Medical service Access
- All in and outpatient services can only be obtained from our appointed Medical service Providers. This list is subject to change from time to time. We currently have over 600 hospitals, clinics, doctors and other healthcare providers across East Africa.
- Frontline list: Services can be accessed directly from these providers.
- Members must present their Resolution Insurance Membership 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.
- Age Definition:
- Child: 30 days to 18 years
- Adult: 19 years and above
- Value Plans: Joining Age is 30days to 64 years. Members aged 65 years and above are only covered on renewal and are required to undergo a medical examination annually before each renewal.
- 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 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 applicant’s cost.
- In case of a child born prematurely, membership shall commence one month from the date the child ought to have been born full term.
- At the time of application to membership, the child ought to have been discharged from hospital.
- 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 notify our care management team to obtain written authorizations for medical services above.
- Members are not required to pay any deposits; Resolution Insurance will co-ordinate admissions through our existing arrangements with hospitals.
- Admission will strictly be by doctors on our select panel as per our Medical Service Providers list.
- Daily cash is applicable after 3 days of admission up to a maximum of 180 days. For benefits with defined sub limits, the daily cash is payable within the sublimit except in cases of maternity and pregnancy related admission where it is not applicable. This benefit is only eligible to working adults.
Annual Well Person Benefits
- Annual Well Person check-up that includes the following:
- Comprehensive History and Physical exam
- Random blood sugar
- Urea, electrolytes* creatinine (kidney functions)
- Liver function test
- Stool for occult
- Nutritional consultation: One consultation per year
- Lipid Profile: One test per year
- Pap Smear: One test per year for women aged 18 and above
- Mammogram: For women aged 40 and above one test every two years
- Prostate cancer screening: one test per year for men aged 50 and above
- Waiting periods are effective from the start date issued by Resolution Insurance 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 for accidents, which are covered from the start date.
- Any medical condition diagnosed during the waiting period will be considered preexisting and not be covered.
- 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.
- Chronic conditions diagnosed within 6 months of joining are considered pre-existing.
- Critical Illness cover has 60 days waiting period.
Inpatient hospitalization services
Including the following while the member is hospitalized:
- 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 pathology (while hospitalized)
- 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)
Out Patient service access
- Authorization must be obtained in advance from Resolution Insurance in respect of chemotherapy, radiotherapy, MRI and CT scan, hospice care, haemodialysis, physiotherapy, dental, optical and annual well person checkups.
Changes To & cancellation of Membership
- Any changes to the membership can only be made within the first 30 days from cover start date issued by Resolution Insurance provided that no claims have been incurred.
- Premium is non-refundable after 30 days of approved cover start date.
- 80% of premium is refundable in case of cancellation within 30 days of cover start date if no claims have been incurred.
- International emergency cover where applicable is limited to 60 days per membership year and caters for emergency admissions only. North America is covered up to 50% of the inpatient cover limit.
- 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 only applies to cases whereby treatment is not available locally and must be authorized and arranged by Resolution Insurance Care Management.
- Access to annual Well person checkups is at selected Medical Service Centres only. The service has to be pre-authorised by Resolution Insurance Care Management.
- At the time of application to membership, the applicant ought to have been discharged from hospital.
- Lodger fee for a parent or guardian accompanying a child below 6 years during an admission.
- Personal accident cover caters for accidental death, permanent total disability (PTD) and critical illness. 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 given and is limited to once in a lifetime.
- 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.
- Services offered are Physiotherapy services, Occupational Therapy and Post Admission Consultation Reviews.
- Rehabilitation is subject to a specific number of days, or a sublimit whichever occurs earlier.
- 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.
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:
- Resolution Insurance Membership Application Form – Kindly ensure you complete all questions and personally sign the form. Any alterations MUST be counter signed
- Two Passport size photos for each applicant
- Copies of Voters Card, ID card or passport for all adult applicants
- Premium Payment
- Medical Examination Report for applicants above 50 years
- Dependants above 19 years must fill in own application form
- Any dependant above 18 years 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 depending on applicants medical history/information.