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Resolution Insurance entered the Kenyan market in 2002 (as
Resolution Health East Africa), the first company to be registered
as a Medical Insurance Provider (MIP). We were recognized as
Medical Insurance Provider of the Year in 2012 in the Think
Business Insurance Awards.
We were licensed as a General Insurer by the Insurance
Regulatory Authority (IRA) in 2013. We are licensed to provide
Personal Accident, Workmens Compensation, Liability, Medical and
Miscellaneous classes of General Insurance Business.
With 10 years experience, Medical Insurance is our core product.
We have managed the medical needs of over 60,000 members comprising
of corporate, social groups, families and individuals through
innovative solutions.
As we grow our product offering our aim is to be a one-stop shop
for Employee Benefits. Over the last year we have introduced
products targeted at corporate organizations namely Work Injury
Benefits Act (WIBA), WIBA Plus, Employers Liability and Group
Personal Accident Cover (GPA). We also offer Personal Accident
Covers to Individuals & Families.
Resolution Insurance has partnered with a multi-national travel
insurance expert Linkham Services to offer Resolution Travel to
cater for persons travelling for leisure, business or studies.
Resolution Travel Plans are delivered on a fully automated web
platform. We offer seven plans that have local, regional, schengen
countries and worldwide cover options.
Thank You for your interest in our Medical Insurance plans for
Individuals & Families. We have developed a strong network of
over 750 medical service providers (hospitals, clinics and doctors)
across East Africa that our members can access.
If you would like to consider these plans for you and your
family we have Business Consultants, and have partnered with
Brokers & Agents who are available to develop a proposal based
on your needs.
Our Medical Insurance products offer an unparalleled level of
cover to all our members with key highlights as:
Variety of plans for both in-patient and out-patient
Membership for Life
24 hour medical emergency and pre-authorization call centre
Chronic conditions including HIV/ AIDS covered to full cover
limits.
Maternity cover includes home deliveries and Lamaze classes.
Ante natal visits are covered from Out-patient benefit and not
maternity limit.
New born babies (38 weeks) can join from birth.
New Born Baby Illness covers babies born prematurely, for
illness after birth and before discharge.
Offer our members overseas evacuation and treatment with
partnerships with leading medical service providers in India.
Dental Illness is covered.
Lodger fee is extended to older children up to 10 years
You can start and complete your purchase of medical insurance
including payment online using our BUY ONLINE web platform.
Medical Insurance Product Guide
For Individuals & Families
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www.resolution.co.ke2
VALUE PLANs - ENHANCED INPATIENT BENEFITs
PRODUCT NAME PREMIER PLUs PLAN PREMIER PLANEXECUTIVE
PLANANNUAL LIMIT IN KENYA sHILLINGs THAT COVERs THE FOLLOWING:
Kshs 10,000,000 Kshs 5,000,000 Kshs 2,500,000
Hospital Enhanced Medical Service Provider ListEnhanced Medical
Service Provider List
Enhanced Medical Service Provider List
Bed Capacity Standard Ensuite Private room without bath and
basinShared room without
bath and Basin
Hospitalization services Covered Covered Covered
Dental Illness cover Kshs 85,000 Kshs 85,000 Kshs 85,000
Opthalmology Cover Covered Covered Covered
Maternity (Normal and Caesarean Section) for Principal Member or
spouse - includes Home Deliveries & Lamaze Classes
Kshs 250,000 Kshs 150,000 Kshs 100,000
New Born Baby Illness Cover (Sublimit is from mothers annual
limit if eligible for Resolution maternity benefit)
Kshs 100,000 Kshs 100,000 Kshs 100,000
Chronic conditions (includes HIV/AIDS, excludes Cancer and
Psychiatric conditions)
Covered Covered Covered
Declared pre-existing, Psychiatric, & Congenital conditions
(All Under One Sublimit)
Kshs 500,000 Kshs 450,000 Kshs 350,000
Cancer sublimit for new applicants* Kshs.5,000,000 Kshs.
