1. 2015
Dear Sir/Madam,
RE: MEDICAL COVER PROPOSAL
One of the best things about Medical insurance is the fact that it offers something that is very hard to find:
peace of mind.
Resolution Insurance Limited (RIL) is an Insurance Provider that employs managed care principles in the
provision of its products and services.
We can help—as an established insurance company, our goal is to provide each and every one of our
members with a policy that perfectly suits their Individual or Corporate needs.
WHAT WE WOULD LIKE TO DO FOR YOU
Our aim is to offer you customized medical cover, where you will have no more headaches regarding where
to go for medical services or how to pay your medical bills should you need to. This, we will do by making
sure that we serve you beyond your expectations. Some of the exceptional features of our medical scheme
approach include:
• Giving you a wide range of the best hospitals that you can choose from.
• Giving you a list of private competent doctors or clinics that you can adopt and make any of the
doctors your own family doctor.
• Provide you with an extensive directory of specialists and General Practitioners for consultations.
• Ensuring that you no longer need to worry about how much it will cost you, be it for consultation, x-
ray, biological tests, medication or even admission.
• Provide you with a wide variety of products and benefits to choose from.
• Offer you overwhelming benefits to go with your product of choice.
• Most significantly, guiding you to identify appropriate product that will satisfy your staff or family
healthcare needs.

2. WHAT MAKES US DIFFERENT?
1. Well capitalized: At RIL we have exceeded the minimum laid out capitalization requirement by the
Government & Commissioner of Insurance to the tune of Kshs.40 million, which is over a hundred
percent above the recommended minimum. As a buffer to the above, we have also put in place a
professional indemnity cover whose limit is Kshs. 20 million.
2. Reliability & security of clients’ premium: We are fully insured (100%) and do not retain any risk in our
books. Our Health plans are arranged with the top rated re-insurer First Reinsurance Brokers a
subsidiary of Pacific Group.
3. Flexibility on choice of Hospitals and Network of Clinics: RIL has developed and is continually
developing a wide network of service providers with all the major hospitals and specialists. We
currently provide the widest network of Service providers within Nairobi, countrywide and the smaller
East African region. We are only involved in health care financing and employee related benefits
which are our core businesses, thereby ensuring independence in evaluating services provided to
our clients.
4. Our team consists of well trained, motivated and innovative personnel. Our product innovation team
is in constant consultation with appointed actuaries and underwriters.
Our aim is to develop a mutually beneficial relationship with your organization in a partnership that
guarantees tailor made quality healthcare provision to your staff and their dependants, depending on your
medical insurance needs.
I look forward to an appointment at your convenience to further expound on the various products and
benefits that you would gain from our services. Do find below;
1. Our Company Profile
2. Our Benefits and Services
Yours Sincerely,
Ephantus Gachoka
Business Consultant
Resolution Insurance Ltd.
Parkfield Place, Muthangari Drive, Off Waiyaki Way
Westlands
P. O. BOX 4469-00100.
Mobile +254 701079088
EGachoka@resolution.co.ke
MEDICAL SCHEME BENEFIT WRITE-UP 2

