Policy Summary
Verge Health insurance offering is an enhanced medical insurance cover offering hospitalization and optional outpatient benefits to our clients and their families in the event of an accident or illness. It enables clients to manage their finances and access quality healthcare across a wide range of healthcare providers in Kenya. Cover is enhanced to include Chronic, Pre-existing conditions, Cancer, & HIV/AIDS including cost of ARVs covered up to the full out-patient cover limit per family per annum.
Client profile
Our Health Cover available to Individuals, Families, Businesses, Groups and Institutions. It’s is suitable for clients looking for comprehensive medical cover with minimal restrictions to cushion their families, members or employees against unexpected high medical bills
Policy features and benefits
- Verge Health offers medium to high benefits and diverse limits of medical cover ranging from; hospitalization cover Kshs.300,000 to Kshs.10m and outpatient cover Kshs.50,000 to Kshs.350,000.00 per family per annum. Outpatient benefit could also be designed as a limit per person in the family.
- Out-patient dental and optical cover
- Minimal exclusions
- Enhanced InPatient & OutPatient limits with wide coverage in terms of scope that includes Pre-existing conditions, Chronic conditions, Cancer, HIV/AIDS, Maternity, Dental covers & In patient Ophthalmology (eye disease
- High overall cover limit and sub-limits on the supplementary benefits
- Extensive network of providers all over the country without restrictions, including all the major providers in the country
- Provides cover for senior citizens with entry age up to the age of 79 years subject to acceptable medical report and cover can remain for life subject to continuous renewal of the policy
- You can’t buy Inpatient cover alone or a combined Inpatient and Outpatient cover.
- You can cover a child on their own as a principal member
Benefits of the Verge Health Insurance product
Incorporates most fundamental features that are otherwise not included under standard or individual medical covers – Pre-existing conditions, chronic conditions, Maternity Dental & In patient Ophthalmology(eye disease)
- Premium can be paid through premium financing with any of our partner banks
- Product simplicity – Easy to understand product features
- Waiver of waiting period for clients transferring from other medical policies
- Accessibility of the product online and through all branches of VIB
- Reasonable waiting periods
- Use of biometric technology via smart card for membership identification that eliminates possible abuse/ overuse
In order to take out a Verge Healthcare insurance policy, the client will need to provide the following details:-
- Complete a proposal form with Full Name of the client /proposer for insurance, Postal Address, Telephone Contact, PIN Number, Occupation (Business from which client derives his income) and medical history
- National Identity Card or Passport
- Full premium payment
- Renewal notice of existing policy copy if client is transferring from another medical policy
- Age Limits:
- Minimum age is 1 month for a child joining the scheme as a dependent or principal
- Children are covered up to 25 years of age with proof that they are in school/college. Children over 25 years, whether in school or not are not covered as dependants and will take separate cover as a principal member.
- Eligibility; Minimum age is 1 Month old for children joining as dependent members and 18 years for adults joining as principal members (and maximum 70 years and renewals up to 80 years for existing members.
Terms, conditions and provisions of the policy apply.
Claims Process
Access to medical treatment at any of the appointed providers is strictly through use of Biometric Smart Card and at the point of access and no cash is payable. Reimbursement claims are only acceptable for emergency cases and the original claim form (available at medical providers) duly executed by the treating medical doctor with original receipts attached must be submitted to VIB through any VIB Branch.
