Value Plans: Enhanced in-patient benefits

Resolution Kenya Insurance corporate medical covers enable your company employees to access superior in-patient and out-patient healthcare services through our various Resolution accredited healthcare service providers anytime they need to.

Benefits

  • Corporate value plans enable you to access premium in-patient services with different limits as listed below.
  • Variety of plans for both in-patient and out-patient services
  • Membership for life
  • To cater for Small & Medium Sized Companies we have a low joining number of 5 principal members
  • No waiting period for Companies transferring from another scheme
  • 24-hour medical emergency call centre.
  • Chronic conditions covered.
  • Maternity cover includes home deliveries and Lamaze classes. Ante natal visits are covered from Out-patient benefit and not maternity limit, leaving the limit available for delivery bill.
  • New Babies born after 38 weeks of gestation to full term (and discharged from Hospital) can join immediately after birth.
  • New Born Baby Illness covers babies born prematurely, for illness after birth and before discharge.
  • Dental Illness is covered.
  • Lodger fee for parent accompanying children up to 10 years of age.
  • Our Value Plans have a Worldwide Travel Cover Benefit.

Plans and Limits

  • Premier Plus Plan KES 10M Annual Limit
  • Premier Plan KES 5M Annual Limit
  • Executive Plan KES 2.5M Annual Limit
  • Superior Plan KES 2M (KES 1M Illness and 1M Accident)
  • Advantage Plan KES 1.5M Annual Limit. (KES 0.5M Illness,1M Accident)

Corporate Plans (limits Shared per family)

This plan allows your employees and their families to access superior quality medical care services subject to predetermined limits as follows.

Benefits

  • Variety of plans for both in-patient and out-patient services
  • Membership for life
  • To cater for Small & Medium Sized Companies we have a low joining number of 5 principal members
  • No waiting period for Companies transferring from another scheme
  • 24-hour medical emergency call centre.
  • Chronic conditions covered.
  • Maternity cover includes home deliveries and Lamaze classes. Ante natal visits are covered from Out-patient benefit and not maternity limit, leaving the limit available for delivery bill.
  • New Babies born after 38 weeks of gestation to full term (and discharged from Hospital) can join immediately after birth.
  • New Born Baby Illness covers babies born prematurely, for illness after birth and before discharge.
  • Dental Illness is covered.
  • Lodger fee for parent accompanying children up to 10 years of age.
  • Our Value Plans have a Worldwide Travel Cover Benefit.

Limits Covered

  • KES 5 Million
  • Between KES 2 Million and 5 Million
  • Between KES 1 Million and KES 2 Million
  • Between 0.5 Million and KES 1 Million
  • Between KES 100,000 and KES 500,000

Out-patient Services

This corporate outpatient insurance cover enables your employees to access the following out-patient services from the Resolution Enhanced Medical Provider List subject to different annual limits depending on the plan picked.

  • Outpatient consultations
  • Diagnostic examinations
  • Injections and procedures performed at a primary care level in a doctor’s consultation room
  • Prescribed medicines
  • X-rays, laboratory, scans and MRI
  • Antenatal & Postnatal care
  • Minor trauma treatment
  • Well baby check-ups inclusive of KEPI Immunization Programme at our selected well baby clinics only.
  • HIV services:
    1. Adherence and nutritional counseling
    2. Follow-up every 3 months
    3. Prevention of mother to child Transmission (PMTCT)
    4. ARV’s and Monitoring
    5. Opportunistic infections
    6. Baby friendly vaccines as a benefit to the member child up to a sublimit of Kshs 20,000 from their outpatient benefit (Pre-authorization is required)

Co-Pay Structure

Out-patient Co-Pay of Kshs. 1,000 for all Out-patient visits at

  • The Nairobi Hospital
  • Aga Khan University Hospital – Nairobi
  • MP Shah Hospital (Social Service League)
  • The Karen Hospital and all their branches and satellite clinics.

Out-patient Co-pay of Kshs. 500 for all Out-patient visits at:

  • Gertrude’s Garden Children’s Hospital
  • Mater Hospital
  • Nairobi Women’s Hospital
  • Aga Khan Hospital – Mombasa
  • Aga Khan Hospital – Kisumu
  • Pandya Memorial Hospital
  • AAR Health Services Limited and all their branches and satellite clinics.

NOTES

  • Authorization must be obtained in advance from Resolution Insurance in respect of chemotherapy, radiotherapy, MRI and CT scans and haemodialysis.
  • Out-patient HIV services will be obtained at our selected HIV Comprehensive Care Clinics (List Available).
  • Service Access will be via Resolution Insurance Membership Card.
  • Sub-Limit for Declared Pre-existing conditions is 100% of member’s Out-patient cover limit.
  • Co-payment is levied on visits to particular Medical Service Providers, their branches and satellite clinics.

Optional Benefits

  1. Dental and Optical cover options are available to members who have purchased any Resolution Insurance outpatient plans
  2. Dental and Optical Benefits have the option of sharing within a family or having a limit per person.
  3. Authorization to access these services is required from Resolution Insurance in advance.
  4. These are accessed at selected Resolution Insurance Medical Service Provider.
  5. The riders below if purchased must be purchased for every member/family in the scheme. Riders cannot be purchased for selected members of the scheme.

Optical Plans
The services covered are:

  • Routine optical consultations
  • Prescription of frames
  • Prescribed lenses and replacement of lenses
  • Optical Prescriptions

Dental Plan
The services covered are:

  • Consultation
  • Extractions
  • Fillings (except precious metals)
  • Scaling
  • Dental X-Rays
  • Dental Prescriptions
  • Crowning
  • Bridging
  • Braces

Funeral Expense Cover
This is a benefit paid out to the next of kin on submission of documents confirming death of the insured member.

Notes

  • The riders above if purchased must be purchased for every member/family in the scheme. Riders cannot be purchased for selected members of the scheme.
  • Dental and Optical cover options are available to members who have purchased any Resolution Insurance Out- patient plans except for Faidi and Faraja Out-patient plans.
  • Authorization is required.
  • If Out-patient is funded, the dental and optical riders will be claimed from the fund amount.
  • Funeral expense must be purchased in accompaniment with In-patient.

Hospital Cash
Hospital cash is an amount paid each day of hospitalization. Applicable after 3 days of admission up to a maximum of 180 days.

Personal Accident
The personal accident cover provides compensation to the insured for physical and visible bodily injury caused in an accident.