Policy Summary
This cover is available to organizations and provides a death benefit in the event of a member’s death whilst in the employment before attainment of retirement age in accordance with the benefits specified in the policy. Cover includes disability benefit equivalent to specified years’ salary/ earnings and may be extended to include a critical illness rider of up to 25% of the life sum assured. The sum insured (capital benefit) is derived by multiplying an employee’s monthly salary by the number of years specified in the policy e.g. 5 years earnings. The policy covers the demise/ death of an employee as a result of accident or natural illness. Usually the benefit is based on a multiple of employee’s annual salary e.g. Annual Salary multiplied by 3, 4 or 5. However a lump sum figure known as Capital Sum Insured can also be chosen e.g. a flat Kshs.1,500,000.00 per employee irrespective of their salary.
Cover requirements
- Employees’ Name & Age
- Retirement age
- Gross monthly income
- If contributory, Employer /Employee contribution
FREE COVER LIMIT
This is the limit of cover whereby the insured person is not required to undergo medical test and cover is automatic under the policy for the full sum assured. Full sum insured per person is the amount of annual salary multiplied by the numbers of years of benefit e.g. The sum insured for member X whose monthly salary is Kshs.50,000.00 is computed as follows: Annual Salary is Kshs.600,000.00 x 5 = Kshs.3,000,000.00. Therefore, Kshs.3 Million is the sum insured on member X.
MEDICAL TEST
All employees qualify for cover immediately the premium is paid. However, a medical test is a requirement for all members whose Sums Insured are above the Free Cover Limit. The Free cover limit is determined by the Insurance Company for each Policy/ scheme.
BENEFIT PAYABLE
During the first three months of cover and also for any new member, the benefit is based on Y times annual salary. This method of determining the level of cover per employee is considered equitable as it is pegged to the level of earnings. However members whose sums assured exceed the free cover limit stipulated under the policy but fail to undergo the required medical tests within the grace period of three months, have their sums assured for death due to natural illness restricted to the free cover limit. In case of death due to accidental causes full benefits are payable.
BENEFICIARY NOMINATION
Each member nominates one or more immediate family members as beneficiaries. The nomination can be updated from time to time usually annually. The benefit is payable through the employer within two weeks on submission of the Original Death Certificate. No tax is payable on the benefit.
SCHEME RENEWAL
The scheme period runs for twelve (12) months effective the date insurers are be advised to go on cover. Thereafter, the scheme is renewable annually. The employer pays the required renewal premium annually in advance as a benefit to the employee. Renewal premium may change depending on the claims experience during the previous cover period and revision in the number of members in the scheme.
MEDICAL TEST
All employees qualify for free cover limit immediately the premium is paid. However, a medical test is a requirement for the cover above the Free Cover Limit (Refer to definition of free cover and sum assured).
COST OF MEDICALS
The insurance company pays for the cost of medical examination. Medical tests/ examinations are done at intervals of four (4) years by any of the doctors appointed by the insurance company.
CONFIDENTIALITY
Medical reports are strictly confidential between the insurance company and the doctor and are sent directly to the insurance company under confidential cover. The employer has no access to the reports. However, if the employee wants an interpretation of the medical reports, he/she should send a written request to the Insurance Company indicating the address of his/her personal doctor or appointed doctor to whom a copy of the report should be sent for professional interpretation.
VOLUNTARY MEDICAL EXAMINATION
It is unethical to force employees to go for medical examination. Employees whose medical reports are required are at liberty to comply or not. In the absence of medical reports however, the benefit payable in the event of death is limited to the applicable Free Cover Limit.
IN-BUILT LAST EXPENSE RIDER
An Inbuilt funeral expense cover of between Kshs.50,000.00 to Kshs.200,000.00 can be included alongside the Group Life Cover. The insurance company pays the Last Expense amount from the Group Life sum assured within 48 hours of notification of the demise of a covered member. This is part of the group life claim and the balance of the Group Life Sum assured is payable upon submission of Death Certificate. No additional premium is charged for this rider.
SEPARATE LAST EXPENSE COVER
A separate Last Expense Cover can be obtained at a nominal additional premium. The cover limits range from Kshs.50,000.00 to Kshs.200,000.00. This amount is payable upon immediate notification of death and is not deducted from the group life claim amount.
EXPIRY OF COVER
Cover ceases immediately an employee leaves service. It also ceases if the employer fails to renew the cover or pay premium at the beginning of the scheme year.
