Waiting Periods
a. Waiting Periods for Individuals
Waiting periods are effective from the start date issued by Resolution Health upon membership acceptance
- All plans are subject to an in-patient waiting period of 60 days for all illnesses
- Outpatient plans have a waiting period of 21 days
- All membership benefits commence on expiry of the waiting period except following an accident, this is covered from the start date.
- Any medical condition diagnosed during the waiting period will be considered pre-existing
- All Maternity services and pregnancy related conditions are subject to a 10 month waiting period
- A 10 month waiting period applies from the start date for myomectomies, hysterectomies, adenoidectomies, cataracts, lipomas, hernias and tonsilectomy.
- Critical Illness has 60 days waiting period
- Chronic conditions diagnosed within 6 months of joining are considered pre-existing and shall be covered under the pre-existing conditions.
- Psychiatric, Declared Pre-existing, HIV & Congenital conditions have a 12 month waiting period.
- Harmony & Fortune Plans have a 6 month waiting period for declared pre-existing, chronic and HIV/AIDS related conditions
- Harmony & Fortune Plans have a 10 month waiting period from the start date for First Emergency Caesarean Section
b. Waiting Periods for Corporate
Waiting periods are effective from the start date issued by Resolution Health upon membership acceptance.
- All plans are subject to an in-patient waiting period of 21 days. This shall be waived for corporate groups with previous medical cover.
- Outpatient plans have a waiting period of 21 days.
- All membership benefits commence on expiry of the waiting period except following an accident, this is covered from the start date.
- Any medical condition diagnosed during the waiting period will be considered pre-existing.
- All Maternity services and pregnancy related conditions are subject to 10 months waiting period. This condition shall be waived for corporate groups with more than 20 principal members.
- A 10 month waiting period applies from the start date for myomectomies, hysterectomies, adenoidectomies, cataracts, lipomas, hernias and tonsilectomy. This shall be waived for corporate with previous medical cover or premiums above Kshs 1 Million.
- Critical Illness has 60 days waiting period
- Cancer diagnosed within 6 months of joining is considered pre-existing.
- Chronic conditions diagnosed within 6 months of joining are considered pre-existing and shall be covered under the pre-existing conditions.
This shall be waived for corporate with previous medical cover
Note: Previous Medical Cover – Applicants seeking waivers as transferring from another Medical Scheme (within 30 days of expiry) need to attach their renewal invitation.
