Our Medical Insurance products offer an unparalleled level of cover with the following key highlights:

  • Variety of plans for both In-patient and Outpatient cover.
  • Guaranteed membership for Life.
  • 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 bills.
  • 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 upto 10 years of age.
  • Our Value Plans have a Worldwide Travel Cover Benefit.

HARMONY PLANS

The Resolution harmony plans are created to offer our clients high quality in-patient services shared within a family. It is designed to allow you and your family to access healthcare from reputable healthcare practitioners when they need it.

Benefits

  • We have a 24-hour medical emergency call center.
  • Organ transplant depending on the cover plan selected
  • First Emergency Caesarean section covered for principal member or spouse
  • Chronic conditions are covered.
  • Declared pre-existing, congenital conditions and psychiatric illness are covered under one sublimit
  • Daily Cash on illness & accident admissions applicable after 3 days of admission up to 180 days
  • Emergency evacuation and ambulance services
  • International Emergency cover
  • Rehabilitation Cover
  • Home Care Services
  • Funeral Expenses for Principal Member

Members on Harmony plans have access to our Enhanced Medical Service Provider List.

Our Harmony Plans have the following annual limits

  • Kshs 5,000,000
  • Kshs 2,000,000
  • Kshs 1,000,000
  • Kshs 500,000

VALUE PLANS

The Resolution Value plans are created to offer our clients high quality in-patient healthcare services for individuals. It is designed to allow you to access quality healthcare from reputable healthcare practitioners when you need it.

Benefits

  • We have a 24-hour medical emergency call center.
  • Variety of inpatient medical plans to choose from
  • Dental Illness cover
  • Opthalmology cover
  • Maternity cover (Normal and Caesarean section) for principal member or spouse, which includes home deliveries and Lamaze classes.
  • New Born Baby Illness Cover (Sublimit is from mother’s annual limit if eligible for Resolution maternity benefit)
  • Declared pre-existing, congenital conditions and psychiatric illness are covered under one sublimit
  • Chronic conditions are covered.
  • Annual Well Person Check-up for adults
  • Organ transplant depending on the plan selected
  • Daily Cash on illness & accident admissions applicable after 3 days of admission up to 180 days
  • Emergency evacuation and ambulance services
  • International Emergency cover
  • Overseas Evacuation and Treatment
  • Rehabilitation Cover
  • Home Care Services

Additional benefits

  • Funeral Expenses cover
  • Personal Accident Cover for adults
  • Critical Illness cover as a sublimit of Personal Accident cover (depending on the cover plan selected)
  • Child guard cover for children
  • Worldwide Travel cover

Members on value plans have access to our Enhanced Medical Service Provider List.

Our Value Plans have the following annual limits:

  • Kshs 10,000,000
  • Kshs 5,000,000
  • Kshs 2,500,000
  • Kshs 2,000,000 (Kshs 1,000,000 Illness, Kshs 1,000,000 Accident)
  • Kshs 1,500,000 (Kshs 500,000 Illness, Kshs 1,000,000 Accident)

Outpatient Plans

Our outpatient benefits include the following outpatient services:

  • 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
    • Adherence and nutritional counseling
    • Follow-up every 3months
    • Prevention of mother to child Transmission (PMTCT)
    • ARV’s and Monitoring
    • Opportunistic infections
  • 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)

Members have access to the Resolution Insurance Enhanced Medical Provider List.

Notes

  • Authorization must be obtained in advance from Resolution Insurance in respect of chemotherapy, radiotherapy, MRI and CT scans and haemodialysis.
  • Outpatient 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 Outpatient cover limit.
  • Co-payment is levied on visits to particular Medical Service Providers, their branches and satellite clinics.

Co-Pay Structure Is As Follows:

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,
  • AAR Health Services Limited

and all their branches and satellite clinics.

FAIDI PLANS

The Faidi medical plans have been developed to offer our clients quality and affordable medical insurance that grants them access to superior healthcare within their budgets. Through these plans you are able to access both inpatient and outpatient services from Resolution Insurance’s country-wide network of hospitals and specialists.

Benefits

  • Bed allowance cover up to Kshs 5,000
  • Inbuilt Outpatient services cover;
  • Inpatient services are covered;
  • Maternity cover;
  • An inbuilt outpatient dental cover;
  • An inbuilt outpatient optical cover;
  • Declared pre-existing and chronic conditions cover all under one sublimit
  • Congenital illness cover (including New Born Baby Illness)
  • Emergency evacuation and ambulance services cover.

