Resolution Insurance Company is proposing a health insurance policy to cover the organization's staff. Resolution has over 10 years of experience in medical insurance and manages coverage for over 60,000 members through a network of 750 medical providers. The proposed policy offers comprehensive inpatient and outpatient benefits including maternity coverage, chronic illness coverage including HIV/AIDS, overseas medical coverage, and wellness benefits. The proposal outlines eligibility requirements, coverage details, waiting periods, and how to access medical services. Resolution requests a quote including company name, number of staff to be covered along with their ages and number of dependents.

1. Resolution Insurance Company ltd.
Nation Center, Kimathi Street, 13th floor.
TEL No: 0715127212
DWaswa@resolution.co.ke
Nairobi
Dear Sir/Madam
RE: PROPOSAL TO PROVIDE HEALTH INSURANCE POLICY
I wish to submit our proposal for covering you and the Organizations’ staff members.
Resolution Insurance entered the Kenyan market in 2002 (as Resolution Health East Africa), the
first company to be registered as a Medical Insurance Provider (MIP). We were licensed as a
General Insurer by the Insurance Regulatory Authority (IRA) in 2013.
With 10 years’ experience, Medical Insurance is our core product. We have managed the
medical needs of over 60,000 members comprising of corporate, social groups, families and
individuals through innovative solutions.
We have developed a strong network of over 750 medical service providers (hospitals, clinics and
doctors’) across East Africa that our members can access.
An individual together with one spouse both between the ages of 19 years and 64 years are
eligible for cover. At renewal a member already in the scheme and above 65 years 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 36 weeks (Full term
and discharged) until the age of 18 years or up to the age of 23 years if proof of full time student
status is provided.
New Members over 50 years will be required to undergo a Medical Examination prior to being
accepted as members.
BENEFITS & SERVICES COVERED BY THIS PROPOSAL
Our Medical Insurance products offer an unparalleled level of cover to all our members with key
highlights as:
Variety of plans for both In-patient and Out-patient
Membership for Life
24 hour medical emergency and pre-authorization call center
Baby friendly vaccines as a benefit to the member child.
Chronic conditions including HIV/ AIDS covered to full cover limits.
Maternity cover (Normal and Caesarean Section) includes home deliveries and Lamaze
classes. Ante natal visits are covered from Out-patient benefit and not maternity limit.
New born babies (38 weeks) can join from birth.

2. New Born Baby Illness covers babies born prematurely, for illness after birth and before
discharge.
Offer our members overseas evacuation and treatment with partnerships with leading
medical service providers in India.
Ophthalmology Cover & Dental Illness is covered
Lodger fee is extended to older children up to 10 years
Personal Accident Cover (for adults) & Child guard cover (For children)
Critical Illness (a sublimit of Personal Accident cover)
Emergency evacuation and ambulance services
International Emergency Cover & Overseas Evacuation & Treatment
External Prosthesis as an in-patient benefit covered up to Ksh 100,000
Rehabilitation benefit Services offered are Physiotherapy services, Occupational Therapy
and Post Admission Consultation Reviews.
INPATIENT BENEFITS
Includes the following while the member is hospitalized:
 Surgical operations and procedures
 Professional fees
 Theatre fees
 Anesthetics for surgery
 Assistants at operations
 Ward 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
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
• Prescribed medicines
• X-rays, laboratory, scans and MRI
• Laboratory
• Antenatal & Postnatal care
• Minor trauma treatment

3. • Well baby check-ups inclusive of KEPI Immunization Programme at our selected well baby
clinics only.
• HIV services
•• Adherence and nutritional counselling
•• Follow-up every 3 months
•• Prevention of mother to child Transmission (PMTCT)
•• ARV’s and Monitoring
•• Opportunistic infections
• Baby friendly vaccines as a benefit to the member child up to a sublimit of Ksh 20,000 from
their outpatient benefit (Pre-authorization is required)
Optical Plan (OPTIONAL BENEFIT PLAN)
The services covered are:
• Routine optical consultations
• Prescription of frames
• Prescribed lenses and replacement of lenses
• Optical Prescriptions
Dental Plan (INBUILT ON OUTPATIENT PLAN)
• Consultation
• Extractions
• Fillings (except precious metals)
• Scaling
• Dental X-Rays
• Dental Prescriptions
• Crowning
• Bridging
• Braces
Maternity Benefit (INBUILT ON INPATIENT PLAN)
This includes:
• Inpatient cost incurred for normal and caesarean deliveries
• Labour and recovery wards
• Professional fees
• Pregnancy & Maternity related hospitalization
• Other related ailments and complications including ectopic pregnancies and miscarriages.
• Home deliveries
• Lamaze classes (pre-authorization required)
Annual Well Person Check-up Benefits (For Principal & Spouse Only)
• Annual Well person check-up that includes the following:
i. Comprehensive History & physical exam
ii. Random blood sugar
iii. Urea, Electrolytes creatinine (kidney functions)
iv. Liver function test

