Jubilee Health Insurance Medical Cover

One of the forerunners in the formation, the Jubilee Insurance Company of Kenya was founded on August 3, 1937, in a modest office in Mombasa.

Jubilee Insurance took the risky step of becoming a public corporation, in keeping with its goal of assisting in the region’s economic progress. To increase its local ownership base, which presently has more than 5,000 stockholders, in 1984. Today marks the Jubilee of more than 75 years since its founding.

A significant insurance provider in East Africa, Jubilee Insurance places a strong emphasis on policyholder protection and information. It has the greatest shareholder money. Technology, devoted, experienced, and professional employees, as well as a track record of providing excellent customer service.

Jubilee J Care Medical Insurance

With J-Care medical insurance, our clients have the freedom to select the facility and kind of care that best suits them. Adults between the ages of 18 and 60, as well as children between the ages of 1 month and 17 years, are eligible members for this coverage.

N/B: Before membership and eligibility for coverage may be confirmed, members over 50 must have a medical exam at a designated medical facility. Please be aware that this will be at the expense of the applicant.

Jubilee Medical Insurance Benefits

1. Five levels of complete coverage with add-on advantages (maternity, outpatient, dental and optical). Pick the strategy and features that best meet your needs and financial constraints for medical insurance.
2. Protection against pre-existing, persistent, mental health, congenital, and HIV/AIDS conditions, as well as their linked conditions.
3. Nationwide network of providers
4. Credit-covered overseas inpatient referrals from hospitals on the list
5. Pay for inpatient dental and vision care

6. Benefit following hospitalization

7. Benefit of funeral expenditures
8. Direct access to care while travelling throughout East Africa

9. Free Personal Accident Benefit for Principle Member

Jubilee Insurance Cost and Plans

J-CARE
INDIVIDUAL/FAMILY MEDICAL INSURANCE
INPATIENT BENEFITS (CORE PRODUCT – COMPULSORY)
All inpatient treatment is subject to pre authorisation
All benefits are subject to overall annual benefit unless specified otherwise. Amounts shown in in Kenya Shillings
CLASSIC PREMIER ADVANCED EXECUTIVE ROYAL
Overall benefit limits in KES per insured family per

annum

500,000 1,000,000 2,000,000 3,000,000 5,000,000
Pre -existing and/or chronic conditions, gynaecological conditions, Hernias, Haemorrhoids, Thyroidectomy, Adenoidectomy, congenital, organ transplant, HIV/AIDS and related conditions existing/not existing and/or not diagnosed at the time of joining.

(1 year waiting period)

 

 

 

250,000

 

 

 

300,000

 

 

 

400,000

 

 

 

500,000

 

 

 

1,000,000

Cancer treatment subject to above conditions (2 years waiting period)
Psychiatric conditions subject to above conditions (1 year waiting period) 100,000 200,000 250,000 300,000 500,000
Pre maturity – for child born to an existing member who has completed 1 year waiting period on maternity benefit  

50,000

 

100,000

 

150,000

 

200,000

 

250,000

Bed Limits per day. NHIF rebate will be applied on the limits shown General Ward

Bed

General Ward

Bed

General Ward

Bed

Standard Private

Room up to KShs. 12,500

Standard Private

Room up to KShs. 18,000

Lodger fees for parent accompanying sick child member Covered for child under 10

years

Covered for child under 10

years

Covered for child under 10

years

Covered for child under 10

years

Covered for child under 10

years

Physicians, specialists, surgical fees including anaesthetist fees, theatre charges, HDU, CCU & ICU, diagnostic tests, physiotherapy as part of inpatient treatment  

Covered

 

Covered

 

Covered

 

Covered

 

Covered

Inpatient MRI/CT Scans and PET Scans (subject to pre authorisation) Covered Covered Covered Covered Covered
Surgical appliances/internal prosthesis Covered Covered Covered Covered Covered
Reconstructive surgery following an accident Covered Covered Covered Covered Covered
Inpatient non accidental related dental surgery/ treatment (1 year waiting period) 100,000 100,000 100,000 100,000 100,000
Inpatient dental surgery from an accident Covered Covered Covered Covered Covered
Inpatient opthalmology surgery as a result of an accident Covered Covered Covered Covered Covered
Inpatient non accident related eye treatment (excluding correction of refractive errors and laser treatment) (1 year waiting period)  

100,000

 

100,000

 

100,000

 

100,000

 

100,000

Day case admission Covered under relevant sub-limit Covered under relevant sub-limit Covered under relevant sub-limit Covered under relevant sub-limit Covered under relevant sub-limit
Medically necessary home nursing (subject to pre authorisation) 45 days 45 days 45 days 45 days 45 days
Post hospitalisation treatment/review – up to 3 weeks after discharge from hospital up to Kes. 10,000 up to Kes. 15,000 up to Kes. 20,000 up to Kes. 25,000 up to Kes. 30,000
Take home prescribed medication after discharge from hospital up to 30 days after discharge up to 30 days after discharge up to 30 days after discharge up to 30 days after discharge up to 30 days after discharge
OTHER BENEFITS INCLUDED WITHIN INPATIENT COVER
All benefits are subject to overall annual benefit unless specified otherwise. Benefits/treatment subject to pre authorisation
Medically necessary local road ambulance leading to

admission in hospital

Covered Covered Covered Covered Covered
Commercial Air Evacuation out of Kenya (must be pre authorised) for inpatient treatment not available locally or not safe to undertake locally  

