Claims & Resources

INSURANCE CLAIMS

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PROCEDURES

Health / Medical Claim Procedure

Submit duly executed claim form which can be obtained from the insurer or downloaded in the website within 30 days from date of service.

Ensure you attach the following documents.
The membership number of client and facility visited.
A detailed medical report if it was an inpatient case.
An original invoice and receipts of payment done and keep copies for your own records.
If it’s an inpatient claim an itemized hospital bill will be required.
For overseas claim, letter of approval is normally issued prior to the services and hence a copy of that letter should be attached.
For a last expense/funeral claim, a copy of burial permit/death notification form will be required.
Give reason for seeking reimbursement (since services can be authorized directly with provider without having to pay).
Provide Bank details.

Prescriptions

Prescriptions are fully covered under outpatient.
If you have an inpatient cover only they are covered to a specific number of days e.g AAR does for the first 14 days after discharge and UAP does it for the first 21 days after discharge.

Emergency Cases

Call the emergency numbers provided on the membership card or sticker for rescue and evacuation.
If you were taken to the hospital by a good Samaritan ensure you inform your insurer within 24 hours from the time the emergency occurred.

Getting a Pre-authorisation

After a physician orders for a medical service for a patient, they contact the insurer to determine if they recquire a prior authorization check to be run.
If so a process is initiated to obtain prior authorization.
The authorization varies from one insurance provider to another.
This will include completion of an authorization form.
If a service is rejected the physician can appeal based on the provider’s medical review process.

Guide to make when getting treatment.

Walk to a provider with your medical cover card.
Produce it to the reception/front office staff of the facility.
They will check whether it is up to date and if not you will be advised accordingly.
They will key you in the system and request for visit fee which varies from insurer to insurer and if again it’s applicable.
You will be requested to wait for your turn.
Once you are called you will go and see the specialist.
If there is lab tests to be done you will proceed to the laboratory.
After the results are out you will go for a review and prescriptions will be given.
Collect your prescription and proceed to the reception where you will be provided with a bill of all the stages you went through and the cost will be deducted from your card.
You are advised to always request for a copy of the invoice at each given visit.
Collect your card and leave the premise.

In the unfortunate event that you are involved in a motor accident, here are the important steps you need to take to make the insurance claims process as smooth as possible get you back on the road faster.

Try to remain calm and help others if any involved to also remain calm. Accidents can be a distressing experience.
Make sure all those involved are physically alright and in case of bodily injury please seek medical attention immediately by calling for an ambulance.
Do not admit fault to anyone as this may be used against you in the claims process or Courts of Law.
Ensure to involve the police. Allow them to control the accident scene and help determine who is at fault.
You may take photos of the scene of the accident and damaged motor vehicle(s), road marks and any other features of the accident scene that may be useful during the investigation of the accident.
Ensure to obtain any relevant information from everyone involved in the accident. Information such as names, addresses, phone numbers, and motor insurance details are important as they may be using during the insurance and any criminal investigations.
Report the claim as soon as possible.
Maintain strict confidentiality of the case, do not discuss any matters pertaining to the case with anyone except the police and your insurance provider.

The majority of the international travel insurance policies available in Kenya will be re-insured or underwritten by internationally reputed insurance providers like AXA, Allianz, TravelSafe, MAPFRE and others.

This means that if you are travelling overseas, you will be covered by international insurance experts who have a global network and reach.

For medical emergencies and any other personal accident, please contact your insurance provider using the emergency telephone numbers provided on your insurance policy. You will receive assistance immediately 24hrs 7 days all year round.

To make a claim under your policy, you may be required to produce the following or more documents/evidence at YOUR own cost:

Medical Emergency claims

Receipts or bills for all in-patient/ out-patient treatment or emergency dental treatment received.
Receipts or bills or proof of purchase for any other transport, accommodation or other costs, charges or expenses claimed for, including calls to the Emergency Assistance Service.

Baggage Loss/Delay

A police report from the local Police in the country where the incident occurred for all loss, theft or attempted theft.
A Property Irregularity Report from the airline or a letter from the carrier where loss, theft or damage occurred in their custody.
An original receipt, proof of ownership or valuations for items lost, stolen or damaged and for all items of clothing, medication and toiletries replaced if your baggage is temporarily lost in transit for more than 12 hours.
All travel tickets and tags for submission

Travel Delay/Curtailement

A medical certificate from the treating medical practitioner explaining why it was necessary for you to cancel or curtail the trip.
Booking confirmation together with a cancellation invoice from your travel agent, tour operator or provider of transport/accommodation.
In the case of curtailment claims, written details from your travel agent, tour operator or provider of transport/accommodation of the separate costs of transport, accommodation and other pre-paid costs or charges that made up the total cost of the trip.
Your unused travel tickets.

Please read your policy document for more details on the claims procedure and supporting documentation required.

To make a claim for golfers insurance, you may have to present the following to your insurance provider :

National ID/Passport and Copy.
Description of the event.
Receipts for any golf equipment.
Any letters of claim from members of the public or third parties.
Where applicable, a letter from the police/authorities detailing the event.

What we require for Personal Accident (PA) / Group personal accident (GPA) Claims:

Notify us immediately, and provide the following documents

Duly completed claim form;
Medical certificate by the attending doctor;
Claimant’s payslips for three months prior to the accident;
Discharge summary (if admitted in hospital)
Sick off sheets by the attending doctor(s);
Original medical receipts;
Original police abstract report, if any;(accident cases)

Incase of fatal accidents provide:

Original death certificate
Post mortem report

What we require to process Property Claims

From the insured:

A duly filled Claim Form
Original police Abstract Report
Replacement Invoice/Purchase Receipt /Proforma Invoice
Statement on the circumstances of the loss
Adjusters Final Report
Adjusters Fee Note
Acceptance of Loss Form/Discharge Voucher
Letter forwarding documents to reinsurers
Other (specify) …………………………….

From the third party:

AGRICULTURE INSURANCE

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