AAR RETAIL MEDICAL PLANFOR FAMILIES AND INDIVIDUALS

AAR Medical Insurance product is run by a team of medical and insurance personnel who guarantee quality and efficient services. Below are cover benefits for our retail medical plan.

Cover Benefits

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Overall Inpatient Benefit

40,000,000.00

20,000,000.00 12,000,000.00

8,000,000.00

3,000,000.00

1,000,000.00

Accident Benefit

20,000,000.00

10,000,000.00

8,000,000.00

6,000,000.00

2,000,000.00

500,000.00

Illness Benefit 20,000,000.00

10,000,000.00

4,000,000.00

2,000,000.00

1,000,000.00

500,000.00

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Chronic and Pre-existing Conditions (andrelated conditions)

5,000,000.00

1,000,000.00 750,000

500,000.00

300,000.00

150,000.00

Maternity Limit (For principal or Spouse only)

500,000.00

200,000.00 150,000.00 100,000.00

75,000.00

50,000.00

Bed limit per night

40,000.00

25,000.00

15,000.00

12,000.00

8,000.00

6,000.00

Congenital Limit

500,000.00

250,000.00

200,000.00

150,000.00

100,000.00

50,000.00

Psychiatric Limit

500,000.00

250,000.00

200,000.00 150,000.00

100,000.00

50,000.00

Accidentaldamage to eyes

Dental IllnessLimit

Accidentaldamage tonatural teeth

OPTOMETRY :INPATIENT

DENTALTREATMENT:INPATIENT

100% in Network

100% in Network 100% in Network

100% in Network

100% in Network

100% in Network

100% in Network 100% in Network 100% in Network

100% in Network

100% in Network

100% in Network

Optical illnessLimit

KES 75,000

KES 75,000

KES 75,000

KES 75,000

KES 75,000

KES 75,000

KES 100,000

KES 100,000

KES 100,000

KES 100,000

KES 100,000

KES 100,000

1,000,000.00

1,000,000.00

Funeral Expenses

200,000.00

175,000.00

150,000.00

125,000.00

100,000.00

50,000.00

Personal accident cover(Death)

OutpatientCover Limits

250,000.00

Sub-limits within Outpatient Cover

200,000.00 150,000.00

100,000.00

75,000.00 50,000.00

Dental 25,000.00

20,000.00

15,000.00

10,000.00

7,500.00

5,000.00

Optical 25,000.00

20,000.00

15,000.00

10,000.00

7,500.00

5,000.00

Annual Check up 25,000.00

20,000.00

15,000.00

10,000.00

7,500.00

2,500.00

General information about the cover.

Outpatient

Eligible dependents include;

Spouse Children below the age of 18 years. Children above 18 years old to 25 years with proof of full time schooling. 3

Access to Inpatient and outpatient services.

Waiting Periods

All services must be within our contracted provider’s panel.

We have contracted a wide range of healthcare providers including hospitals, clinics, doctors and specialists. List of providers is available on www.aar-insurance.com

All emergency admissions should be reported to AAR Insurance within 24 hours.

Scheduled admissions should be reported to AAR Insurance at least 48hours prior to the admissions.

14 days waiting period for outpatient services

Two months waiting period for inpatient illness admission

No waiting period for accident services and admission

12 months waiting period for Congenital, Chronic and pre-existing conditions.

12 Months waiting period for maternity hospitalization

5 years waiting period for Organ transplant

4

Co-payment (Visit –Fee) for outpatient services

Exclusions

i. Co-payment of Ksh. 500 for outpatient services at AAR Healthcare clinic, Nairobi Hospital, Aga Khan Hospitals, Mater hospital, Karen Hospital, M.P Shah Hospital and Gertrudes Children’s hospital.

ii. Co-payment of Ksh.200 in all other providers in our extensive provider network other than the ones listed in (i) above.

Expenses recoverable under any other insurance including NHIF.

Hearing Aids.

War invasion, civil war, riots and act of terrorism.

Cost resulting from Intentional self-injury, suicide or attempted suicide, drug addiction, intoxication, drunkenness.

Cost of cosmetic surgery unless caused by accident.

Family planning and fertility treatment i.e. costs of treatment related to infertility and impotence.

Cost resulting from riding or driving in any kind of race and participation in extreme sports.

The following exclusions apply.

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Exclusions

Stays at sanatoria, old age homes, places of rest etc

Chiropractors, acupuncturists herbalists treatment or other forms of alternative treatment

Dentures, bridges and plates unless damage to the said dentures bridges and plates becomes necessary as the result of bodily injury sustained by the member caused solely and directly by accidental external and visible means.

The cost of orthodontic treatment of a cosmetic nature unless such treatment becomes necessary as the result of bodily injury sustained by the member caused solely and directly by accidental external and visible means or as a result of disease other than normal decay.

Maternity services other than for the principal or Spouse.

Vaccinations & Immunizations other than KEPI recommended regime.

Treatment incurred as a result of the removal of a donor organ from a donor, or treatment for removal of an organ from an insured person for purposes of transplantation into another person and any complications arising thereafter.

All costs for the boarding of the parent for children over Eight (8) years.

Contact lenses and Laser correction of eyesight.

All forms of shampoos, soaps, herbal products whether prescribed or requested.

Beauty treatment in nature cure clinics or health hydro

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Reimbursement Procedures

In case of a reimbursement, the following requisite documents should be submitted within 30 days from date of service for claim processing:

Original receipts attached.(Breakdown of receipts should be provided i.e. specific service items and specific charge per item i.e. consultation cost, investigation cost and drugs issued and cost per drug)

Stamped medical report and/or claim form filled in by the visited provider clearly indicating the diagnosis and treatment given.

Reason for seeking reimbursement indicated in writing.

Full bank details provided indicating bank name, account number, account name and branch of payee.

All Inpatient reimbursement claims require pre authorization from the insurer.

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1. What is a chronic and recurrent condition?An illness or injury which has at least one of the following characteristics:

o Has no known cureo Is likely to recur.o Requires palliative treatment o Needs prolonged monitoring/treatment o Requires specialist training or rehabilitation o Is caused by changes to the body that cannot be reversed. o Leads to permanent disability

2. What are pre-existing conditions? These are conditions that one has sought treatment for or had symptoms ofor diagnosed & treated prior to the inception or renewal of the policy or priorto upgrading from one health plan to another.

3. What are congenital conditions? Birth disorders and/or illnesses occurring as a result of genetic predisposition.

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AAR CONTACTS

Safaricom -0730 633 000Orange - 020 2895000Airtel - 0703 063 000

AAR EMERGENCY NUMBERS.0703 063333020 2895333