2,500,000 Kshs. 1,250,000
Annual Well Person Check Up (For Adults) Covered Covered
Covered
Organ Transplant Covered Covered Covered
Daily Cash on illness & accident admissions applicable after
3 days of admission upto 180 days
Kshs 2,500 per day Kshs 2,500 per day Kshs 1,250 per day
Emergency evacuation and ambulance services Covered Covered
Covered
International Emergency Cover Covered Covered Covered
Overseas Evacuation & Treatment Covered Covered Covered
Rehabilitation Cover
Within 30 days of discharge upto a maximum of Kshs
30,000
Within 30days of discharge upto a maximum of Kshs
30,000
Within 15 days of discharge upto a maximum of Kshs
15,000
Home Care services Covered Covered Covered
ADDITIONAL BENEFITs
Funeral expense Kshs 100,000 Kshs 100,000 Kshs 100,000
Personal Accident Cover (for adults) Kshs 2, 000,000 Kshs 1,
000,000 Kshs 500,000
Critical Illness (a sublimit of Personal Accident cover) Kshs
500,000 Kshs 500,000 Kshs 250,000
Child guard cover (For children) Kshs 100,000 Kshs 100,000 Kshs
100,000
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My Health, My Life, MY RESOLUTION 3
VALUE PLANs - ENHANCED INPATIENT BENEFITs
PRODUCT NAME sUPERIOR PLAN ADVANTAGE PLAN
ANNUAL LIMIT IN KENYA sHILLINGs THAT COVERs THE FOLLOWING:
Kshs 2,000,000 (Kshs 1,000,000 Illness, Kshs 1,000,000
Accident)
Kshs 1,500,000 (Kshs 500,000 Illness, Kshs 1,000,000
Accident)
Hospital Enhanced Medical Service Provider ListEnhanced Medical
Service Provider List
Bed Capacity Ward Bed Ward Bed
Hospitalization services Covered Covered
Dental Illness cover Kshs 85,000 Kshs 85,000
Opthalmology Cover Covered Covered
Maternity (Normal and Caesarean Section) for Principal Member or
spouse - includes Home Deliveries & Lamaze Classes
Kshs 75,000 Kshs 50,000
New Born Baby Illness Cover (Sublimit is from mothers annual
limit if eligible for Resolution maternity benefit)
Kshs 75,000 Kshs 50,000
Chronic conditions (includes HIV/AIDS, excludes Cancer and
Psychiatric conditions) Covered Covered
Declared pre-existing, Psychiatric, & Congenital conditions
(All Under One Sublimit) Kshs 250,000 Kshs 150,000
Cancer sublimit for new applicants* Kshs.500,000
Kshs.250,000
Annual Well Person Check Up (For Adults) Covered Covered
Organ Transplant Covered Nil
Daily Cash on illness & accident admissions applicable after
3 days of admission upto 180 days
Kshs 1,250 per day Kshs 1,250 per day
Emergency evacuation and ambulance services Covered Covered
International Emergency Cover Covered Covered
Overseas Evacuation & Treatment Covered Covered
Rehabilitation CoverWithin 15 days of discharge upto a
maximum of Kshs 15,000
Within 15 days of discharge upto a
maximum of Kshs 15,000
Home Care services Covered Covered
ADDITIONAL BENEFITs
Funeral expense Kshs 100,000 Kshs 100,000
Personal Accident Cover (for adults) Kshs 500,000 Kshs
500,000
Critical Illness (a sublimit of Personal Accident cover) Kshs
250,000 Nil
Child guard cover (For children) Kshs 100,000 Kshs 100,000
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www.resolution.co.ke
Pro
duc
tPr
em
ier P
lus
Pre
mie
rEx
ec
utiv
esu
pe
rior
Ad
vant
ag
e
Ann
ual L
imit
Ksh
s 10
,000
,000
Ksh
s 5,
000,
000
Ksh
s 2,
500,
000
Ksh
s 2,
000,
000
Ksh
s 1,
500,
000
Me
mb
er
spo
use
Me
mb
er
spo
use
Me
mb
er
spo
use
Me
mb
er
spo
use
Me
mb
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spo
use
Chi
ld (
0 -
18 y
ea
rs)
32,5
43-
29,1
05-
22,7
02-
21,3
76-
16,5
96-
19 -
24
yea
rs43
,363
38,6
3737
,724
33,7
8627
,879
25,2
2725
,927
23,5
2020
,057
18,4
33
25 -
