CIC CoopCare

Health Insurance solution built for

Cooperative members

GENERAL •LIFE •HEALTH • ASSET

TABLE OF CONTENTS

Page

03
Introduction

Page
Value proposition
4

Page

6 Product overview

Client’s journey
Page

13

GENERAL •LIFE •HEALTH •ASSET | We keep our word

Appreciating the Cooperative Movt..Healthcare
needs

 Growing  Financial needs  Need for good

movement  Financing of the quality
 The cooperative healthcare healthcare
movement is needs  Rising cost of
strong  High cost of treatment
premiums
Insurance
Speaks
product(s) to
to a ..a gap/need that needs respond to
good to be addressed need
market
Target market?

registered
members of
the Cooperative
Societies & Saccos.

Must be between 18
years and 70
years at the point of
entry.

Individuals only
or with their
family members.
Value Proposition

• Affordability: Affordable premium based on low

cost provider panel pulled from mission hospitals
and low cost private hospitals.
• Simple: Comprehensive cover for all medical
needs.
• Higher Benefits: Cover includes higher benefits
for members and dependants.
• Flexibility:
 easy to enrol : online application
 no proposal forms
 group advantage
Product overview
The CoopCare Product..

Scope
Scope Panel Controls

CoopCare
• Co-pay
• Inpatient • Waiting period
• Maternity • Faith- based • Sub-limits
• Outpatient • Affordable private • Provider Panel
• Dental & Opt • Government

Product Name-
 Some details of the cover

1 4
-4 Members -IP- 100,200 & 300K
Membe
-of the Co-op rship
Limits -OP-30, 40 & 50K
-Mat- 20,25 & 30K
-Dent & Opt- 5 & 7K

Age Covid-

2
guide 19
5
-Maximum -100, 150 & 200K
joining age is
70 yrs
Options Providers

3 6
-Inpatient
-Select panel for
-Outpatient
the product
-Dental/Optical & Maternity
Premium Rates

All benefits Inpatient only

Plan M M+6 extra Plan M M+6 extra

Option I
100K IP Option I
30K OP 7,500 26,700 3,600 100K IP 2,500 7,300 1,100

Option II
200K IP Option II
40K OP 8,500 31,600 4,100 200K IP 3,200 10,800 1,400

Option III
300K IP Option III
50K OP 9,500 36,000 4,600 300K IP 3,800 12,700 1,700

Per annum premiums as low as:

 2,500 per person
 7,500 per family
 Some Cover Terms
1. Waiting periods
 No waiting period for accident related admissions.
 No waiting period for acute illnesses & outpatient.
 1 year for pre existing & chronic conditions treatment.
 10 months waiting period for maternity related treatment.

2. Eligibility
• Children from birth (born at full term of 37 weeks) to 18
years;
• 21 years up to 25 years subject to proof of full time learning
with proof from the learning institution.
• Principal member and spouse – up to 70 years.

3. Geographical limit
• Kenya.

4. Copay
• Kes 100 -outpatient visit.
• Kes 500- IP members without NHIF.

5. Access
• strictly within the designated panel provided.
Cover Summary
Benefit Inpatient Outpatient Maternity Dental Optical Last Accom
Expense modati
on
Family/ Family Family Family Family Family Family Bed
Person Type
Option 1 100,000 30,000 15,000 5,000 5,000 50,000 Ward
Bed
Option 2 200,000 40,000 20,000 5,000 5,000 50,000 Ward
Bed
Option 3 300,000 50,000 25,000 7,500 7,500 50,000 Ward
Bed

Benefits
Benefit cover Summary Limit of Cover Sublimit/Stand Alone
Inpatient overall cover limit As per table above. Stand alone
Outpatient As per table above. Stand alone
Outpatient Dental
As per table above. Sublimit of Outpatient
Outpatient Optical
Maternity As per table above.

