BRITAM MILELE JUNIOR HEALTH PLAN

MILELE JUNIOR HEALTH PLAN

At Britam, we understand how much your children mean to you, that is why we have designed a medical solution just for them. So that you can always have peace of mind that their medical needs will always be taken care of by providing you access to world class healthcare cover.

Why Milele Junior?

Milele Junior allows you to get a stand alone health cover that is solely dedicated to your child. This means that your loved one will get access to a variety of benefits catering for their medical insurance need.

Milele Junior will have a variant perfectly suited for it. Milele Junior will be there for the health requirements of your child until they turn 18 years old and once they do, they would seamlessly

transition to our main Milele cover with minimal requirements. So you can sit back, enjoy the happy times with your child from their infancy to adulthood and leave the rest to us.

What does Milele Junior Cover?

Milele Junior comprises an inpatient and outpatient. The benefits that come with this cover are provided for a period of one year ( 12 months) and can be renewed annually.

Cover Benefits

Child Standalone Cover – Milele Junior provides you with an opportunity to cover your loved one, without the parent or the guardian having to take a cover on themselves.

Fit for all – Milele Junior has four custom made options to choose from that provide differing level of benefits catering for the medical insurance needs of your child. Whatever needs your child may have, Milele Junior will have a variant perfectly suited for it.

Seamless Transition – Milele Junior will be there for the health requirements of your child until they turn 18 years old. Once they do, they would seamlessly transition to a main Milele cover.

Comprehensive Protection – Bed & Lodger Charges, Pre-existing, chronic and congenital conditions, Doctors’ fees, Diagnostics, Covid-19 Cover and Prescribed drugs are all taken care off by Milele Junior.

What are the different Milele Junior options?

The coverage provided will be available in four (4) variants, namely

Milele Junior Premier: This serves as the main go-to variant. It will provide Medical Insurance, With Free Annual Health Check up on children, Critical illness for 5M, PA & Last Expense. The package has the standard Milele terms and is operational across the entire

Milele list of service providers

Milele Junior Advantage: It is similar to Milele Junior Premier variant, save that for pre-existing illnesses, chronic and congenital conditions, the advantage package will provide coverage up-to the full inpatient limit.

Milele Junior Essential 1: This option targets a more cost-saving clientele who is seeking a medical insurance, personal accident & last expense cover. The Essential 1 variant is similar to the premier variant, with the main difference being the limited selection of Providers accessible to the policyholder.

Milele Junior Essential 2: This option is crafted for customers who are seeking a Medical Insurance, Personal Accident Cover and a Last Expense cover. The Essential 2 variant is similar to the premier variant, with the main difference being the Limited Selection of Providers accessible to the policyholder.

Outpatient Cover Scope:

Outpatient cover features treatment as per applicable limits. The cover shall have two variants based on two separate panels of hospitals and will be available in 3 benefit options, either KES 50K, KES 100K or KES 150K.

Dental and Optical benefits

Dental and optical benefits can be purchased as standalone benefits in addition

to the outpatient benefit at an additional premium.

COVID-19 Benefit:

Milele Junior comes with an embedded covid- 19 standalone benefit to cater for homebased

care expenses up to a maximum of KES 15K

Co-Payment Structure:

A copay is a fixed out-of-pocket amount paid for certain covered services. Britam often charges

co-pays for services such as doctor visits or prescription drugs. Milele Junior\’s Outpatient services offered shall be subject to co-pays of KES 1,500 to Tier 1 providers and KES 500 to all other providers

Who is eligible to be covered?

• The minimum joining age is 37 weeks for children, and the child is added into cover by filing an application form and attaching birth notification.
• The maximum entry age is 17 years. The exit age shall be at the underwriters’ discretion, based on the assessment of the health of the insured.
• Children who are 18 years and above can be covered until 25 years as dependants with proof of schooling, at the prescribed rates offered by the main Milele cover, whether inpatient or outpatient.
• Members who are on transfer from other insurance products will have to provide proof e.g. a renewal invitation letter to enable waiver of waiting periods. Waiver of waiting periods will apply to covers that are already being enjoyed and policy has not lapsed. This is subject to underwriting decision and favorable claims experience.

Frequently Asked Questions;

I would like to have the cover for a child for whom I am not the parent, is this possible?

The owner of the policy is the parent or the legal guardian of the child. Only they can fill out the application form for the child. However, the premium charged for the cover can be paid by

whomever the parent/guardian authorizes to do so.

As the parent/guardian, can I utilize this cover for use on myself?

The cover only provides benefits applicable to children i.e. persons in the 37 weeks to 18 years age bracket. Parents that want to be covered can seek out our Main Milele Cover.