34
yea
rs51
,494
45,8
8144
,797
40,1
2133
,107
29,9
5930
,789
27,9
3023
,818
21,8
89
35 -
39
yea
rs59
,624
53,1
2551
,871
46,4
5538
,333
34,6
8935
,650
32,3
4027
,579
25,3
45
40 -
55
yea
rs73
,175
65,1
9963
,659
57,0
1447
,045
42,5
7343
,753
39,6
9033
,845
31,1
05
56 -
64
yea
rs10
5,69
794
,178
91,9
5382
,353
67,9
5561
,495
63,1
9857
,330
48,8
8844
,930
65 -
69
yea
rs
(re
new
al o
nly)
121,
957
108,
666
106,
100
95,0
2478
,409
70,9
5672
,921
66,1
5056
,410
51,8
41
70 -
79
yea
rs13
5,50
812
0,74
011
7,88
810
5,58
187
,122
78,8
4181
,022
73,5
0062
,677
57,6
02
80 y
ea
rs &
ab
ove
(r
ene
wa
l onl
y)15
7,19
014
0,05
913
6,75
012
2,47
410
1,06
191
,455
93,9
8685
,259
72,7
0666
,818
All
Rate
s a
re in
Ke
nya
Shi
lling
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ain
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VA
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s
ww
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co
.ke
4
-
My Health, My Life, MY REsOLUTION 5
My
He
alth
, My
Life
, MY
REs
OLU
TIO
N
5
ww
w.re
solu
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co
.ke
HA
RMO
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PLA
N -
INPA
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(LIM
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HA
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Kshs
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Kshs
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Kshs
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Chr
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Kshs
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Kshs
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Kshs
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Ca
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Kshs
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Kshs
100
,000
Kshs
50,
000
Kshs
50,
000
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www.resolution.co.ke6
My
He
alth
, My
Life
, MY
REs
OLU
TIO
N
6
HA
RMO
NY
PLA
NS
- IN
PATI
ENT
RATE
S (L
IMIT
SH
ARE
d P
ER F
AM
ILY)
Ann
ual I
npa
tient
Lim
it (P
er F
am
ily S
hare
d)
19 -
34
yea
rs (
Rang
e o
f the
ag
e o
f the
old
est
ad
ult i
n th
e fa
mily
)
MM
+1M
+2M
+3M
+4M
+5Ex
tra
5,00
0,00
030
,384
47,3
7556
,342
64,9
0473
,080
80,8
8812
,617
2,00
0,00
021
,357
29,6
0035
,203
40,5
5245
,661
50,5
398,
671
1,00
0,00
019
,503
27,0
2932
,146
37,0
3041
,695
46,1
507,
918
500,
000
16,9
1521
,099
25,0
9328
,906
32,5
4736
,025
6,18
1
Ann
ual I
npa
tient
Lim
it (P
er F
am
ily S
hare
d)
35 -
55
yea
rs (
Rang
e o
f the
ag
e o
f the
old
est
ad
ult i
n th
e fa
mily
)
MM
+1M
+2M
+3M
+4M
+5Ex
tra
5,00
0,00
050
,641
63,1
6675
,123
86,5
3897
,439
107,
851
16,8
22
2,00
0,00
031
,641
39,4
6746
,937
54,0
6960
,881
67,3
8611
,562
1,00
0,00
028
,893
36,0
3942
,861
49,3
7455
,593
61,5
3410
,558
500,
000
22,5
5428
,132
33,4
5738
,541
43,3
9648
,033
8,24
1
Ann
ual I
npa
tient
Lim
it (P
er F
am
ily S
hare
d)
56 y
ea
rs a
nd A
bo
ve (
Rang
e o
f the
ag
e o
f the
old
est
ad
ult i
n th
e fa
mily
)
MM
+1M
+2M
+3M
+4M
+5Ex
tra
5,00
0,00
063
,301
78,9
5893
,904
108,
173
121,
799
134,
814
21,0
28
2,00
0,00
039
,551
49,3
3358
,672
67,5
8776
,101
84,2
3214
,452
1,00
0,00
036
,116
45,0
4953
,576
61,7
1769
,492
76,9
1713
,197
500,
000
28,1
9235
,165
41,8
2248
,177
54,2
4560
,042
10,3
02
All
Rate
s a
re in
Ke
nya
Shi
lling
s a
nd e
xclu
sive
of 0
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(tr
ain
ing
levy
& p
olic
y ho
lde
rs
