Below are the prices for Jubilee Insurance health medical cover:

PLAN SUMMARY

JCARE JOHARI

INDIVIDUAL/FAMILY MEDICAL INSURANCE

All inpatient treatment is subject to pre authorization.

All benefits are sub-limits of the overall annual benefit unless specified otherwise. Amounts shown in Kenya Shillings

  PLAN A PLAN B
INPATIENT BENEFITS 200,000 400,000
Bed limits per day. NHIF rebate applicable on the cost of the bed per night. General Ward Bed General Ward Bed
     
  Covered up to Kes. Covered up to Kes.
COVID-19 hospitalization benefit 200,000 200,000
  per family per family
Confirmed newly diagnosed chronic conditions after 3 months of cover 50,000 100,000
inception
   
     
External Aids Cover- This benefit caters for external aids on prescription 20,000 20,000
including hearing Aids & hearing tests
   
     
Pre-existing and/or Chronic, Cancer, Congenital, Psychiatric,    
Haemorrhoidectomy, Thyroidectomy, Adenoidectomy, Organ transplant, HIV/ 100,000 200,000
Aids and related conditions, Hernias, Gynaecological
   
conditions, Tonsillectomy (1 year waiting period)    
Day case admission Covered Covered
     
Inpatient dental surgery from an accident Covered Covered
     
Inpatient non accidental related dental surgery/treatment (1 year waiting 25,000 40,000
period)
   
     
Inpatient non accident related eye treatment (excluding correction of refractive 25,000 40,000
errors and laser treatment) (1 year waiting period)
   
Maternity (Normal delivery, all C-Sections and related complications (1 year 40,000 50,000
waiting period) (pre and post-natal outpatient visits not covered)
   
Take home prescribed medication after discharge Up to 14 days Up to 14 days
from hospital after discharge after discharge
Medically necessary local road ambulance leading to admission in hospital Covered Covered
Occupational and/ Speech Therapy caused by an acute episode of an eligible    
condition or caused by an accident    
Eligible therapies will be limited to 6 months maximum, from the onset of Covered Covered
episode    
within the cover period subject to pre-authorization    
Pain management    
Within inpatient pre-existing & chronic sub benefit (Subject to pre-authorization) Covered Covered
     
Last expense 20,000 25,000
Personal Accident cover for principal member only 100,000 100,000
OUTPATIENT BENEFITS 40,000 50,000
COVID-19 testing Kes. 15,000 Kes. 15,000
per family per family
 
Pre-existing, chronic cover, Psychiatric, Congenital conditions and HIV/ Covered up to Covered up to
AIDS and related treatment (1 year waiting period) outpatient sub-limit outpatient sub-limit
     
Confirmed newly diagnosed chronic conditions after 3 months of cover Covered as above Covered as above
inception
   
Consultation with GP (doctors on specified panel) Covered as above Covered as above
     
Consultation fees for Specialists on referral only (doctors on specified Covered as above Covered as above
panel)
   
     
Pathology, X-rays, Ultrasounds and other necessary (non-advanced) Covered as above Covered as above
diagnostic tests (preauthorization) required
   
Prescription drugs and dressings up to a maximum of 14 days dosage Covered as above Covered as above
     
Annual medical checkup applicable for main member and/ spouse 10,000 10,000
within outpatient
   
Family Planning cover limited to long-acting methods such as Intrauterine    
Contraceptive Device (IUCD) and Norplant implants Only, within 2,500 2,500
outpatient    
Routine Pre-natal & post-natal outpatient treatment (1 Year waiting Covered as above Covered as above
period).
   
Routine immunizations (KEPI/Baby Friendly Vaccinations). Limit for child Covered as above Covered as above
up to 1.5 year
   
Pain management Covered as above Covered as above
Covered within Outpatient subject to pre-authorization
   
Occupational and/ Speech Therapy caused by an acute episode of an    
eligible    
condition or caused by an accident Covered Covered
Eligible therapies will be limited to 6 months maximum, from the onset
   
of episode    
within the cover period subject to pre-authorization    
This is only a summary of the benefits for more details refer to the policy document  
     
  PLAN A PLAN B
  IP 200,000 IP 400,000
     
FAMILY RATES OP 40,000 OP 50,000
M 25,564 30,687
M+1 35,749 42,922
M+2 45,936 55,157
M+3 56,121 67,391
M+4 66,307 79,626
M+5 76,492 91,861

The above rates do not include 0.45% (Training levy & policyholders funds) and Stamp Duty (Kes. 40).

