Medical Service Access
a. Medical Service Access
- All in and outpatient services can only be obtained from our appointed Medical Service Providers. This list is subject to change from time to time. We currently have over 500 hospitals, clinics, doctors and other healthcare providers across East Africa.
- Frontline List: Services can be accessed directly from these providers.
- Referral List: Services are on referral basis only by a frontline provider or a Resolution Insurance Care Manager. For a subsequent visit, authorization must be obtained from a Resolution Insurance Care Manager.
- Members must present their Resolution Insurance Membership Card at the Medical Service Providers for identification.
- Member validity will be verified by the Medical Service Provider representative prior to service delivery.
- Members shall be required to sign the Resolution Insurance claim form at the Medical Service Provider.
b. Hospital Admissions
- All scheduled hospital admissions must be reported to Resolution Insurance at least 48 hours prior to admission, while emergency admissions must be reported within 24 hours of admission. Please notify our care management team to obtain written authorizations for medical services above.
- Members are not required to pay any deposits; Resolution Insurance will co-ordinate admissions through our existing arrangements with hospitals.
- Admission will strictly be by doctors on our select panel as per our Medical Service Providers list.
- Resolution Insurance shall pay all approved admissions bills less National Hospital Insurance Fund (NHIF) rebates.
- Daily cash is applicable after 3 days of admission up to a maximum of 180 days. For benefits with defined sub limits, the daily cash is payable within the sub limit except in cases of maternity and pregnancy related admission where it is not applicable. This benefit is only eligible to working adults.
c. Outpatient Service Access
- There is co-payment levied on visits to particular Medical Service Providers. A co-payment of Kshs 500 will be charged for out patient visits at the Nairobi Hospital and The Aga Khan Hospital in Nairobi. For Getrudes Hospital a co-payment of Kshs 200 will be charged.
- Authorization must be obtained in advance from Resolution Insurance in respect of chemotherapy, radiotherapy, MRI and CT scan, hospice care, haemodialysis, physiotherapy, dental, optical and annual well person checkups.
- Harmony out-patient plans are available to those who have purchased a Harmony Plan in-patient cover.