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ont
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Sta
mp
Dut
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f Ksh
s 40
is p
aya
ble
up
on
join
ing
the
sc
hem
e (
No
t ap
plic
ab
le a
t re
new
al)
-
My Health, My Life, MY RESOLUTION 7
My
He
alth
, My
Life
, MY
REs
OLU
TIO
N
7
OUTPATIENT COVER
Outpatient Plan Annual Limit
Plan 150 Kshs 150,000
Plan 100 Kshs 100,000
Plan 75 Kshs 75,000
Plan 50 Kshs 50,000
Plan 35 Kshs 35,000
Members can choose to have access to the Resolution Insurance
Enhanced Medical Provider List or standard Medical Provider List
which has restrictions on some providers. They also have an option
of purchasing Outpatient limits that are shared within the family
or allocated per person within the family. Members who opt for the
shared option can only access the Resolution Insurance Standard
Medical Services Providers List
This cover includes the following Outpatient services:
Outpatient consultations Diagnostic examinations Injections and
procedures performed at a primary care level in a doctors
consultation room Prescribed medicines X-rays, laboratory, scans
and MRI Laboratory Antenatal & Postnatal care Minor trauma
treatment Well baby check-ups inclusive of KEPI Immunization
Programme at our selected well baby
clinics only. HIV services
Adherence and nutritional counseling Follow-up every 3months
Prevention of mother to child Transmission (PMTCT) ARVs and
Monitoring Opportunistic infections
Baby friendly vaccines as a benefit to the member child up to a
sublimit of Kshs 20,000 from their outpatient benefit
(Pre-authorization is required)
Notes Co-payment is levied on visits to particular Medical
Service Providers and their branches and
satellite clinics. Authorization must be obtained in advance
from Resolution Insurance in respect of
chemotherapy, radiotherapy, MRI and CAT scans and haemodialysis.
Outpatient HIV services will be obtained at our selected HIV
Comprehensive Care Clinics (List
Available). Service Access will be via Smart Card. Sub-Limit for
Declared Pre-existing conditions is 50% of members outpatient cover
limit. Declared Pre-existing, Congenital & Maternity conditions
are covered if covered on in-patient
cover benefits.
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www.resolution.co.ke8
OUTPATIENT COVER RATEs
Outpatient Plans from Enhanced Medical service Providers
List
Annual Outpatient Limit (Per Person )
Kshs 150,000
Kshs 100,000
Kshs 75,000
Kshs 50,000
Kshs 35,000
Child ( 0 - 18 years) 29,212 22,874 19,879 17,363 13,328
19 - 24 years 30,972 24,240 21,057 18,384 14,097
25 - 34 years 40,284 31,482 27,322 23,827 18,224
35 - 39 years 46,155 36,032 31,248 27,230 20,786
40 - 55 years 53,981 42,099 36,483 31,765 24,200
56 - 64 years 77,462 60,298 52,186 N/A N/A
65 - 69 years (renewal only) 89,202 69,397 60,037 N/A N/A
70 - 79 years (renewal only) 98,986 76,981 N/A N/A N/A
80 years & above (renewal only) 114,640 N/A N/A N/A N/A
Outpatient Plans from standard Medical service Providers
List
ANNUAL OUTPATIENT LIMIT (PER FAMILY)
Kshs150,000
Kshs100,000
Kshs75,000
Kshs50,000
M 41,446 31,455 27,852 23,394
M+1 63,008 46,031 42,528 34,398
M+2 67,667 50,447 46,003 37,945
M+3 78,206 57,831 53,374 43,671
M+4 85,712 63,327 58,736 N/A
M+5 89,576 72,196 61,684 N/A
Co-payment
A co-payment fee of Ksh 500 for outpatient visits to the
following providers is applicable: Nairobi Hospital, all its
Branches and Satellite clinics
Aga Khan University Hospital, Nairobi, all its Branches and
Satellite clinics.