3. BENEFITS FOR GROUP MEDICAL INSURANCE
We are pleased to present to you a scope of the benefits covered under our scheme medical insurance for
covering your esteemed members of staff and their dependents. This will be tailor made based on your
specific needs and requirements.
Our medical schemes cover is for:-
• An Employee actively in service together with one spouse both between the ages of 18 years and
64years. At renewal a member already in the scheme and above 65years may be considered for
cover provided that he/she remains in active service and resolution is satisfied with his/her detailed
medical report.
• Dependent children (Biological or legally adopted) are eligible for cover from 38 weeks (Full term
and discharged) till the age of 18 years or up to the age of 23 years if proof of schooling is provided.
There will be no waiting period but All NEW Members over 50 years will be required to undergo a Medical
Examination at own cost prior to being accepted as members.
Kindly see below our benefits and the various options / limits offered. This can guide you in giving us
specification on what you would require us to quote for your scheme in the Quotation request form given on
the last page.
SUMMARY OF BENEFITS OFFERED AND OPTIONS AVAILABLE FOR THE CLIENT TO CHOSE FROM
BENEFIT
OPTION FOR
RISK TRANSFER
OPTION FOR
BENEFIT STRUCTURE
OPTION FOR
BENEFIT ALLOCATION
Inpatient Insured Option or Funded Option Stand Alone Per Person/Per family
Outpatient Insured Option or Funded Option Stand Alone Per Person/Per family
Maternity Insured Option or Funded Option
Stand Alone or Within
Inpatient
Per family
Dental Insured Option or Funded Option
Stand Alone or Within
Outpatient
Per Person/Per family
Optical Insured Option or Funded Option
Stand Alone or Within
Outpatient
Per Person/Per family
Funeral Benefit Insured Option or Funded Option
Stand Alone or Within
Inpatient
Per Principal member/Per
member
Group Excess of Loss Insured Option Only Stand Alone Per Person/Per Incidence
Bed Type Insured Option Only Within Inpatient As per inpatient purchased
Providers
Enhanced Providers or Standard
Providers
Outpatient Only or For All
benefits
As per cover purchased
MEDICAL SCHEME BENEFIT WRITE-UP 3

4. RANGE OF BENEFIT LIMITS FOR SCHEME’S
Minimum Age of Entry (main member) 18 years
Maximum Age of Entry (main member/Spouse) 64 years
Minimum Age of Entry (dependant) Term baby of 38 weeks (Full Term and discharged)
Maximum Age of Entry (dependant) 23 years
Waiting Period 0 days
Outpatient Reimbursement 90% (Subject to our reimbursement guidelines)
Inpatient non-accidental Dental KES 50,000
Inpatient non-accidental Optical KES 50,000
Inpatient accidental Dental Within inpatient
Inpatient accidental Optical Within inpatient
First emergency caesarean (Within inpatient) KES 150,000
Lodger Fees (parent accommodation) 10 years
Range of Inpatient Limit Between 100K and 10M
Range of Outpatient Limit Between 30K and 300K
Range of Maternity Limit Between 50K and 250K
Range of Dental Limit Between 5K and 50K
Range of Optical Limit Between 5K and 50K
Range of Funeral Benefit Between 35K and 200K
Range of Group Excess of Loss Limit Between 1M and 15M
Chronic, Psychiatric, HIV/AIDS and declared Pre-existing
conditions
Between 350 and 1M
Congenital and Prematurity Conditions Between 50K and 250K
Bed Type
Either general Ward bed, Standard Private room or
Ensuite room
MEDICAL SCHEME BENEFIT WRITE-UP 4

5. BENEFITS & SERVICES COVERED
INPATIENT BENEFITS
Includes the following while the member is hospitalized:
 Surgical operations and procedures
 Professional fees
 Theatre fees
 Anesthetics for surgery
 Assistants at operations
 Accommodation net of NHIF
 Intensive care and high care units
 Visits and consultations by a GP and/or Specialist (while hospitalized)
 X-rays and pathology (while hospitalized)
 Physiotherapy
 Ultrasound scans (other than for pregnancy).
 MRI and CT scan (while hospitalized)
 Blood transfusions
 Internal prostheses
 Medicine dispensed and used in hospital
 Home nursing where medically necessary
 Organ Transplants
 Medicine dispensed on discharge from hospital 100% cost(maximum of 14 days’ supply)
MATERNITY BENEFITS (STAND ALONE OR WITHIN INPATIENT)
 Maternity cover as a benefit will cater for delivery expenses and maternity complications all within
the maternity limit.
 Pre and Post natal care will be covered within the outpatient limit if maternity is purchased.
 Please note that all families must be covered for maternity benefits for the maternity package to
apply.
OUTPATIENT BENEFITS
Includes the following outpatient services:
 Outpatient consultations
 Diagnostic examinations, injections and procedures performed at a primary care level in a doctor's
consultation room.
 Diagnostic Laboratory and Radiology
 Prescribed medicines
 X-rays, Pathology, Scans and MRI
MEDICAL SCHEME BENEFIT WRITE-UP 5

