About Faidi and Faraja
In a bid to provide our customers with a variety of quality and affordable medical insurance solutions, we have developed a new range of products namely Faidi and Faraja, which offer unique and exciting benefits such as:
- Outpatient services which can be utilized up-to the full cover limit;
- Inpatient services which can be utilized up-to the full cover limit;
- Maternity cover;
- Dental cover;
- Optical cover;
- Declared pre-existing and chronic conditions cover;
- Emergency evacuation and ambulance services cover.
Why Faidi & Faraja?
- Faidi & Faraja are the first of their kind to offer both In-patient and Out-patient services in one product;
- These products give you easier access to medical services from our country-wide network of hospitals and specialists;
- Faidi and Faraja give you access to our 1st class care and medical advisory services ensuring you get the best medical services when you need them.
Members will access their Faidi & Faraja Out-patient Services from the Resolution Insurance FAIDI & FARAJA OUT-PATIENT MEDICAL SERVICE PROVIDER list.
This cover includes the following Out-patient services:
- Out-patient consultations
- Electrocardiogram Test (ECG)
- Injections and procedures performed at a primary care level in a doctor’s consultation room
- Prescribed medicines
- Antenatal & Postnatal care
- Minor trauma treatment
- Well baby check-ups inclusive of KEPI Immunization Programme at our selected well baby clinics only.
- HIV services
- Treatment and medication of pre-existing conditions
- Treatment and medication of chronic conditions.
- Physiotherapy (5 sessions)
- Health and wellness education
- Specialized counseling services
- Chemotherapy, radiotherapy, immuno-suppressants up to Kshs 10,000
Basic Dental up to Kshs 10,000 Covers:
- Dental Consultation
- Anesthetist fees
- Root Canal
- Tooth extraction
- Scaling, Polishing
- Filling and X-ray
Basic Optical up to Kshs 10,000 Covers:
- Expenses related to eye treatment
- Cost of Lens once during scheme year
- Cost of Frames once during scheme year
Faidi Plans (Annual Overal Limit per Person)
|COVER LIMITS||Kshs 750,000||Kshs 350,000||Kshs 200,000|
|Bed allowance per day (Less NHIF rebate)||5,000||5,000||5,000|
|Out-patient Dental services||10,000||10,000||10,000|
|Out-patient Optical services||10,000||10,000||10,000|
|Maternity Cover (Normal and Caesarean Section) for Principal Member or Spouse||30,000||25,000||20,000|
|Declared pre-existing & Chronic conditions diagnosed while on cover (All Under One Sublimit)||100,000||75,000||50,000|
|Congenital Cover (including New Born Baby Illness) Cover as a sublimit of Declared Pre-existing cover||30,000||25,000||20,000|
|Emergency evacuation and ambulance services||Road Ambulance||Road Ambulance||Road Ambulance|
Faraja Plans (Annual Overal Limit per Person)
|Bed allowance per day (Less NHIF rebate)||12,000||12,000||10,000||10,000|
|Out-patient Dental services||10,000||10,000||10,000||10,000|
|Out-patient Optical services||10,000||10,000||10,000||10,000|
|Maternity Cover (Normal and Caesarean Section) for Principal Member or Spouse||120,000||100,000||75,000||50,000|
|Declared pre-existing conditions||500,000||300,000||150,000||150,000|
|Congenital conditions & New Born Baby illness Cover (All Under One Sublimit of Declared Pre-existing conditions)||120,000||100,000||75,000||50,000|
|Psychiatric illness Cover (as a sublimit of Declared Pre-existing Conditions Cover)||500,000||300,000||150,000||150,000|
|Emergency evacuation and ambulance services||Covered||Covered||Covered||Covered|
|International Emergency Cover||Upto Ksh 2.5 Million||Upto Ksh 1 Million||Upto Kshs 500,000||Upto Kshs 250,000|
|Rehabilitation Cover||Within 30 days of discharge upto a maximum of Kshs 30,000||Within 15 days of discharge upto a maximum of Kshs 15,000||Within 15 days of discharge upto a maximum of Kshs 15,000||Within 15 days of discharge upto a maximum of Kshs 15,000|
|Home Care Services||Covered||Covered||Covered||Covered|
All Rates and Limits are in Kenya Shillings and exclusive of 0.45% (training levy & policy holders fund) contribution.
Stamp Duty of Kshs 40 is payable upon joining the scheme (Not applicable at renewal)
Notes for Faidi and Faraja
- To access In-patient services use the Standard Medical Service Provider list for Faidi Plan user and Enhanced Medical Service Provider list for Faraja Plan.
- Members will access their Faidi & Faraja Out-patient Services from the Resolution Insurance Faidi & Faraja Out-patient Medical Service Provider list.
- Service Access will be by use of Photo card for identification and fingerprint (biometric) for verification.
- There will be a co-payment fee for out-patient services.
Membership only becomes effective after approval of the application and written confirmation of terms by Resolution Insurance; not withstanding the fact that payment may have been received. Application processing will only commence once ALL application requirements have been received.
- All expenses associated with Dental services and Optical services unless covered under the plan or purchased separately.
- All expenses associated with Chronic, Pre-existing, Congenital Illnesses and related conditions unless where covered under the plan.
- Compensation for pain and suffering; loss of income; funeral expenses or claims for damages; expenditure incurred by a member or dependants arising from any illegal or criminal act.
- Expenses arising from injuries sustained as a result of participation in and not limited to professional sport or hazardous pursuits such as motor racing, skydiving, parachute jumping and bungee jumping.
- Operations, treatments and/or procedures of own choice for purely cosmetic purposes, eating disorders, obesity and related illnesses, and any complications that may arise thereof.
- Expenses incurred from recuperative or convalescent holidays.