A co-payment fee of Ksh 200 for outpatient visits to the
following providers is applicable: Gertrudes Childrens Hospitals,
all its branches and all its satellite clinics
Mater Hospitals, all its branches and all its satellite
clinics
Nairobi Womens Hospital, all its branches and all its satellite
clinics
AAR Clinics
All Rates are in Kenya Shillings and exclusive of 0.45%
(training levy & policy holders fund) contribution.Stamp Duty
of Kshs 40 is payable upon joining the scheme (Not applicable at
renewal)
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My Health, My Life, MY RESOLUTION 9
OPTIONAL BENEFITs
Dental and Optical cover options are available to members who
have purchased any Resolution Insurance outpatient
plans.Authorization to access these services is required from
Resolution Insurance in advance.These are accessed at selected
Resolution Insurance Medical Service Providers.
Optical Plan
The services covered are: Routine optical consultations
Prescription of frames Prescribed lenses and replacement of lenses
Optical Prescriptions
Dental Plan
The services covered are:
Dental and Optical Rates
Dental Plans Optical Plans
Limit Rates Per Person Limit Rate Per Person
10,000 3,621 10,000 3,931
20,000 7,241 20,000 7,862
30,000 10,862 30,000 11,793
Funeral Expense Cover
This is a benefit paid out to the next of kin on submission of
documents confirming death of the insured member.
Annual Limit Rate per Person
50,000 556
100,000 1,001
150,000 1,502
200,000 2,002
The riders above if purchased must be purchased for every
member/family in the scheme. Riders cannot be purchased for
selected members of the scheme.All Limits and Rates are in Kenya
shillings. Rates are exclusive of 0.45% tax (for training levy and
policy holders fund) contributionStamp Duty of Kshs 40 is payable
upon joining the scheme (Not applicable at renewal)
Consultation Extractions Fillings (except precious metals)
Scaling Dental X-Rays
Dental Prescriptions Crowning Bridging Braces
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www.resolution.co.ke10
Membership Eligibility Age definition: Child: 38 weeks (Full
term and discharged) to 18 years
Adult: 19 years and above Joining Age is 38 weeks (Full term and
discharged) to 64 years. In case of a child born prematurely,
membership shall commence one month from the
date the child ought to have been born full term. Child
applicants must join under a parent or adult guardian Adult
dependant (except the spouse) are required to fill in their own
application forms All new applicants over 50 years will be required
to undergo a Medical Examination at
specific providers prior to being accepted as members. This will
be at the applicants cost.
Members aged 65 years and above are only covered on renewal and
are required to undergo a medical examination annually before each
renewal. This will be at the applicants cost, however, members with
Annual Well person Check Up Benefit can utilize this benefit before
the cover end date.
At the time of application to membership, the applicant must
have been discharged from hospital should there have been an
admission.
Full disclosure of all medical information is mandatory. Failure
to disclose means the member will be terminated with no option for
a refund.
Medical service Access All In and Outpatient services can only
be obtained from our appointed Medical service
Providers as per the plan purchased. These lists are subject to
change from time to time. We currently have over 750 hospitals,
clinics, doctors and other healthcare providers across East
Africa.
Members can choose to have access to the Resolution Insurance
Enhanced Medical Provider List or standard Medical Provider List
which has restrictions on some providers.
Frontline List: Services can be accessed directly from these
providers. Referral List: Services are on referral basis only by a
Frontline provider or through
Resolution Pre-authorization. Members must present their
Resolution Insurance smart 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.
Hospitalization servicesIncludes the following while the member
is hospitalized:
DEFINITIONs
Surgical operations and procedures Professional fees Theatre
fees Anaesthetics for surgery Assistants at operations Ward
accommodation Intensive care and high care units Visits and
consultation by a GP and / or
Specialist (while hospitalized) X-ray and lab (while
hospitalized)
Physiotherapy Ultrasound scans (while hospitalized) MRI and CT
scan (while hospitalized) Blood transfusion Internal prostheses
Medicine dispensed and used in
hospital Medicine dispensed on discharge from
hospital 100% of cost (maximum of 14 days supply)
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My Health, My Life, MY RESOLUTION 11
DEFINITIONs
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 seek written
pre-authorization through the contacts at the back of your Smart
Card.
Members are not required to pay any deposits; Resolution
Insurance will co-ordinate admissions through our existing
arrangements with hospitals and doctors on the medical service
provider list.
