Q: Can premium be settled monthly or installments?
A: Premiums are payable upfront as per regulatory requirements but can be settled through IPF or approved payment plans.
Q: What happens if a member exhausts their cover limit?
A: 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.
Q: Can I cover my parents and siblings under me? If no, why not and what solution is available for them?
A: 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.
Q: In the event of an emergency, who should I call? The insurer or Zamara?
A: You should call our Zamara 24 hour call centre.
Q: Will your services as our intermediary have a cost implication?
A: 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.
Q: What is a sub-limit and how does it work?
A: A sub-limit is a capped amount within the primary limit that dictates the maximum claim payable for a given risk.
Q: What exclusions apply on the cover?
A: 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.
Q: What happens when I sell my insured car?
A: 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.
Q: Can I switch my cover from a Third Party Only to Comprehensive at a later date?
A: 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.
Q: Which documents do I need for claiming?
A:
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
Q: Who do I forward the claim documents to?
A: 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.
Q: What cover is provided under Special Perils?
A: Loss or damage by perils of nature including floods, rainstorms, earthquakes, hurricanes, etc.
Q: When do you consider a vehicle carrying excess or being overloaded
A: 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.
Q: Can I change my beneficiaries?
A: 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.
Q: How should I deal with bills that have surpassed the allocated medical limit?
A: 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.
Q: What happens if I have paid premium yet by card has been deactivated?
A: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.
Q: What is a chronic condition?
A: 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.
Q: What is a copay?
A: 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.
Q: What is the last expense?
A: 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.
Q: What is excess?
A: 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.