- All expenses in respect of illness or conditions that were subject to waiting periods when the member joined the Scheme and where the diagnosis for such illness occurred during the waiting period.
- Purchase of:
- Applicators, toiletries, sunglasses and/or lenses for sunglasses and beauty preparations;
- Patented foods and nutritional supplements including baby foods;
- Contraceptive preparations, remedies and devices;
- Tonics, slimming preparations, appetite suppressants and drugs as advertised to the public for the specific treatment of obesity;
- Sunscreen and sun tanning lotions, emollients, soaps and shampoos (medicinal or otherwise);
- Household and biochemical remedies which are not promoted by the medical profession;
- Cosmetic products (medicinal or otherwise); anti-habit forming products; vitamins and multi-vitamins (unless prescribed for documented deficiency);
- Remedies for body building purposes;
- Patent medicines and proprietary preparations; household bandages, cotton wool, dressings and similar aids.
- Monitoring and assistive devices including Blood Pressure machines, glucometers and thermometers.
- Investigation and treatment for infertility and impotence.
- Vaccinations and/or immunizations and other preventive treatments with the exemption of KEPI and baby friendly vaccines.
- Services arising from an accident or event of which the member or dependants has received, or is likely to receive, compensation from any source whatsoever including NHIF and employer liability insurance.
- Any treatment relating to an accident/illness which occurred while the member was intoxicated or was under the influence of alcohol or drugs (unless prescribed and taken according to the instructions of a medical practitioner).
- Dialysis of any kind (except for acute renal failure).
- All expenses associated with sickle cell disease, connective tissue diseases, auto immune diseases, muscular dystrophies, Systemic lupus erythematosus, Alzheimer’s disease and autism.
- Treatment or services rendered in respect of dependence producing substances and their complications.
- Exercising and/or guidance programmes inclusive of antenatal exercises (unless where covered under plan), special diets and weight control.
- Kilometers charges and traveling expenses with the exception of ambulance services as per plan benefits.
- Gold or other precious metal inlays in dentures.
- Hormonal Replacement Therapy.
- Examinations or check-ups such as general health examinations not related to diagnosis of sickness or accidental bodily injury unless explicitly agreed in writing by Resolution Insurance.
- Accommodation in convalescent or old age homes or similar institutions catering for the aged.
- Costs associated with Vocational Guidance, Child Guidance, and Marriage Guidance.
- Cost of alternative therapy including chiropractic, acupuncture, herbal treatment and any complication arising as a result thereof.
- Laser treatment
- Illness, injury or disablement directly or indirectly caused by or contributed to by:
- Active participation in Civil war, riots, rebellion, revolution, insurrection or political activity.
- Any declared or undeclared war, invasion, act of foreign enemy, hostilities or war like operations.
- Nuclear fusion, ionizing or non-ionizing radiation.
- Operating, learning to operate or serving as a Member of a crew of any aircraft being used for sky-diving, racing, testing or exploration.
- Participation in Naval, Military, Air Force, Paramilitary, Police or Police Reserve service or operations.
- Attempted suicide or self-injury deemed deliberate by Resolution Insurance
- The willful non-compliance on the part of the member with Resolution Insurance’s appointed doctors prescribed treatment.
- Allergy tests.
- Costs incurred by a member at a Medical Service Provider not approved by Resolution Insurance.
Additional Faidi & Faraja Out-patient Exclusions
- Exclusions under Dental:
- Crowns, Caps and Bridges
- Self Prescribed Scaling
- Replacement or repair of old dentures, bridges and plates unless damage to dentures, bridges and plates becomes necessary as a result of an accident.
- Orthodontic treatment of a cosmetic nature, false teeth, Semi-precious or Precious Crowns
- Exclusions under Optical:
- Photo chromatic and/or antiglare lenses unless prescribed by a doctor,
- Contact lenses
- Natural non-medical degenerative sight defects
- Chiropractors, Acupuncturist, Herbalist
- Injuries arising from drunkenness, drug addiction or any other forms of substance abuse
- External prosthesis
- Beauty treatment cosmetic purposes
- Patented foods and nutritional supplements including baby foods/ shampoos, skin cleansing remedies, gels e.g. deep heat
- All forms of taxis, travel costs other than ambulance, overseas referral, non emergency transportation
- Unwarranted use of lipid lowering agents, Chiropractors, acupuncturists
- Routine and periodic health examinations and vaccinations outside KEPI schedule /self requests
- A dependant who is over 18years of age and a dependant with maternity and pregnancy related complication/condition
- Herbal medication/herbalists, willful non compliance to medical advice and related complication of the same, experimental drugs and treatment & Treatment by any medical person (s) who is not registered/approved by medical regulatory bodies
- Internal surgical prosthesis etc., home-based care, hearing test and cost of deaf aids
- Expenses recoverable under any other insurance including workmen’s compensation, & treatment prior to date of entry or after cancellation or period of nonpayment of premiums, misstatement or any withheld information
- Obesity treatment, addictive eating disorders congenital conditions, Bone Marrow/organ transplant, cost treatment/complication Foetal surgery
- Plastic/cosmetic surgery to alter appearance or improve function of body part, massage or beauty treatment
- Costs relating to appointments not kept or cancelled by member/dependant, any action pursuit undertaken by member against medical advise
- Internal surgical prosthesis etc., home-based care, hearing test and cost of deaf aids
- Search and rescue operations
- Cost relating to treatment consequential to medical procedures / treatment which the policy does not pay
- Out-patient medical bills incurred by the member outside Faraja and Faidi Out-patient Plan Providers
- Services offered to a member by a consultant/specialist outside Faraja and Faidi Out-patient Plan Providers, unless supported by a referral letter.
- Treatment of a non -dependant.