Having health insurance is important for several reasons. Uninsured people receive less medical care and less timely care, they have worse health outcomes, and lack of insurance is a fiscal burden for them and their families.
No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and offers many other important benefits.
- Health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents
- Health insurance protects you from unexpected, high medical costs.
- You pay less for covered in-network health care, even before you meet your deductible.
- You get free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible.
- If you have a Marketplace plan or other qualifying coverage, you don’t have to pay the penalty that people without coverage must pay.
Pioneer Medlife is the solution for all this problems. It has Life as the main cover and Inpatient medical as a core rider.
- It is a life policy that provides medical as a rider
- It covers inpatient only and does not cover out patient at all
- It does not cover chronic illness and maternity or any maternity related issues
- Medical cover limits are a minimum of Kshs. 100,000.00 and a maximum of Kshs. 500,000.00.
Death of Policyholder during policy term – On death of the main policyholder due to Natural or Accidental causes during the policy period, the Policy will pay the full sum assured.
- Age at entry: children from one (1) month to adults of fifty-five (55) years. Joining between 50 years to 55 years requires a medical examination report (MER).
> Children between 18 to 21 years need to prove that they are still in school/college)
- Covered dependants – one legal spouse, own or legally adopted or foster children
- Term: Minimum term=5 years and Maximum term= Up to age 70
- Waiting period: A waiting period of 90 days will apply for illnesses and 120 days for surgery. There will be no waiting period for benefits payable on accidental death; however a six month waiting period will apply for deaths due to natural causes.
- Identification: All persons qualifying for membership shall be issued with PHOTO-CARDS upon production of their latest passport-size coloured photographs through the Insured. The cards shall be the only mode of identification at the appointed medical facilities and any loss must be reported to PIONEER immediately for replacement (at the insured’s cost). Members without photo-cards will only be treated once written authorization has been given from PIONEER. (NB: In addition to the membership card any other form of identification may be requested for if necessary)
- No Claims Discount: Where the family does not make any claim within a given period, the applicant will be entitled to a no-claims discount as tabulated below. The discount will be paid in cash for check-off & Banker’s order cases and in form of reduced premium at renewal for cash cases.
Years without a claim Discount rate on premium* 3 20% 4 25% 5+ 30%
7. Income on Hospitalization: The policy also incorporates an additional income on hospitalization benefit at the rate of KShs. 500 from the third day of hospitalization up to the 14th day. This benefit will be paid only when the applicant (not dependant) is hospitalized.
8. Riders: The policy offers a funeral expense rider based on the current premium rates. This benefit is compulsory to the spouse and must be at least half of the life cover but its optional for the principal and should not exceed ten times the annual premium.
Preferred medical service providers: A comprehensive list of reputable hospitals is provided as attached