6.  ECG exams
 KEPI Vaccines
 Minor trauma treatment
DENTAL BENEFITS (STAND ALONE OR WITHIN OUTPATIENT)
This cover includes the following services:
 Dental consultations and gum diseases
 Extractions
 Fillings (except precious metals)
 Scaling
 Dental X-Rays
 Dental Prescriptions
 Crowning
 Bridging
 Braces
OPTICAL BENEFITS (STAND ALONE OR WITHIN OUTPATIENT)
This cover includes the following services:
 Routine optical consultations
 optometrist consultations and eye examinations
 Prescription of frames
 Prescribed lenses and replacement of lenses
 Optical Prescriptions
GROUP EXCESS OF LOSS COVER (IF PURCHASED)
The group excess of loss cover may only be accessed once the entire inpatient limit has been exhausted.
The group cover limit will be the maximum amount payable for the entire scheme but with the
respective sub-limits per person/per incidence per annum.
The maximum liability as regards Maternity, pre-existing, chronic conditions, HIV conditions and any sublimit
within the main plan will remain limited to the specified amounts under the basic inpatient limit and
shall not extend to the Group Excess of Loss cover.
FUNERAL EXPENSE COVER
The sum assured will be payable to the next of kin on submitting documentation confirming death of a
scheme member. This will only be payable during the policy period under which the member died.
MEDICAL SCHEME BENEFIT WRITE-UP 6

7. Summary of Inpatient Benefits
INPATIENT BENEFITS ARE AS FOLLOWS :- Coverage Limit as per clients request
Geographical coverage East Africa
Hospital
Enhanced/Standard Medical Service
Provider List
Bed Type General ward Bed/Standard Private/Ensuite
Inpatient Dental Illness
Kshs.50,000 per family within the inpatient
limit
Inpatient Dental Accidents Covered within the Inpatient limit
Inpatient Optical -Ophthalmology Kshs.50,000 per family within inpatient
Inpatient Optical -Accidents Covered within the inpatient limit
1st Emergency C-Section
Kshs.150,000 per family within the inpatient
limit
Chronic ,Psychiatric, HIV/AIDS & Declared Preexisting
conditions (All Under One Sublimit)
Between Kshs.350,000 and Kshs.1,000,000 per
family within the inpatient limit or 50% of the
inpatient limit, whichever is lower
Chronic Conditions diagnosed while a continuous resolution
Insurance member except HIV/AIDS and psychiatric
conditions
Covered up to 50% of the inpatient limit
Maternity (if purchased within inpatient)
Between Kshs.50,000 and Kshs.250,000 per
family within the inpatient limit
Congenital and Prematurity Conditions
Between Kshs.50,000 and Kshs.250,000 per
family within the chronic limit
Annual Well person Check Up (where applicable)**
Covered for employee and spouses within
the inpatient limit
Local Road and Air Emergency evacuation Covered within the inpatient limit
Emergency hospitalization expenses incurred while
temporarily traveling abroad**
Re-imbursed within the inpatient limit as per
local customary rates for a travel period that
does not exceed 6weeks
Overseas Referral Treatment**
Covered within the inpatient Limit
depending on care management
authorization
Rehabilitation Cover **
Covered within 30days of discharge up to a
maximum of Kshs 30,000
Lodger fees 10 years
Home Care Services Covered within the inpatient limit
Funeral Expense (if purchased within inpatient)
50,000 per Employee/member within
inpatient limit
NOTES:
I. Emergency hospitalization while travelling abroad is for emergency illnesses and injuries and does not
include elective treatment abroad or self-referral cases.
II. Oversea referral for treatment not available locally will be to a medical facility approved by
Resolution.
III. Rehabilitation covers post hospitalization review and care. This includes physiotherapy and specialist
review
MEDICAL SCHEME BENEFIT WRITE-UP 7