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 except in cases of maternity and pregnancy
related admission where it is not applicable. Daily cash payable
for admissions under the pre-existing sublimit will be paid from
the same sublimit. This benefit is only eligible to working
adults.
Home care servicesThis includes home based health and nursing
services provided by visiting professionals such as a nurse,
physiotherapist or home health agency. This benefit is provided
post discharge where medically necessary. Access is subject to
approval and is coordinated by Resolution Insurance
Pre-authorization Team. The service is limited to a maximum of 90
days per membership year.
Lodger feeLodger fee is an accommodation charge for a parent or
guardian accompanying a child up to 10 years of age during an
admission.
Maternity BenefitThis includes:
Waiting periods All membership benefits commence after the
waiting period has been served
except for hospitalization following an accident, which is
covered from the date of commencement of cover.
21 days waiting period for all outpatient services. 30 days
waiting period for all illness admissions. Chronic conditions
diagnosed within 6 months of joining are considered pre-existing
and
shall be covered under pre-existing conditions 10 months waiting
period for all maternity services and pregnancy related conditions.
10 months waiting period from the start date for cataract, lipoma
and hernia surgeries;
myomectomy; adenoidectomy; tonsillectomy; hysterectomy and any
treatment for related conditions.
12 months waiting period for psychiatric, declared pre-existing,
HIV/AIDS, cancer & congenital conditions and all related
conditions.
Inpatient cost incurred for normal and caesarean deliveries
Labour and recovery wards Professional fees Pregnancy &
Maternity related
hospitalization
Other related ailments and complications including ectopic
pregnancies and miscarriages.
Home deliveries Lamaze classes (pre-authorization
required)
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www.resolution.co.ke12
Annual Well Person Check-up Benefits (For Principal & Spouse
Only) Annual Well person check up that includes the following:
i. Comprehensive History & physical exam
ii. Random blood sugar
iii. Urea, Electrolytes creatinine (kidney functions)
iv. Liver function test
v. Stool for occult
vi. ECG
Nutritional consultation: One consultation per year Lipid
profile: One test per year Pap smear: One test per year for women
Mammogram: One test every two years for Women Prostate Cancer
screening: One test per year for men.
To access the services above, members are required to contact us
through the contacts appearing at the back of your smart card.These
services are only available at selected providers on the Resolution
Medical Service Provider List.
Changes To & Cancellation of Membership Any changes to
membership can only be made within the first 30 days from the date
of
commencement of cover as communicated by Resolution Insurance.
This is provided that no claims have been incurred.
Premium is non-refundable after 30 days of commencement of
cover. 80% of premium is refundable in case of cancellation within
30 days of cover
commencement date if no claims have been incurred.
International Emergency Cover International emergency cover
where applicable is limited to 60 days per membership
year and caters for emergency admissions only. All emergencies
that arise out of any condition that is subject to a sublimit
(stated as per
cover plan) will be covered upto the applicable sublimit.
Overseas Evacuation Cover Overseas evacuation cover only applies
in cases where treatment is not available locally and
the same must be authorized and arranged by Resolution
Insurance.
Notes All members of a family will be required to take up the
same product line. Dependants
are not allowed to have higher benefits than the principal
member. Our product lines are Value Plans and Harmony Plans.
New Born Baby Illness Cover is a benefit under the mothers
annual limit if the mother is eligible for maternity benefit. It
covers care for babies born prematurely, illness after birth and
before discharge.
Personal Accident cover provides accidental death, permanent
total disability(PTD) or critical illness benefit. Child guard is a
Personal Accident cover for children. These vary as per plan
selected.
The Personal Accident claim on Death, PTD and Critical Illness,
is payable only on one of the benefits and is limited to once in a
lifetime.
Recovery of over utilization amounts: Member/applicants
undertake to repay the scheme any amounts paid under circumstances
where no benefits were payable under
DEFINITIONs
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My Health, My Life, MY RESOLUTION 13
DEFINITIONs
the terms and conditions of the scheme. Acknowledgment should be
on the form. Rehabilitation benefit includes aiding a member,
following an admission due to illness or
accident using medically necessary practices to manage their
current medical status. A consultant has to confirm in writing that
rehabilitation is required.
i. Services offered are Physiotherapy services, Occupational
Therapy and Post Admission Consultation Reviews.
ii. Rehabilitation is subject to a specific number of days, or a
sublimit whichever occurs earlier.
