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Faidi & Faraja Plans

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?

  1. Faidi & Faraja are the first of their kind to offer both In-patient and Out-patient services in one product;
  2. These products give you easier access to medical services from our country-wide network of hospitals and specialists;
  3. 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
Inpatient services Covered Covered Covered
Out-patient Services Covered Covered Covered
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)

COVER LIMITS 5,000,000 2,000,000 1,000,000 500,000
Bed allowance per day (Less NHIF rebate) 12,000 12,000 10,000 10,000
Inpatient services Covered Covered Covered Covered
Out-patient Services Covered Covered Covered Covered
Out-patient Dental services 10,000 10,000 10,000 10,000
Out-patient Optical services 10,000 10,000 10,000 10,000
Organ Transplant Covered Covered Covered Nil
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
Chronic conditions 2,500,000 1,000,000 500,000 250,000
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

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.

Membership Eligibility
Medical Service Access
Exceptional Customer Care Services
Travel Cover
Hospital Admissions
Home care services
Lodger fee
Maternity Benefit
Waiting periods
Annual Well Person Check-up Benefits (For Principal & Spouse Only)
Changes To & Cancellation of Membership
International Emergency Cover
Overseas Evacuation Cover
Emergency Evacuation
Emergency Ambulance Service
Misrepresentation and Fraud
Notes
Member Acceptance Is Subject To Medical Underwriting
  1. All expenses associated with Dental services and Optical services unless covered under the plan or purchased separately.
  2. All expenses associated with Chronic, Pre-existing, Congenital Illnesses and related conditions unless where covered under the plan.
  3. 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.
  4. 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.
  5. 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.
  6. Expenses incurred from recuperative or convalescent holidays.
  7. 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.
  8. Purchase of:
    1. Applicators, toiletries, sunglasses and/or lenses for sunglasses and beauty preparations;
    2. Patented foods and nutritional supplements including baby foods;
    3. Contraceptive preparations, remedies and devices;
    4. Tonics, slimming preparations, appetite suppressants and drugs as advertised to the public for the specific treatment of obesity;
    5. Sunscreen and sun tanning lotions, emollients, soaps and shampoos (medicinal or otherwise);
    6. Household and biochemical remedies which are not promoted by the medical profession;
    7. Cosmetic products (medicinal or otherwise); anti-habit forming products; vitamins and multi-vitamins (unless prescribed for documented deficiency);
    8. Remedies for body building purposes;
    9. Aphrodisiacs;
    10. Patent medicines and proprietary preparations; household bandages, cotton wool, dressings and similar aids.
    11. Monitoring and assistive devices including Blood Pressure machines, glucometers and thermometers.
  9. Investigation and treatment for infertility and impotence.
  10. Vaccinations and/or immunizations and other preventive treatments with the exemption of KEPI and baby friendly vaccines.
  11. 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.
  12. 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).
  13. Dialysis of any kind (except for acute renal failure).
  14. All expenses associated with sickle cell disease, connective tissue diseases, auto immune diseases, muscular dystrophies, Systemic lupus erythematosus, Alzheimer’s disease and autism.
  15. Treatment or services rendered in respect of dependence producing substances and their complications.
  16. Exercising and/or guidance programmes inclusive of antenatal exercises (unless where covered under plan), special diets and weight control.
  17. Kilometers charges and traveling expenses with the exception of ambulance services as per plan benefits.
  18. Gold or other precious metal inlays in dentures.
  19. Hormonal Replacement Therapy.
  20. 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.
  21. Accommodation in convalescent or old age homes or similar institutions catering for the aged.
  22. Costs associated with Vocational Guidance, Child Guidance, and Marriage Guidance.
  23. Cost of alternative therapy including chiropractic, acupuncture, herbal treatment and any complication arising as a result thereof.
  24. Laser treatment
  25. Illness, injury or disablement directly or indirectly caused by or contributed to by:
    1. Active participation in Civil war, riots, rebellion, revolution, insurrection or political activity.
    2. Any declared or undeclared war, invasion, act of foreign enemy, hostilities or war like operations.
    3. Nuclear fusion, ionizing or non-ionizing radiation.
    4. Operating, learning to operate or serving as a Member of a crew of any aircraft being used for sky-diving, racing, testing or exploration.
    5. Participation in Naval, Military, Air Force, Paramilitary, Police or Police Reserve service or operations.
    6. Attempted suicide or self-injury deemed deliberate by Resolution Insurance
    7. The willful non-compliance on the part of the member with Resolution Insurance’s appointed doctors prescribed treatment.
  26. Allergy tests.
  27. Costs incurred by a member at a Medical Service Provider not approved by Resolution Insurance.

Additional Faidi & Faraja Out-patient Exclusions

  1. Exclusions under Dental:
    1. Crowns, Caps and Bridges
    2. Orthodontics
    3. Dentures
    4. Self Prescribed Scaling
    5. Replacement or repair of old dentures, bridges and plates unless damage to dentures, bridges and plates becomes necessary as a result of an accident.
    6. Orthodontic treatment of a cosmetic nature, false teeth, Semi-precious or Precious Crowns
  2. Exclusions under Optical:
    1. Photo chromatic and/or antiglare lenses unless prescribed by a doctor,
    2. Contact lenses
    3. Natural non-medical degenerative sight defects
    4. Myopia
    5. Hypermetropia
    6. Astigmatism
  3. Chiropractors, Acupuncturist, Herbalist
  4. Injuries arising from drunkenness, drug addiction or any other forms of substance abuse
  5. External prosthesis
  6. Beauty treatment cosmetic purposes
  7. Patented foods and nutritional supplements including baby foods/ shampoos, skin cleansing remedies, gels e.g. deep heat
  8. All forms of taxis, travel costs other than ambulance, overseas referral, non emergency transportation
  9. Unwarranted use of lipid lowering agents, Chiropractors, acupuncturists
  10. Routine and periodic health examinations and vaccinations outside KEPI schedule /self requests
  11. A dependant who is over 18years of age and a dependant with maternity and pregnancy related complication/condition
  12. 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
  13. Internal surgical prosthesis etc., home-based care, hearing test and cost of deaf aids
  14. 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
  15. Obesity treatment, addictive eating disorders congenital conditions, Bone Marrow/organ transplant, cost treatment/complication Foetal surgery
  16. Plastic/cosmetic surgery to alter appearance or improve function of body part, massage or beauty treatment
  17. Costs relating to appointments not kept or cancelled by member/dependant, any action pursuit undertaken by member against medical advise
  18. Internal surgical prosthesis etc., home-based care, hearing test and cost of deaf aids
  19. Search and rescue operations
  20. 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.