What happens if I had another cover with another insurer?

Renewal invitation showing benefits enjoyed shall be attached and only the specific covers enjoyed previously shall qualify for the waiver of the waiting period. Acute illness and accidental cases however shall be covered immediately.

Is there a waiting period for the cover?

A 12-month waiting period will apply for disclosed pre-existing and chronic conditions, with a 12-month waiting period for cancer treatment. All illnesses are subject to 30 days waiting period except for accident-related cases and covers on transfer.

Can I buy an outpatient cover only without having to take up an inpatient cover?

An inpatient cover is a MANDATORY requirement for every outpatient purchase made.

For institutions that would like to have the cover for children, how much would I be charged and what would the cover requirements be?

Premiums for institutions shall be determined based on volumes with reference to the individual rates.

What is the effects of non-disclosure?

If pre-existing and chronic condition are not disclosed, cover does not attach for those conditions and may lead to cancellation of the cover.

What is the effects of non-disclosure?

If pre-existing and chronic condition are not disclosed, cover does not attach for those conditions and may lead to cancellation of the cover.

What are congenital conditions?

A birth disorder or occurring as a result of genetic pre disposure.

What do I need in order to access a medical facility?

Remember to always carry your medical card and your national ID/Passport in case further

verification is required.

What does Milele Junior not cover? (exclusions)

• Expenses resulting from the insured’s self-referred or self-prescribed treatment.
• Treatments for contraceptive and family planning procedure including treatment for infertility and/or impotence.
• Treatments for injury/harm brought on by intentional self- injury (regardless of the insured’s state of sanity), chronic drunkenness, suicide or attempted suicide, drug and substance abuse.
• Treatment for injury/harm brought on by the participation in hazardous pursuits (sports and hobbies) and any extreme activities.
• Treatment for cosmetic and beauty treatment unless necessitated by accidental injury that occurs while insured is covered.
• Experimental treatment or treatment subject to medical research or testing purposes.
• Treatment of obesity or slimming preparation. This includes weight management treatment and drugs.
• Diagnostic equipment such as glucometers, BP Machines etc.
• External surgical appliances (crutches and wheelchairs and prosthesis). Cost of hearing aids are also excluded.
• Dental prosthesis, crowns, dentures, bridges and braces unless the insured has purchased the dental cover.
• Alternative medicine (acupuncture, chiropractor, herbal medicine) unless referred by a GP from the list of service providers.
• Expenses recoverable under any other insurance or sources such as NHIF, Workmen’s
• compensation, personal accident etc.
• Nutritional supplements unless prescribed as part of medical treatment for specified conditions.
• Costs of treatment for, or related to menopause, andropause, ageing, puberty and pre-menstrual tension syndrome.
• Expenses incurred whilst the insured is outside Kenya, except for a maximum of eight weeks
• Any claim where material information shall have been misstated or withheld at the time of application e.g. Non-declared pre-existing and chronic condition.
• Expenses in excess of the specified policy limits and/or sub-limits. Britam General Insurance Limited will not be liable for medical expenses resulting from excluded conditions or exceeded benefits (as per policy).
• Cost of donor and related cost of donor transplant
• Expenses incurred before cover is issued and/or premium is paid in full. Cover is not effective until your application is accepted in writing and the full annual premium paid.
• Expenses incurred when the life(s) covered does not meet underwriting requirements/conditions.
• For applicants that require medical tests, cover will only commence once the requisite tests are done and underwriting deems the life able to be covered.
• For retail cover, applicants aged 55 years and above will be required to go for medical tests at their own cost.
• Pregnancy, child birth, maternity benefits, maternity related complications, antenatal or postnatal care, caesarean operation except where purchased and subject to twelve months waiting period.
• Any other exclusion as specified in the policy document.

Milele Junior Payment Options

Bank Name: ABSA

Account Name: Britam General Insurance (Kenya) Limited

Account Number: 0755782424 (Kenya Shillings)

Account Number: 0227054077 (US Dollars)

Bank Swift Code: BARCKENX

Branch Name: MOI AVENUE NAIROBI

Bank Clearing Code: 03075

Bank Name: NCBA

Account Name: Britam General Insurance (Kenya)

Limited

Account Number: 6631200088 (Kenya Shillings)

Bank Swift Code: CBAFKENX

Branch Name: Wabera Street

Bank Clearing Code: 07002

MPESA PAYBILL NO – 584065

ACCOUNT NAME: CLIENT\’S FULL NAMES

For More Infor Contact

Gallin Wekesa: Financial Advisor@Britam

0712 870-447 gwwekesa@britam.com/gallywexa@gmail.com