External Prosthesis as an in-patient benefit covered up to Kshs
100,000
Third party recovery: Where costs incurred are recoverable from
a third party, the Member shall facilitate Resolution Insurance
involvement to ensure it recovers such costs from and through all
relevant parties.
Continuous Resolution membership means having been on cover with
Resolution insurance for consecutive years with no lapses in
between cover periods. Once a member lapses, they reapply as new
members.
A Pre-existing condition refers to a medical condition (whether
declared or not) of which a member was aware, or in the companys
opinion, ought to have known existed prior to becoming member.
Please note that cover for Pre-existing conditions is subject to
medical underwriting and that not all pre-existing conditions will
be covered.
A congenital condition is a genetic, physical or (bio) chemical
defect, disease or malformation which may be either
hereditary/familial or due to an influence during intra uterine
development of the foetus and which may or may not be obvious at
birth.
* New applicants under the Cancer sublimit is any member who
joins Resolution Insurance after June 2014
MEMBER ACCEPTANCE Is sUBJECT TO MEDICAL UNDERWRITING Membership
only becomes effective after approval of the application and
written
confirmation of terms by Resolution Insurance; not withstanding
the fact that payment may have been received.
Application processing will only commence once ALL application
requirements have been received. These are:
Fully completed and personally signed Resolution Insurance
Membership Application Form - Any alterations MUST be counter
signed
One Passport size photo for each applicant
Copies of ID card or passport for all adult applicants
Premium Payment to Resolution Insurance
Medical Examination Report for applicants above 50 years
Dependants above 19 years must complete own application form
except for full time students who must provide proof of full time
student status
Resolution Insurance is not liable for any medical expenses
incurred before an application is formally approved by Resolution
Insurance
Cover benefits, limits and terms may be altered during the
application process. These will be communicated in the policy
document depending on the applicants medical
history/information.
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www.resolution.co.ke14
Exclusions1. All expenses associated with Dental services and
Optical services unless covered under
the plan or purchased separately.
2. Pre-existing cancer is not covered including cancer diagnosed
within six months of joining.
3. Compensation for pain and suffering; loss of income; funeral
expenses or claims for damages; expenditure incurred by a member or
dependants arising from any illegal or criminal act.
4. Expenses arising from injuries sustained as a result of
participation in and not limited to professional sport or hazardous
pursuits such as motor racing, skydiving, parachute jumping and
bungee jumping.
5. Operations, treatments and/or procedures of own choice for
purely cosmetic purposes, eating disorders, obesity and related
illnesses, and any complications that may arise thereof.
6. Expenses incurred from recuperative or convalescent
holidays.
7. All expenses in respect of illness or conditions that were
subject to waiting periods when the member joined the Scheme and
where the diagnosis for such illness occurred during the waiting
period.
8. Purchase of:
9.1. Applicators, toiletries, sunglasses and/or lenses for
sunglasses and beauty preparations;
9.2. Patented foods and nutritional supplements including baby
foods;
9.3. Contraceptive preparations, remedies and devices;
9.4. Tonics, slimming preparations, appetite suppressants and
drugs as advertised to the public for the specific treatment of
obesity;
9.5. Sunscreen and sun tanning lotions, emollients, soaps and
shampoos (medicinal or otherwise);
9.6. Household and biochemical remedies which are not promoted
by the medical profession;
9.7. Cosmetic products (medicinal or otherwise); anti-habit
forming products; vitamins and multi-vitamins (unless prescribed
for documented deficiency);
9.8. Remedies for body building purposes;
9.9. Aphrodisiacs;
9.10. Patent medicines and proprietary preparations; household
bandages, cotton wool, dressings and similar aids.
9.11. Monitoring and assistive devices including Blood Pressure
machines, glucometers and thermometers.
9. Investigation and treatment for infertility and
impotence.
10. Vaccinations and/or immunizations and other preventive
treatments with the exemption of KEPI.
11. Services arising from an accident or event of which the
member or dependants has received, or is likely to receive,
compensation from any source whatsoever including NHIF and employer
liability insurance.