Not applicable

 

Not applicable

Economy return fare only within Africa, India and

Pakistan

Economy return fare only within Africa, India and

Pakistan

Economy return fare only within Africa, India and

Pakistan

Last Expense (free for principal member, optional for dependents). 50,000 50,000 75,000 100,000 100,000
Personal Accident (Free for principal member, optional for dependents over 18 years) 500,000 500,000 500,000 500,000 500,000
OUTPATIENT BENEFITS (OPTIONAL)
Annual limits per person only 50,000 50,000 80,000 100,000 150,000
Consultation fees for GP (doctors on panel) Covered Covered Covered Covered Covered

 

Consultation fees for Specialist on referral only (doctors on panel) Covered Covered Covered Covered Covered
Pathology, Xrays, MRI, CT Scan and other necessary diagnostic tests (pre authorisation required) Covered Covered Covered Covered Covered
Prescription drugs and dressings upto a maximum of 30 days dosage Covered Covered Covered Covered Covered
Pre -existing and/or chronic conditions, gynaecological conditions, Hernias, Haemorrhoids, Thyroidectomy, Adenoidectomy,Psychiatric, congenital, organ transplant, HIV/AIDS and related conditions existing/ not existing and/or not diagnosed at the time of joining. Subject to full disclosure at the time of joining. (1 year

waiting period)

 

 

Covered

 

 

Covered

 

 

Covered

 

 

Covered

 

 

Covered

Cancer treatment (2 years waiting period) Covered Covered Covered Covered Covered
KEPI/Baby Friendly Vaccinations Physiotherapy (pre authorisation required) up to 5,000 up to 5,000

Covered

up to 5,000 up to 5,000

Covered

up to 5,000

Covered

Covered Covered
Pre-natal & Ante-natal outpatient treatment (1 Year waiting period). Only applicable if maternity benefits

have been purchased.

Covered up to

5,000

 

up to 5,000

 

up to 5,000

 

up to 5,000

 

up to 5,000

ROUTINE MATERNITY BENEFITS (OPTIONAL)
Annual limits per member/spouse 80,000 100,000 120,000 120,000 150,000
Benefits covered under maternity limit (1 year waiting period). Excludes expenses related to the new born Normal and C-Section delivery. Labour/recovery ward, professional fees, pregnancy/ maternity related hospitalisation, other related ailments & complications including etopic pregnancy and miscarriage.
ROUTINE DENTAL BENEFITS (OPTIONAL) *
Annual Limit per person only 5,000 10,000 20,000 30,000 40,000
Benefits covered (pre-authorisation required) Dental Consultations, Extractions, Fillings, Dental Xrays and Prescriptions. Removal of impacted or buried teeth and root canal treatment.
ROUTINE OPTICAL BENEFITS (OPTIONAL) *
Annual Limit per person only 5,000 10,000 20,000 30,000 40,000
Benefits covered subject to pre-authorisation 1 eye test per person per annum. Frames and prescription lenses
Frames limit (1 every 2 years) Up to full optical limit Kes. 10,000/- per frame
VALUE ADDITIONS
Automatic enrolment to Jubilee Health Insurance Wellness Club Free Jubilee Health Wellness Card (smart card)

Jubilee Medical Insurance PROVIDER PANEL

The provider panel for Jubilee Health Insurance gives members access to the essential medical care on a credit basis, which means that as long as the procedure is covered and pre-authorized as needed, the bill will be paid directly to the service provider within reasonable and customary timeframes. This enables members to receive high-quality care as needed.

The provider panel will be included in the membership box once the insurance is purchased, and it can also be accessible online through the customer portal or website of Jubilee Health Insurance. Members are also urged to register for this online portal, which will give them access to information on claims, medical benefits, and other topics.

Jubilee Medical Insurance Application for Coverage

Fill up and sign the member application form to request coverage. Send it in with the necessary supplemental documentation. After receiving your application, Jubilee Health Insurance will respond within 3 working days and confirm the terms and conditions in writing.

When the payment is fully paid, the policy will go into force. Where applicable, waiting periods will begin on the later of the policy’s effective date or the date the benefit is purchased.

Jubilee Health Insurance Overseas inpatient referrals

Jubilee Health Insurance covers treatment at overseas Hospitals. Many patients from Kenya travel to abroad for advanced medical treatment. Jubilee medical Insurance covers Inpatients bills for different types of treatment including Cancer, Bone Marrow Transplant, Kidney Transplant, Liver Transplant, Radiation Therapy, many advanced surgeries.

Jubilee Medical Insurance Key Benefits

According to the benefit options you selected and as described in the acceptance letter and policy document, you will be covered.

Your membership pack will include a list of providers and experts. The Jubilee Health Insurance website offers access to the same information. For more help, you may also contact our offices directly.

There will be a list of doctors and specialists available, and clients online or on the Jubilee Health Insurance website can also access it. Always keep your national ID or passport on hand for identification and verification, as well as your Jubilee Health Insurance medical card.

Some of the waiting periods may be waived, allowing for a smooth transition, subject to the underwriting procedures and with no disruption in cover.

Jubilee Medical Insurance treatment Abroad

If an emergency illness or accidental injury happens while travelling, a member is covered while temporarily overseas and in need of emergency treatment, provided that the total length of the trip does not exceed six weeks. This coverage is offered on a reimbursement basis. The expense of travel and lodging is not covered.

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