application form.

CORE PLANS

ROYAL

EXECUTIVE

ADVANCED

PREMIER

Overall limit per year Bed Limits*(1)

5M Standard Private room Max. KShs.12,500

3M Standard Private room Max. KShs.12,500

2M General Ward Bed

1M General Ward Bed

Paid in full Paid in full Paid in full Medically necessary subject to approval by Jubilee. Maximum 90 days

Paid in full

Local emergency road ambulance which is medically necessary

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full Paid in full

Paid in full Paid in full

Paid in full Paid in full

Paid in full Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid according to the fees guideline of the Kenya Medical Practitioners and Dentist Board Paid in full

Paid in full

Paid in full

300,000 Paid in full

300,000 Paid in full

250,000 Paid in full

200,000 Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Air evacuation through AMREF membership at an additional fee Non elective (emergency) treatment outside Kenya preauthorization compulsory (INDIA, PAKISTAN & S. AFRICA) Air fare costs for non elective treatment outside Kenya for the patient. Also, airfare for an accompanying guardian where patient is below 6 years Psychiatric treatment (Year 2) Pathology, Radiology, and other necessary diagnostic tests Accidental related dental treatment Accidental related optical treatment

ROYAL

EXECUTIVE

ADVANCED

PREMIER

Available through Amref / Flying Doctors Membership

Within applicable limits

Within applicable limits

Within applicable limits

Within applicable limits

Economy Class 200,000

Economy Class 200,000

Not Applicable 200,000

Not Applicable 100,000

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

100,000

100,000

80,000

50,000

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full

Paid in full Paid in full Paid in full Paid in full Upon approval by Jubilee

Paid in full Paid in full Paid in full Paid in full Upon approval by Jubilee

Paid in full Paid in full Paid in full Paid in full Upon approval by Jubilee

Paid in full Paid in full Paid in full Paid in full Upon approval by Jubilee

80,000

60,000

Not Applicable

Not Applicable

Within applicable limits

Within applicable limits

Outpatient Benefits

Limits Consultation fees (Doctors on panel) Pathology, X-rays, MRI, CT scan, and other necessary diagnostic tests *(3) Prescription drugs and dressing up to a maximum of 30 days dosage Gynaecological illness and treatment* (2) Pre-existing and chronic cover (Year 2) Cancer treatment (Year 3) HIV/AIDS treatment (Year 2) Psychiatric treatment (Year 2) Physiotherapy Maternity Benefits

Main Benefits Inpatient Benefits Prescription drugs and dressing upon discharge maximum of 30 days’ supply Surgical appliances and internal prostheses Nursing care Physiotherapy as part of treatment Physicians' fees, Specialist fees procedure fees and anaesthetist fees Gynaecological illness and treatment (Year 3) Pre-existing and chronic cover (Year 2) Cancer treatment (Year 3) HIV/AIDS treatment (Year 2) Organ Transplant (Year 2) Theatre charges, ICU & HDU Lodger fee for parent accompanying child below 6 years Day surgery under general anaesthesia or heavy sedation Home nursing

Paid in full

CORE PLANS

Paid in full

Normal Delivery Normal delivery including all costs below shall not exceed limit Cost of delivery and related complications of pregnancy resulting in admission Professional fees Labour and recovery ward Caesarean Section Delivery Caesarean section delivery including all other costs above shall not exceed limit Cost of delivery and related complications of pregnancy resulting in admission Professional fees Labour and recovery ward Last Expense Provision of a burial permit and death certificate will allow the insurer to make payment to the nominated beneficiary Personal Accident Accidental death Applicants above 18 years Free Personal Accident for the Principle member

Paid according to the fees guideline of the Kenya Medical Practitioners and Dentist Board Within applicable limits Within applicable limits 150,000

120,000

Within applicable limits

Within applicable limits

Within applicable limits Paid according to the fees Within applicable limits

Not Applicable

Not Applicable

Within applicable limits guideline of the Kenya Medical Practitioners and Dentist Board Within applicable limits

100,000

100,000

50,000

50,000

Paid in full

Paid in full

Paid in full

Paid in full

500,000

500,000

500,000

500,000

Paid in full

Paid in full

Paid in full

Paid in full

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individual & family health insurance - Mavic Insurance Agency

WWW.JUBILEEINSURANCE.COM Important Notes: • *(1) All inpatient hospital bills shall be paid net of National Hospital Insurance Fund (NHIF) • *(2) Fib...

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