12. Any treatment relating to an accident/illness which occurred
while the member was intoxicated or was under the influence of
alcohol or drugs (unless prescribed and taken according to the
instructions of a medical practitioner).
13. Dialysis of any kind (except for acute renal failure).
EXCLUsIONs
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My Health, My Life, MY RESOLUTION 15
EXCLUsIONs
14. All expenses associated with sickle cell disease, connective
tissue diseases, auto immune diseases, muscular dystrophies,
Systemic lupus erythematosus, Alzheimers disease and autism.
15. Treatment or services rendered in respect of dependence
producing substances and their complications.
16. Exercising and/or guidance programmes inclusive of antenatal
exercises, special diets and weight control.
17. Kilometers charges and traveling expenses with the exception
of ambulance services as per plan benefits.
18. Gold or other precious metal inlays in dentures.
19. Hormonal Replacement Therapy.
20. Examinations or check-ups such as general health
examinations not related to diagnosis of sickness or accidental
bodily injury unless explicitly agreed in writing by Resolution
Insurance.
21. Accommodation in convalescent or old age homes or similar
institutions catering for the aged.
22. Costs associated with Vocational Guidance, Child Guidance,
and Marriage Guidance.
23. Cost of alternative therapy including chiropractic,
acupuncture, herbal treatment and any complication arising as a
result thereof.
24. Laser treatment
25. Illness, injury or disablement directly or indirectly caused
by or contributed to by:
26.1. Active participation in Civil war, riots, rebellion,
revolution, insurrection or political activity.
26.2. Any declared or undeclared war, invasion, act of foreign
enemy, hostilities or war like operations.
26.3. Nuclear fusion, ionizing or non-ionizing radiation.
26.4. Operating, learning to operate or serving as a Member of a
crew of any aircraft being used for sky-diving, racing, testing or
exploration.
26.5. Participation in Naval, Military, Air Force, Paramilitary,
Police or Police Reserve service or operations.
26.6. Attempted suicide or self-injury deemed deliberate by
Resolution Insurance
26.7. The willful non-compliance on the part of the member with
Resolution Insurances appointed doctors prescribed treatment.
26. Allergy tests.
27. Costs incurred by a member at a Medical Service Provider not
approved by Resolution Insurance.
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REsOLUTION INsURANCE COMPANY LIMITEDHEAD OFFICE: Parkfield
Place, Muthangari Drive, Off Waiyaki Way, WestlandsP.O. Box 4469
00100, Nairobi, Kenya | Tel No: +254 20 2894 000, +254 20 3874
774Mobile: +254 722 200 025, +254 724 635 001, +254 734 600 886 |
Fax: +254 20 2894 210
NATION CENTRE: 13th Floor, Kimathi Street, Nairobi CBD | Tel:
+254-20-2260 000
MOMBAsA BRANCH: 1st Floor Harbour House, North Wing, P.O. Box
99769 - 80107, Mombasa Tel: +254-41-2221051, +254-41-2230454, +
254-41-2229343Mobile: +254-724-635002
KIsUMU AGENCY: Ground Floor Mega City, P.O. Box 106-40123
Kisumu,Tel: +254-57-2025211, +254-57-2025222 | Mobile:
+254-729-476276
MERU AGENCY: Upper Ground Floor, Hart Towers, Njuri Ncheke
Street,P. O. Box 3020-60200 Meru | Tel: +254-64-31107
AGENT CONTACT DETAILs
June
201
4
Our Business Consultants, Brokers and Agents are available to
meet with you at your convenience to take you through our
products.
RI/UW/PL/01 Rev.5
@ResolutionKE Resolution Insurance -Kenya ResolutionKE
EMAIL: [email protected]|WEBsITE: www.resolution.co.ke
Our BUY ONLINE portal is a web based application that allows you
to purchase Medical Insurance
Plans tailor made for you. The site is designed for purchase of
individual medical plans.
Log on to our website www.resolution.co.ke
Our BUY ONLINE portal is a web based application that allows you
to purchase Medical Insurance
Plans tailor made for you. The site is designed for purchase of
individual medical plans.
Log on to our website www.resolution.co.ke
Our BUY ONLINE portal is a web based application that allows you
to purchase Medical Insurance
Plans tailor made for you. The site is designed for purchase of
individual medical plans.
Log on to our website www.resolution.co.ke