Giving your employees medical insurance is the most valuable benefit that you as an employer can offer.it will give them The peace of mind that cannot be quantified.
Just as the peace of mind that you will get by choosing the right insurer. You need an insurer that is strong, reliable and that has a proven track record in the industry; one whose size and strength ensures you the best rates in the market without sacrificing a personalised, customised attention to your needs.
At Jubilee, we provide you with first-class products to suit your needs from in-patient and out-patient through to maternity, dental, optical and scheme administration.
As the largest medical insurance underwriter in East Africa, we have also partnered with a range of service providers to create a customised product that is specific to your medical needs. We also offer credit facilities for both in and out-patient medical schemes.
And this is why you want Jubilee to look after the medical needs of your employees.
Who is eligible for group medical cover?
- All current employees aged between 18 to 60 years.
- One Legal Spouse per principle member.
- Own or legally adopted child aged between 1 Month and 18 years (or 23 Years for a child who is a full-time school or college student).
- The principal will have to prove the student status of the dependent.
What is the minimum number of members per scheme?
- Our minimum number is 20 principal members per scheme.
What are the unique features of Jubilee’s Medical Cover?
- We offer a one stop shop for all your medical needs ranging from inpatient, outpatient, and maternity, dental,optical and scheme administration.
- We do not segregate the benefits under the various headings e.g. drugs, doctor’s fees, etc as long as it is within the overall limit of cover.
- There is no ceiling amount for ward bed. The client can therefore go to any hospital regardless of the cost of the ward bed. Use of Private room is not allowed.
- For a child aged 6 years and below, we pay the accommodation fee for the accompanying parent/Guardian.
- We offer identification membership photo cards at no additional fee
- We offer credit facility for both in and outpatient scheme.
- We have 24 hour emergency numbers accessible in cases of emergencies
What are the core benefits available under the group medical cover?
- A fully insured In-patient cover.
What optional benefits are available?
- Outpatient Cover
- Dental Cover
- Optical Cover
- Maternity Cover
- Last/Funeral expense cover
- Excess of loss cover
What enhanced benefits are available?
- Cover for Pre-existing and chronic conditions
- HIV/AIDS including treatment for opportunistic infections of HIV conditions and administration of ARV drugs
What other benefits are offered, at a fee?
- Fund management / Scheme administration
- HIV management program / administration
Can you take an out-patient option only?
- Yes, on a fund management basis.
How is the cover structured?
- The cover can either be on a
- Per Family/ shared limit. The family shares the cover on a first come first to claim basis until the limit is exhausted.
- Per person basis. Each member has own limit.
What is the scope of the cover?
Inpatient (Kshs. 100,000 – 5,000,000) provides for:
- Diagnostic consultation
- Doctor’s, surgeons, anaesthetist, operating theatre fees and hospital board and accommodation charges in a general ward bed.
- Physiotherapist’s fees
- HDU & ICU expenses
- Drugs, dressings, surgical appliances and laboratory and cost of investigations reasonably incurred by an insured member.
- Local rescue and evacuation within the inpatient limit
Outpatient (Kshs. 20,000 – 100,000) provides for:
- Treatment costs by medical practitioners registered with the Kenya Medical Practitioners & Dentists Board.
- Drugs prescribed by a physician and dispensed by a licensed pharmacist
- Other services covered include surgical dressing when necessitated by accidental body injury or disease
- X-ray, laboratory and physiotherapy fees
Dental (Kshs. 5,000 – 30,000) provides for:
- Cost of fillings, x-rays, extractions including surgical extraction together with anaesthetics fees.
- You may visit a registered dentist of your choice, but you will have to pay for the service. You will then be reimbursed 100% of the valid claim amount depending on the benefit selected.
Optical (Kshs. 5,000 – 30,000) provides for:
- The cost of eyeglasses and eye testing. Please note that eyeglasses are limited to one pair every two years, unless otherwise proven to be necessary.
- You may visit a registered optician of your choice, but you will have to pay for the service. You will then be reimbursed 100% of the valid claim amount
Maternity (Kshs. 50,000 – 150,000) provides for:
- Delivery fees, consultation and treatment for both mother and child during the period of confinement in hospital.
- Cost of pre-natal and post natal expenses
Excess of Loss (Up to Kshs. 10,000,000) provides for:
- Medical expenses incurred by a Member even after the limit under the in-patient cover has been exhausted, as long as the maximum liability shall not exceed the sub-limit specified.
What is not covered under the Standard Medical Scheme?
- HIV/AIDS (including related conditions)*
- Chronic/Pre-existing/ recurrent conditions e.g. heart condition, cancer, Asthma, high blood pressure and diabetes (except newly diagnosed condition for the first time in life during the currency of the policy in which case the policy pays for the first admission).*
- Maternity and pregnancy related complications except first caesarian (elective first caesarian not covered)*
- Congenital Illness (Condition that a person is born with)*
- Injury/Disablement directly or indirectly caused by war, participation in riots, civil commotion, rebellion, terrorism, suicide or attempted suicide and participating in any Hazardous activities e.t.c
- Dental Treatment*, eye testing, cost of eyeglasses or contact lenses*,
- Hearing tests or the cost of deaf aids, unless the cause of admission is as a result of accident.
- Family planning, infertility and senility
- Nervous breakdown, general debility and psychoneurosis(except where its caused entirely by an accident)
- Cosmetic or beauty treatment or surgery
- Venereal diseases
- Alternative treatment and pain management
- A hospitalization expense incurred outside Kenya except if a member is temporarily abroad on holiday or business for a period not exceeding six weeks.
- Accident hospitalization expenses recoverable under Group Personal Accident Cover and amount recoverable from NHIF
- Get more exclusions as per the details we send to the providers
* Note the above is covered if the benefit is purchased.
What do I need to get a quotation for group medical cover?
- Claims experience for the last three years
- Occupation/Industry of the group and their geographical location
- Average age for the staff
- Number of employees and dependents
- Limit of cover required and any optional riders required