Inpatient and outpatient are sold as one package and cannot be purchased separately.

GENERAL CONDITIONS

  1. Standard waiting period of 30 days for new entrants on general illness claims. No waiting period for accident related treatment.
  2. Eligibility of main member and spouse is from 18 years to 60 years. Members of the scheme will continue to be covered up to the age of 65 years.
  3. Eligibility of dependent children is from 0 days (term baby of 38 weeks) up to 18 years. Dependent children over 18 years are covered up to 25 years old with proof of schooling.
  4. Fibroids, Adenoidectomy, Hernias, Thyroidectomy, Hemorrhoidectomy and Tonsillectomy procedures and all Gynaecological illness and treatment shall have a waiting period of 1 year.
  5. Pre-existing and/or Chronic, Cancer, Psychiatric, Congenital, Organ Transplant, HIV/Aids and related treatment, Maternity and related complications, inpatient non accident related ophthalmology and dental surgery is subject to 1 year waiting period.
  6. All inpatient hospital bills shall be paid net of all the applicable National Hospital Insurance Fund (NHIF).
  • Treatment must be within the prescribed provider panel. Claims outside the panel will not be paid.
  • This scheme does not cover for reimbursement of claims.
  • Changes to benefit levels can only be done at renewal.

EXCLUSIONS (These are some of the exclusions. For more details please refer to the policy document)

  1. Peri-Menopause Menopause, andropause, hormone replacement therapy, age and puberty related treatment.
  • Genetic disorders, genetic testing and related conditions.
  • Cosmetic or plastic surgery unless necessitated by an accidental injury that occurs while the insured is covered under this contract.
  • Beauty treatment or massage, stays in sanatoria, old age homes, places of rest etc.
  • General health examinations, prophylactic treatment, vaccinations except for KEPI vaccinations.
  • Transportation other than a licensed ambulance, as provided for under the inpatient coverage of this contract.
  • Nutritional food supplements or replacements and vitamins whether prescribed by a physician or not.
  • Navel, Military or air force operations, injury or illness resulting from insurrection, war, civil commotion or an act of terrorism, whether declared or undeclared or as a result of participation in riot and/or strikes.
  • Alternative treatment such as herbal, acupuncture treatment, chiropractors etc.
  1. Expenses resulting from the insured participating in extreme/hazardous sports and activities and/or riding or driving in any kind of race.
  2. Dental treatment including teeth extractions, fillings, teeth scaling, etc.
  1. Optical treatment relating to correction of eyesight e.g. eye glasses and contact lenses.
  1. Intentional self-injury while sane or insane, suicide or attempted suicide, treatment of acute or chronic alcoholism and drug addiction.
  2. Expenses recoverable under any other insurance such as NHIF, Workmen’s Compensation, Personal Accident among others.
  3. Treatment required as a result of non-compliance, failure or refusal to comply with medical advice.
  1. Fertility treatment e.g. costs of treatment related to infertility and impotence, any injury, illness or disease specified as an exclusion and complications caused by a condition that is excluded.
  2. Services primarily for weight reduction or treatment of obesity and slimming operations or any care which involves weight reduction as a main method of treatment.
  3. Epidemics, pandemics or unknown diseases except for COVID-19 up to the indicated limits
  1. Treatment for consumption of alcohol, drugs, intoxication, dependency on or abuse of alcohol, drugs or any other substance abuse, complications, injury or illness arising directly or indirectly thereof.

APPLYING FOR COVER

Apply for cover by dialing *643*5# and following the instructions or filling in an application form via https://www.digital.jubileeinsurance.com/johari

POLICY PACK

Once the policy commences you will receive a policy pack via email which will include:

E-cards, Welcome letter confirming the plan and benefits purchased, Policy document, List of providers and a receipt.





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January 31, 2024

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