What is individual medical insurance?
Health insurance covers medical expenses for illnesses, injuries and conditions. But, unlike a plan through an employer, individual health insurance is something you select and pay for on your own.
Can I buy individual health insurance?
The only way you can enroll in a health plan is through an intermediary e.g insurance brokers, agents or direct with a health insurance provider physically or online health insurance sellers.
How do I get health insurance if I am unemployed?
If you’re unemployed you may be able to get an affordable health insurance plan through the Marketplace, with savings based on your income and household size.
How much is health insurance per year for a single person?
The premium rates are variables and differ from one insurance company to another. In addition, it also depends on the limit of coverage one chooses.
How does a medical insurance work?
Health insurance helps protect you from the high costs of health care. It helps you pay for doctor visits, hospital stays, prescription drugs and important preventive care. You can choose from a variety of health insurance plans with different levels of coverage to fit your needs and budget.
What does the health insurance cover?
Most insurance plans will cover a set of preventive services at no cost to you. This includes shots and certain health screenings. … Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) Prescription drugs. Below are SOME of key benefits in most plans:
1. 5 Levels of Comprehensive cover with optional benefits (Maternity, Outpatient, Dental and Optical). Select the plan and options to suit your medical insurance needs and budget
2. Cover for Pre-Existing, Chronic, Psychiatric , congenital and HIV/AIDS including related conditions
3. Country wide Provider Network
4. Overseas inpatient referrals covered on credit under listed hospitals or on reimbursement basis depending on the insurance provider.
5. Cover for inpatient dental and optical treatment
6. Post hospitalization benefit
7. Funeral expenses benefit
8. Free Personal Accident benefit for Principle member by some providers
9. Direct access to treatment within East Africa by some providers
10. The benefit options are provided in this brochure and the further details will also be provided in the policy document
When does my cover commence?
The cover commences once premiums are paid in full and insurance provides you with an acceptance letter.
To whom should premiums be paid to once I have received confirmation that my application has been accepted?
Payment should be made directly to the insurance provider by the following means:
MPESA Playbill Number
However, some providers do not accept cash payments and it’s always important to confirm in advance.
Which hospitals can I go to?
A list of providers and specialists will be provided in your membership pack. The same can be accessed on the provider’s website. You can also call your provider, Agent or broker offices for further assistance.
What do I need in order to access a credit facility?
Remember to always carry your medical card and your national ID/ Passport in case further verification is required.
What is the procedure of enrolling a new born child?
Inform the provider immediately the child is born and provide all documentation (application form and passport size photo) as soon as possible. Cover commences once the Insurance confirms acceptance and full premium is paid.
What does the policy say about treatment abroad?
A member is covered whilst temporarily abroad and requiring emergency treatment for an illness or injury that occurs during the period of travel provided that such period does not exceed six weeks or as may be provided in the plan by the provider, in any one visit and will be covered on reimbursement. Travel and accommodation costs are not covered by most providers.
How do I change my policy if I am covered with another Insurer?
Provided there is no break in cover, and subject to the underwriting procedures some of the waiting periods may be waived allowing for a seamless transition.
Once I have the initial medical examination having joined after the age of 50 years, will I need to go for an examination at each renewal?
The Insurance may require medical examination when necessary. Communication will be provided in writing at the policy renewal
1. General waiting period of 30 days for new entrants on illness claims. No waiting period for accident related treatment.
2. *(1) MRI, CT scan on pre authorization.
3. *(2) Fibroids, Adenoidectomy, Haemorrhoidectomy and Tonsillectomy procedures shall have a waiting period of 1 year.
4. Cancer treatment will be subject to 2 years waiting period.
5. Pre-existing, Chronic, Psychiatric, Congenital, Organ Transplant, HIV/Aids and related treatment, Maternity and related complications, inpatient non accident related ophthalmology and dental surgery shall be subject to 1 year waiting period.
6. Eligible for the main member and his/her legal dependents from the age of 1 month to 60 years. Existing members can continue on cover up to age of 65 years. Children above 18 years will enjoy their own cover as principle members.
7. New applicants aged 50 years and over 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 applicants cost.
8. Cover must be confirmed in writing and premiums paid to Jubilee Insurance for the benefits to be effective.
9. All scheduled admissions must be pre authorized at least 48 hours prior to admission.
10. For emergency admission the hospital will contact Jubilee Insurance within 48 hours of admission.
11. All inpatient hospital bills shall be paid net of National Hospital Insurance Fund (NHIF)
12. Medical cards must be presented at the accredited panel of providers for access to service. Each member will also be required to complete and sign a claim form.
13. A member travelling 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 Kenyan Medical Practitioners and Dentists Board and as per the policy terms and conditions.
1. Treatment for pre-existing chronic conditions, congenital and psychiatric conditions (within the first year)
2. Treatment for HIV/AIDS and related ailments (within the first year)
3. Treatment of Cancer (within the first two years)
4. Sexually transmitted diseases except HIV/AIDS
5. Peri-Menopause, Menopause, andro-pause ,hormone replacement therapy, age and puberty related treatment Organ transplant (within the first year)
6. Treatment of Haemorrhoids, Fibroids, Hernia (except congenital), Adenoidectomy (within the first year).
7. Genetic disorders and related conditions.
8. Cosmetic or plastic surgery unless necessitated by an accidental injury that occurs while the insured is covered under this contract;
9. Riding or driving in any kind of race
10. Beauty treatment or massage
11. Naval, military and air force operations
12. Stays at sanatoria, old age homes, places of rest etc.
13. Medical check-up, general health examinations, prophylactic treatment, vaccinations except for KEPI vaccinations.
14. Transportation other than a licensed ambulance, as provided for under the in-patient coverage of this contract
15. Hearing tests or cost of hearing aids unless resulting from an accidental injury
16. Nutritional food supplements or replacements.
17. Injury or illness resulting from insurrection or war, civil commotion or an act of terrorism, whether declared or undeclared
18. Injury as a result of participating in riot, strike
19. Alternative treatment such as herbal treatment, acupuncture treatment, chiropractors etc.
20. Expenses resulting from the insured participating in extreme/hazardous sports and activities
21. Pain management
22. Dental treatment including teeth extractions, fillings, teeth scaling, etc. unless the dental cover has been purchased.
23. Optical treatment relating to correction of eyesight e.g. eye glasses, contact lenses, laser eye treatment unless the optical cover has been purchased.
24. ntentional self-injury while sane or insane, suicide or attempted suicide, treatment of acute or chronic alcoholism and drug addiction
25. Expenses recoverable under any other insurance e.g. NHIF
26. Treatment required as a result of noncompliance, failure or refusal to comply with medical advice
27. Pregnancy, childbirth, maternity benefits, medically necessary abortion, miscarriage, antenatal or postnatal care, caesarean operation except where purchased and subject to twelve months waiting period
28. Contraceptive services and supplies, family planning and fertility treatment e.g. costs of treatment related to infertility and impotence, any injury, illness or disease specified as exclusion and complications caused by a condition that is excluded.
29. 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.
30. Epidemics, pandemics or unknown diseases