4. v. Stool for occult
vi. ECG
• Nutritional consultation: One consultation per year
• Lipid profile: One test per year
• Pap smear: One test per year for women
• Mammogram: One test every two years for Women
• Prostate Cancer Screening: One test per year for men.
International Emergency Cover/Travel Insurance
• International emergency cover where applicable is limited to 60 days per membership year and
caters for emergency admissions only.
• All emergencies that arise out of any condition that is subject to a sublimit (stated as per
cover plan) will be covered up to the applicable sublimit under Travel insurance.
Overseas Evacuation Cover
• Overseas evacuation cover only applies in cases where treatment is not available locally and
the same must be authorized and arranged by Resolution Insurance.
New Born Baby Illness Cover is a benefit under the mother’s cover (if eligible for maternity
benefit) and includes babies born prematurely. This cover is for illness after birth and before
discharge.
External Prosthesis as an in-patient benefit covered up to Ksh 100,000.
A congenital condition is a genetic, physical or (bio) chemical defect, disease or malformation
which may be either hereditary/familial or due to an influence during intra uterine development
of the foetus and which may or may not be obvious at birth.
Home care services
This includes home based health and nursing services provided by visiting professionals such as a
nurse, physiotherapist or home health agency. This benefit is provided post discharge where
medically necessary. Access is subject to approval and is coordinated by Resolution Insurance
Pre-authorization Team. The service is limited to a maximum of 90 days per membership year.
Lodger fee
Lodger fee is an accommodation charge for a parent or guardian accompanying a child up to 10
years of age during an admission.
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.
i. Services offered are Physiotherapy services, Occupational Therapy and Post Admission
Consultation Reviews.
ii. Rehabilitation is subject to a specific number of days or a sublimit whichever occurs
earlier.
Funeral Expense Cover

5. This is a benefit paid out to the next of kin on submission of documents confirming death of the
insured member.
Waiting periods
• All membership benefits commence after the waiting period has been served except for
hospitalization following an accident, which is covered from the date of commencement of
cover.
• 21 days waiting period for all outpatient services.
• 21 days waiting period for all illness admissions.
• The 21 days waiting period to be waived if scheme is transferring from another insurer
(Provide proof of cover using a renewal notice/renewal invite within 30 days of expiry of
previous cover).
• Chronic conditions and cancer diagnosed within 6 months of joining are considered pre-
existing and shall be covered under pre-existing conditions
• 10 months waiting period for all maternity services and pregnancy related conditions.
• 10 months waiting period from the start date for cataract, lymphoma and hernia surgeries;
myomectomy; adenoidectomy; tonsillectomy; hysterectomy and any treatment for related
conditions.
• The 10 months waiting periods to be waived if scheme is transferring from another insurer
(Provide proof of cover using a renewal notice/renewal invite within 30 days of expiry of
previous cover).
Medical Service Access
• All In and Outpatient services can only be obtained from our appointed Medical Service
Providers as per the plan purchased. These lists are subject to change from time to time.
We currently have over 750 hospitals, clinics, doctors and other healthcare providers across East
Africa.
• Members can choose to have access to the Resolution Insurance Enhanced Medical Provider
List or Standard Medical Provider List which has restrictions on some providers.
• Frontline List: Services can be accessed directly from these providers.
• Referral List: Services are on referral basis only by a Frontline provider or through Resolution
Pre-authorization.
• 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.
Hospital Admissions
• 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 pre-authorization team (contacts at the back of your Membership Card) to
obtain written authorizations for Medical Services above.

6. • Members are not required to pay any deposits; Resolution Insurance will co-ordinate
admissions through our existing arrangements with hospitals and doctors on the medical service
provider list.
• Admission will strictly be by doctors on our select panel as per our Medical Service Providers
list.
• Resolution Insurance shall pay all approved admissions bills less National Hospital
Insurance Fund (NHIF) rebates.
IMPORTANT NOTES
Authorization must be obtained in advance from Resolution Insurance in respect of
chemotherapy, radiotherapy, MRI and CAT scans and haemodialysis.
Membership Eligibility
• Age Definition: Child: 38 weeks (Full term and discharged) to 18 years
Adult: 19 years and above
• Joining Age is 38 weeks (Full term and discharged) to 64 years.
• In case of a child born prematurely, membership shall commence one month from the date
the child ought to have been born full term.
• 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 new 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.
• Members aged 65 years and above are only covered on renewal and are required to undergo a
medical examination annually before each renewal. This will be at the applicant’s cost;
however, members with Annual Well person Check-up Benefit can utilize this benefit before the
cover end date.
• At the time of application to membership, the applicant must have been discharged from
hospital should there have been an admission.
• Full disclosure of all medical information is mandatory. Failure to disclose means the member
will be terminated with no option for a refund.
Kindly request for a quotation and provide the following:
i. Company Name
ii. Number of staff to be covered including:-
a. Staff age
b. Number of dependants per staff member
c. Age of dependants
Thank you for considering Resolution as your medical insurance provider. If you need any
clarification or additional information, please do not hesitate to contact the undersigned. We
look forward to a favorable response to our proposal.
Thank you.

7. RESOLUTION INSURANCE COMPANY.
*Resolution insurance also offers Work Injury Benefit Act (WIBA), Employers liability and Group
personal accident. Did you know that the WIBA Act makes it compulsory for every employer to
provide compensation for all their employees against bodily injury, disease or death sustained
and arising out of and in the course of their employment? Resolution Insurance would be
delighted to insure you against such liability with our enhanced benefits.