Faidi Plans have the following annual limits per person:

  • Kshs 750,000
  • Kshs 350,000
  • Kshs 200,000

Out-patient services

This cover includes the following Outpatient services:

  • Outpatient 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 for pre-existing conditions.
  • Treatment and medication for chronic conditions.
  • Physiotherapy.
  • Specialized counseling services.
  • Chemotherapy, radiotherapy, immune-suppressants up to Kshs 10,000.

Basic dental treatment up to Kshs 10,000 which covers:

  • Dental Consultation.
  • Anesthetist fees.
  • Root Canal.
  • Tooth extraction.
  • Scaling, Polishing.
  • Filling and X-ray.

Basic optical treatment up to Kshs 10,000 which covers:

  • Expenses related to eye treatment.
  • Cost of Lens once during scheme year.
  • Cost of Frames once during scheme year.

NOTES

  • To access In-patient services use the Standard Medical Service Provider list.
  • Members will access their Faidi & Faraja Out-patient Services from the Resolution Insurance Faidi & Faraja Outpatient 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 of Ksh 100 for outpatient services.

FARAJA PLANS

The Faraja medical plans have been developed to offer our clients quality and affordable medical insurance that grants them access to superior healthcare within their budgets. Through these plans you are able to access both inpatient and outpatient services from Resolution Insurance’s country-wide network of hospitals and specialists.

Benefits

  • Bed allowance cover up to Kshs 12,000
  • Inbuilt Outpatient services cover;
  • Inpatient services are covered;
  • Maternity cover;
  • An inbuilt outpatient dental cover;
  • An inbuilt outpatient optical cover;
  • Organ Transplant is covered
  • Declared pre-existing conditions and Psychiatric illness cover
  • Congenital conditions & New Born Baby illness Cover (All Under the Sublimit of Declared Pre-existing conditions)
  • Chronic conditions cover
  • Emergency evacuation and ambulance services cover.
  • International Emergency Cover
  • Rehabilitation Cover
  • Home care Services

Faraja Plans have the following annual limits per person:

  • Kshs 5,000,000
  • Kshs 2,000,000
  • Kshs 1,000,000
  • Kshs 500,000

Out-patient services

This cover includes the following Outpatient services:

  • Outpatient 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 for pre-existing conditions.
  • Treatment and medication for chronic conditions.
  • Physiotherapy.
  • Specialized counseling services.
  • Chemotherapy, radiotherapy, immune-suppressants up to Kshs 10,000.

Basic dental treatment up to Kshs 10,000 which covers:

  • Dental Consultation.
  • Anesthetist fees.
  • Root Canal.
  • Tooth extraction.
  • Scaling, Polishing.
  • Filling and X-ray.

Basic optical treatment up to Kshs 10,000 which covers:

  • Expenses related to eye treatment.
  • Cost of Lens once during scheme year.
  • Cost of Frames once during scheme year.

NOTES

  • To access In-patient services use the Enhanced Medical Service Provider List.
  • Members will access their Faidi & Faraja Out-patient Services from the Resolution Insurance Faidi & Faraja Outpatient 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 of Ksh 100 for outpatient services.

FARAJA PLANS

Optical Plan
The services covered are:

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

Optical plan optional benefit has the following limits per person:

  • Kshs 10,000
  • Kshs 20,000
  • Kshs 30,000

Dental Plan
The services covered are:

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

Dental plan optional benefit has the following limits per person:

  • Kshs 10,000
  • Kshs 20,000
  • Kshs 30,000

Hospital Cash
Hospital cash is an amount paid each day of hospitalization. This benefit comes into effect after 3 days of admission in a hospital for up to a maximum of 180 days.

Hospital cash is given in the following amounts per night admitted in hospital:

  • Kshs 500
  • Kshs 1,000
  • Kshs 2,000

Please note that this benefit is applicable meant for the principal member only.

This benefit can only be bought if you have already purchased a Value or Harmony Plan.

Funeral Expense
Funeral Expenses is an amount paid to the family incase of death of the insured.

Funeral Expense has the following annual limits:

  • Kshs 50,000
  • Kshs 100,000
  • Kshs 150,000
  • Kshs 200,000

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.
  • All Limits and Rates are in Kenya shillings. Rates are exclusive of 0.45% tax (for training levy and policy holders fund) contribution.
  • Stamp Duty of Kshs 40 is payable upon joining the scheme (Not applicable at renewal)
  • Dental and Optical cover options are available to members who have purchased any Resolution Insurance Out-patient plans. Authorization is required.

DEFINITIONS

We would like you to be in the know about all the terms and conditions that accompany every medical insurance cover. Download the full list of terms used for your chosen medical insurance cover below.

EXCLUSIONS

For every medical insurance cover, there are some medical services which Resolution Insurance does not cover. Please download the full list below.