8. IV. Annual wellness checkup will cover the following:- (where applicable)
• Prostate – Specific antigen (PSA) Test : One annual test for men
• Pap smear : one annual test for women
• Lipid profile once a year
• Mammogram for women once every two years
• Annual well person check-up :-Comprehensive history & physical exams, Random blood
sugar, Urea, Electrolytes * Creatinine (Kidney functions ), Liver functions, Stool for occult and
ECG
Summary of Outpatient Benefits
OUTPATIENT BENEFITS ARE AS FOLLOWS:- Coverage Limit as per clients request
Geographical coverage East Africa
Hospital
Enhanced/Standard Medical Service
Provider List
Co-Payment for Outpatient Visits
500/- at Nairobi Hospital and Aga Khan
hospital and all their branches and satellite
clinics and
Kshs. 200/- Gertrude's Children's hospitals,
Mater hospitals, Nairobi Women’s, AAR
clinics, Aga Khan Mombasa
and all their branches and satellite clinics
Scheme may choose not to have co-pay for
its members
Chronic ,Psychiatric, HIV/AIDS & Declared Preexisting
conditions
Covered up to 50% of outpatient limit
Congenital and Prematurity Conditions Covered up to 50% of outpatient limit
Pre and Post Natal (if Maternity is purchased) Covered within outpatient limit
KEPI Vaccines and Well Baby check-ups Covered within the Outpatient limit
Dental Cover (if purchased within the outpatient limit)
Between Kshs.5,000 and Kshs.50,000 per
person/per family within the Outpatient limit
Optical Cover (if purchased within the outpatient limit)
Between Kshs.5,000 and Kshs.50,000 per
person/per family within the Outpatient limit
Notes:
 Members will be exclusively restricted to our selected panel of outpatient medical service providers
except in genuine medical emergency cases where there are no appointed services providers
available. Under such cases only will reimbursement be allowed at 90% of the incurred cost
 Some specialists are seen on referrals.(see our panel of providers)
 Authorization must be obtained in advance from RESOLUTION INSURANCE in respect of
chemotherapy, radiotherapy, MRI and CAT scans, hospice care and haemodialysis, Day Surgery.
MEDICAL SCHEME BENEFIT WRITE-UP 8

9. CLAIMS PROCEDURE
 Authorization must be obtained in advance from RESOLUTION INSURANCE in respect of all hospital
admissions. In the case of true emergency admissions, authorization must be obtained within 24 hours
or on the first working day after admission
 RESOLUTION INSURANCE must be informed of any scheduled admissions at least 48 hours prior to the
admission. The members are not required to pay any deposits, as we will co-ordinate admissions vide
our existing arrangements with the hospitals.
 All members are identified using their Resolution Insurance Membership Cards.
 Members validity will then be verified by the Medical Service Provider(MSP) representative prior to
service delivery
 Members shall be required to sign the Resolution Insurance claim form at the MSP
 Resolution Insurance operates on 24 Hours basis vide our Care Managers on our Emergency Lines.
 Access to Well Person Checkups (if purchased) once a year at selected Medical center’s. Service
has to be pre-authorized.
Important Notes:
• All riders (Outpatient, optical, dental, maternity and group excess of loss) have to be taken together
with the Inpatient cover and cannot be purchased without the inpatient benefit
• We have a countrywide network of providers, a selection of which can be availed depending upon
the location of members.
Our quotations are valid for 30days.
Thank you for considering Resolution as your medical insurance provider. If you need any clarification or
additional information, please do not hesitate to contact us. We look forward to a favorable response to
our proposal.
MEDICAL SCHEME BENEFIT WRITE-UP 9

10. RESOLUTION INSURANCE COMPANY LIMITED
QUOTATION REQUEST FOR CORPORATE SCHEME'S
(COMPANIES WITH 20 EMPLOYEES AND ABOVE) OR GROUP MEDICAL
SCHEME
Intermediary
Contact Person Date
Email Address
Company to be
covered
Family Size Total Families Total lives
M
M+1
M+2
M+3
M+4
M+5
M+6
M+7
Total
Benefits Required
Inpatient Limit Kshs…………… Per Person/Per Family Insured/Funded
Outpatient Limit Kshs…………… Per Person/Per Family Insured/Funded
Dental Limit Kshs…………… Per Person/Per Family Insured/Funded
Optical Limit Kshs…………… Per Person/Per Family Insured/Funded
Maternity Limit Kshs…………… Per Family Insured/Funded
Funeral benefit Limit Kshs…………… Per employee/per member Insured/Funded
The quote request should be sent to EGachoka@resolution.co.ke
MEDICAL SCHEME BENEFIT WRITE-UP 10