HARMONY IN-PATIENT PLANS

This is a unique product through Resolution Health EA Limited as it affords a family one single medical insurance package which includes among other benefits cover for HIV, Pre-existing and chronic conditions for individuals and families. The health package for in-patient services will have a plan limit of a maximum of Ksh 2 million to Ksh 5 million and for out-patient Ksh 75,000 to Ksh 100,000. Benefits from the HARMONY PLAN also include emergency Road rescue and evacuation services, Psychiatric conditions, Congenital cover in addition to other services available for hospitalized members.....

Limits:              Kshs. 2 million
                       
                        Kshs. 5 million

Hospital:         Admissions managed by and at selected providers only

Capacity:      Ward Bed

Includes the following while the member is hospitalized:

• Surgical operations and procedures
• First Emergency Caesarean Section up to Kshs. 100,000
• Professional fees
• Theatre fees
• Anesthetics for surgery
• Assistants at operations
• Ward accommodation
• Intensive care and high care units
• Visits and consultation by a GP and /or Specialist (while hospitalized)
• X-ray and pathology (while hospitalized)
• Physiotherapy
• Ultrasound scans (other than for pregnancy)
• MRI and CT scan (while hospitalized)
• Blood transfusion
• Internal prostheses
• Medicine dispensed and used in hospital
• Medicine dispensed on discharge from hospital 100% of Cost (maximum of 14 days’ supply)
  
  Additional Benefits
  
• HIV, Pre-existing and chronic conditions are included (up to sub limits specified below)
  
• Emergency Road rescue and evacuation services
  
• Last expense benefit Kshs. 100,000 for principal member
  
• Psychiatric conditions covered up to Kshs. 200,000 per family
  
• Congenital cover up to Kshs. 50,000 per person 60 days emergency world wide cover excluding North America

Total Sub Limit for Pre-existing, HIV and Chronic Conditions is as follows:

Plan Limit                     Sub-Limit

Kshs. 2 million              Kshs. 350,000
Kshs. 5 million              Kshs. 500,000

HARMONY OUT-PATIENT PLANS
Limits:              Kshs. 100,000
                       
                        Kshs.   75,000

Hospital: These are exclusively obtainable from our selected panel of outpatient Medical Service Providers. General practitioners and specialists are seen on referral

Outpatient services offered:

• Outpatient consultations
  
• Diagnostic examinations
  
• Injections and procedures performed at a primary care level in a doctor’s consultation room
  
• Prescribed medicines
  
• X-rays, pathology, scans and MRI
  
• ECG exams
  
• Pre, post and antenatal care
  
• Minor trauma treatment
  
  Additional Benefits
  
• Well baby check-ups at our selected well baby clinics only
  
• KEPI immunization programme (only accessible at our selected well baby clinics).
  
• HIV, Pre-existing and chronic conditions are covered HIV services
  
• Adherence and nutritional counselling
  
• Follow-up every 3months
  
• Prevention of mother to child Transmission (PMTCT)
  
• ARV's and Monitoring
  
• Opportunistic infections
  
  Total Sub Limit for Pre-existing, HIV and Chronic Conditions is as follows:

Kshs. 30,000 of family's outpatient cover

All in and outpatient services can only be obtained from the providers on our list of select and approved Medical Service Providers. This list is subject to change from time to time in which case you will be notified.

Hospital admissions

• All hospital admissions must be authorized by Resolution Health at least 48 hours in advance. Please contact our care managers to obtain this authorization in writing before admission.
  
• Emergency admissions must also be authorized in writing thus in case of an emergency admission please ensure that Resolution Health is informed within the first 24 hours.
  
• The members are not required to pay any deposits, as we will co-ordinate admissions vide our existing arrangements with the hospitals.
  
• Admission will also be strictly by doctors on our select panel per our Medical Service Providers list.

Resolution Health shall pay all admission bills less National Hospital Insurance
Fund (NHIF) rebates.
Waiting Periods for Harmony Plans

• Waiting periods are effective from the start date issued by Resolution Health upon membership acceptance
  
• 60 days waiting period for all illness admissions
  
• 6 months waiting period for disclosed pre-existing, chronic, newly diagnosed cancer and HIV/AIDS related conditions
  
• Ten (10) months waiting period from the start date for myomectomies, hysterectomies, adenoidectomies, cataracts, lipomas, hernias, tonsillectomy and First Emergency Caesarean Section.
  
• Outpatient plans have a waiting period of 21 days
  

Notes

• Joining age is between 30days and 49years. Membership of the child at the age of 30 days shall however be subject to the following:
  
• In case of a child born prematurely, membership shall commence one month from the date the child ought to have been born full term.
  
• At the time of application to membership, the child ought to have been discharged from hospital.
  
• Emergency world wide cover has a sub limit of 50% of family cover limit.
  
• Authorization must be obtained in advance from Resolution Health in respect of chemotherapy, radiotherapy, MRI and CAT scans, hospice care, haemodialysis and physiotherapy.
  
• All services for HIV to be accessed at our selected comprehensive care clinics.
  
• A Harmony out-patient plan can only be accessed if you have purchased a Harmony in-patient cover.
  
• Members shall be required to sign the Resolution Health claim form at the MSP
  
• Dental and optical additional benefits can only be taken up by members with an outpatient plan and are available at selected Resolution Health providers.

For more information please do not hesitate to contact us.