ACCIDENT EMERGENCY MEDICAL EXPENSES COVER
- 1. General Definitions
- 2. Insured Benefits
- 3. General Conditions
- 4. Exclusions
Wherever the following words and phrases appear in this policy wording they will always have these meanings:
We/Us/Our/Company: Resolution Insurance Limited.
You/Your/Insured person/Policy holder: The person named on the Mobile Money Transaction Confirmation.
Accidental Bodily Injury: An unforeseen, identifiable physical injury caused solely and directly by outward, violent and visible means, and which is caused through road traffic accident occurring at an identifiable time and place during the Period of Insurance cover and which results in the Insured Person’s requiring Emergency Medical Treatment.
Emergency Medical Treatment: Response to an acute injury arising from a Road Traffic Accident involving the Insured, that poses an immediate risk to the Insured Person’s life or long-term health. This excludes emergency medical treatment incurred when travelling on a two or three wheeler.
Immediate Medical Treatment shall mean a Medical Practitioner’s treatment, consultations and prescribed medication in respect of treatment commencing within 24 hours of the time and date of the accidental Bodily Injury
Medical Expenses: The reasonable and customary costs of medical, surgical or other remedial attention or treatment given or prescribed by a suitably qualified medical practitioner and all hospital, nursing home and ambulance charges necessitated by Accidental Bodily Injury, and paid directly to the service provider.
Medical Practitioner: A person legally licensed and duly qualified to practice medicine and surgery authorized in the geographical area of his practice and registered as such under the Medical Practitioners and Dentists Act.
Emergency Medical Expense up to a limit of KES 150,000 including ambulance services subject to a maximum period of 48 hours whichever comes first from the time of occurrence of the accident;
Accidental Last expenses Kshs. 30,000 payable to the nominated next of kin
Period of insurance / Validity of Cover
The period of insurance is 24 hours from purchase of cover, as notified via your Mobile Money Transaction Confirmation.
- 1. This Policy will be governed by the laws of Kenya and the Courts therein shall have exclusive jurisdiction to the exclusion of the courts of any other country.
- 2. This Policy cannot be ceded, assigned or in any way transferred to a third party. Benefits shall be payable only to the Policyholder or its legal representative whose receipt shall discharge the Company.
- 3. This Policy shall be voidable (in the absolute discretion of the Company only) in the event of misrepresentation, mis-description or non-disclosure by or on behalf of the policyholder of any information material to this Policy.
- 4. If any difference shall arise as to the amount to be paid under this Policy (liability being otherwise admitted) such difference shall be referred to arbitration in accordance with the statutory provisions in that behalf for the time being in force in the Republic of Kenya and the making of an award shall be a condition precedent to any liability for The Company to make any payment under this Policy.
- 5. Non-refundable
The Company or the Policyholder may not cancel the policy once purchased, further there shall be no refund upon payment that has been received
- 6. The Company or the Policyholder may not cancel the policy once purchased, further there shall be no refund upon payment that has been received.
- 7. There shall be no age limit on the insured persons. However persons under the age of 18yrs year shall require guardian/parent’s identity card and telephone number to be registered upon payment of full premium for the minor.
- 8. Insured Persons must be residing within Kenya at the time of cover purchase.
- 9. The Insured Event must have directly resulted from Bodily Injury through the immediate road accident;
- 10. The insured shall take reasonable precautions to prevent accidents and comply with the statutory regulations;
- 11. It is hereby declared and agreed that any benefit payable under this policy in respect of Death shall be the last expenses up to the limit specified, the amount shall also be paid to the nominated next of kin.
- 12. It is hereby declared and agreed that any benefit payable under this policy in respect of Death shall be the last expenses up to the limit specified, the amount shall also be paid to the nominated next of kin.
- 13. The policyholder shall notify company within reasonable time after an accident or any occurrence which may give rise to a claim under this Policy.
- 14. No Insured Person shall be entitled to recover benefits under this Policy exceeding Kshs 150,000 for Medical expenses and Kshs 30,000 Last expenses.
- 15. This policy documentation issued by us forms a contract of insurance between the underwriters, Resolution Insurance Limited and Yourself.
- 16. This contract is only valid if you have paid the appropriate premium.
- 17. If any claim under this Policy is in any respect fraudulent or unfounded, all Benefits paid and/or payable in relation to that claim shall be forfeited and/or recoverable.
- 18. Beneficiary Clause
It is hereby declared and agreed that the last expenses benefit payable under this policy in respect of Death of the lives insured shall be payable to the nominated next of kin.
The Company shall not be liable to pay any benefit in respect of any Insured Person for any Insured Event caused by or arising directly or indirectly from
- 1. Any Medical Expenses other than those incurred through Road Accident.
- 2. Medical expenses incurred in accident through any other means other than public service vehicle i.e. Matatu’s and buses. This excludes taxis.
- 3. Direct participation in any violent labor disturbances, strike, lock-out, riot, civil commotion or public disorder;
- 4. An Accident occurring whilst on service or on duty with or undergoing training with any military, police force, militia or paramilitary organization;
- 5. An Accident occurring whilst or as a result of participating in any sport as a Professional Player;
- 6. Investigations, operations or treatment of a purely cosmetic nature other than as a direct result of an Accident;
- 7. War, invasion, act of foreign enemy, hostilities, civil war, rebellion, revolution, insurrection or military or usurped power;
- 8. The use, release or escape of nuclear materials that directly or indirectly results in ionising, radiation or contamination by radioactivity from any nuclear fuel or from nuclear weapons or materials. For the purpose of this exclusion only, combustion shall include any self-sustaining process of nuclear fission;
- 9. The dispersal or application of pathogenic or poisonous biological or chemical materials;
- 10. Illness;
- 11. Willful or deliberate exposure to danger (except in an attempt to save human life), intentional self-inflicted injury, suicide or attempt threat, or arising out of non-adherence to medical advice;
- 12. An Insured Person being under the influence of drugs or narcotics unless such drugs or narcotics were administered by a Medical Practitioner or unless prescribed by and taken in accordance with the directions of a Medical Practitioner;
- 13. An Accident occurring whilst an Insured Person was driving a motor vehicle under the influence of alcohol or any other mind altering substances in his or her blood or breath;
- 14. Violation of criminal law or participation in any illegal activity;
- 15. Driving or riding as a passenger in or on:
- 1. any vehicle engaged in any race, speed test or endurance test or
- 2. any vehicle being used for acrobatic or stunt driving or
- 3. for smashing, such as in ”demolition derby” or
- 4. for any other purposes except transportation; nor
- 16. The policy shall not cover any Injury or death arising from natural disease or weakness or exhaustion consequent upon disease.
By paying the insurance premium and purchasing this cover it is deemed that you have agreed to the terms and conditions set out in this policy document; It is your duty to read this Insurance Policy carefully to ensure that you understand the terms and conditions and that this policy meets your requirements. If there are any changes that may affect the insurance cover provided, please notify us immediately.