FAQs – DRC

Unfortunately, the member may need to purchase a separate policy as the insurance policies are annual contracts hence cannot be altered mid-term unless the member has a self-funded benefit where top-up is allowable.

Corporate insurance provides only for your immediate family, that is your legal spouse and your children. However, you can take a separate individual cover for them in the event a corporate solution cannot be tailored for such. For siblings under the age of 25 and still, in school, they can be covered under your parents where applicable. For those above 18 but out of school, you may need to take separate covers for them.

You should call our Zamara 24 hour call centre.

The premium charged by the insurer does not vary with having us as your medical broker. However, through our value additions, medical broking expertise & top-notch service delivery, we add immense value to our clientele.

A sub-limit is a capped amount within the primary limit that dictates the maximum claim payable for a given risk.

This will be well enumerated on your policy document depending on the purchased benefits. General exclusions include, Hazardous sports e.g. Bungee jumping, Paragliding, Cosmetic treatment unless caused by accident, Family planning/infertility related treatment, Drunkenness, Drug addiction, Intentional self-injury, Attempted suicide, Herbal treatment amongst others.

On return of the motor cover certificate, your policy will be cancelled, and you will receive a refund on your premium if you had not made a claim.

Yes, You can be upgraded from a TPO to a Comprehensive cover after one of our appointed service providers has inspected your vehicle and a premium payment agreed upon.

1. Medical

Below are required for outpatient claiming:

• Original claim form
• Original receipts of all payments made
• Prescription Copy for drugs dispensed
• Lab/ X-ray /MRI/ CT SCAN requests

In the event of an admission: Discharge Summary, Final hospital bill, any x-ray/imaging results, Doctors receipts of payment (if any), Duly filled inpatient insurance claim form.

2. Group Life

In the event of death:

• Original death certificate
• Certified copy of ID/ PP
• Copy of Pay Slip
• Police Abstract/post mortem report (incase of accidents)
• Original claim form
• Discharge Voucher

3. Motor

In the event of accident;

• Duly completed claim form
• Copy of driver’s license (Must be valid) & ID
• Original police abstract report

The claim documents can be forwarded to our offices through HR or alternatively we can arrange for the rider to pick up the claims depending on the client’s location.

Loss or damage by perils of nature including floods, rainstorms, earthquakes, hurricanes, etc.

We consider a vehicle to be overloaded when, it exceeds the load capacity as outlined in the logbook. A vehicle is also considered to be carrying excess when it carries more that its seating capacity.

Employees have the freedom of changing their beneficiaries. This process requires that they fill in the “Change of Beneficiaries” form that we avail through their employer, then the employer will forward it to us for beneficiary amendment.

The service provider should make a formal request via call or email to Zamara’s case management team detailing the type of service been sought and the diagnosis. Thereafter, the Case Management team will be in a position to advise accordingly.

One should provide the membership number which upon checking on the system and confirming proof of payment we will ensure the card is activated immediately.

This is a disease, illness or injury which has at least one of the following characteristics: no known cure or recurs, leads to permanent disability, is caused by changes to your body that cannot be reversed, requires you to be specially trained or rehabilitated or needs prolonged supervision, monitoring or treatment. Examples are Cancer, Asthma, Hypertension, Diabetes, Chronic Back pain, Arthritis etc.

This is a fixed fee that insured persons must pay to obtain specific medical services under the cover of specific service providers. This is most common for outpatient services.

This is the amount paid to beneficiaries to cover funeral expenses within 48hours of confirmation of the death of a member. This is payable upon submission of the burial permit or death certificate.

Excess, also called a deductible, can be defined as the first amount of the claim that the insured has to bear. If the insured has an excess of Kshs. 5,000 and the total repair costs Kshs. 30,000, then the insured has to pay Kshs. 5,000 while the insurer pays the remaining Kshs. 25,000.