Maternity and 1st ever emergency caesarian Sublimit of inpatient

Inpatient maternity complications
section are mutually exclusive and cannot both
be accessed in the same policy year.
1st Ever Emergency Caesarian Up to Kes. 30,000 Sublimit of inpatient
Antenatal and postnatal Covered within the outpatient up to the full limit Sub limit of inpatient
 Benefits
Benefit cover Summary Limit of Cover Sublimit/Stand Alone

Inpatient pre-existing Conditions/pre-existing Up to 50% of the Inpatient cover limit

Sub limit of inpatient
Chronic conditions Newly diagnosed to be covered up to the full
limit.
Congenital and prematurity conditions Up to Kes. 50,000 per family Sub limit of inpatient
Accommodation/Bed Capacity As per table above net of NHIF Sub limit of inpatient
Last Expense As per table above. Stand alone
Inpatient psychiatry Kes. 20% of overall inpatient cover Sublimit of inpatient
Inpatient Non-accidental Dental Surgery Kes. 30,000 of overall inpatient cover Sublimit of inpatient
Inpatient Non-accidental Opthalmological Kes. 30,000 of overall inpatient cover
Sublimit of inpatient
Surgery
Covered up to the full limit subject to the Sublimit of both
Terrorism, Political war and Violence
claimant not being an active participant. inpatient and outpatient.
Vaccines KEPI vaccines. Sub limit of outpatient
Covered within the outpatient up to the full
Outpatient Chronic conditions Sublimit of outpatient
limit.
Covered within the outpatient up to the full
Outpatient congenital conditions Sublimit of outpatient
limit.
Covered within the outpatient up to the full
Outpatient HIV/AIDS and related conditions Sublimit of outpatient
limit.
Lodger fees Payable up to 12 years Inpatient
Road evacuation leading to admission Covered within Inpatient Sublimit of inpatient
Air evacuation Not covered N/A
Outpatient Ambulance services Not covered N/A
Health Check-up Not covered N/A
Joining age 38 weeks subject to discharge N/A
Overseas referral Not covered N/A
Covered up to full Inpatient for Option 1
Covered up to Kes 150,000 for Option 2 within
Inpatient
Covered up to Kes 200,000 for Option 3 within
Inpatient
Inpatient and Outpatient
Covid - 19
as applicable
Outpatient treatment is covered up to full
Outpatient limit. Outpatient tests are capped
at Kes 6,000 per test within Outpatient. The
test must be prescribed by a doctor. Covid
testing for purposes of travel is excluded.
 Exclusions
1. Cosmetic surgery unless caused by accident.
2. Weight management treatments and drugs. Family planning/infertility related
treatment.
3. Hazardous sports e.g., bungee jumping, paragliding.
4. Scaling, caps, crowns, bridges & Plates, orthodontics (unless such treatment is as a
result of an accident), and dentures.
5. Nutritional supplements unless prescribed as part of medical treatment.
6. Alternative treatment - Chiropractors, Acupuncturist, Herbalist.
7. Drunkenness, drug addiction, Intentional self-injury, attempted suicide. Self-referred
or self-prescribed treatment.
8. War and Kindred risks (whether war be declared or not). Participation in Riot, Strike
and Civil commotion, Naval, Military or Air force operations.
9. Expenses recoverable under any other insurance e.g. NHIF, GPA, WIBA.
10. Beauty treatment in nature cures clinics or health hydro’s.
11. External surgical appliances - unless benefit has been provided for.
12. Diagnostic equipment (e.g. Glucometers, BP machines etc.) and hearing aids.
13. Contamination by radio activity from nuclear fuel, waste or fission.
14. Laser correction of eye sight.
15. Pregnancy related treatment for dependants other than the spouse if covered on the
benefit schedule.
16. Optical exclusions – Plano prescriptions, +/-0.25 prescriptions, photo chromatic
lenses, antiglare coatings.
17. Bills incurred by doctors/hospitals outside the CoopCare panel.
18. Pandemic and Epidemic occurrences.
On-boarding Process
 ..the Customer journey...

Data submission to
01 CIC website 02
Cooperative contact person &
CIC admin 03

Prospect goes to the Automatic trigger Verification &

CIC website and
subscribes as an
engagement by Coop
applicant . contact to applicant

04

Collation of data
within the window period

06
Members uploaded per difference
Coop entities
05 Covers commences & cards issued.

Data submission to CIC

By contact person
On-boarding Process
Generated
& shared
Contact Person
with CIC

Digitized-
On-boarding CIC
Window Website

Will
coordinate Membership List
the
enrolment

Monthly Enrolment
enrollment Process
model.
Customer Service 24 hours

Relationship Approvals Service Providers Care Management

Management

-Dedicated
-Hospital visits &
Relationship Officers -24 hour call center Defined panel
-Engagements where
necessary
-Case follow ups
-Daily & monthly
admissions report
 CIC MEDICAL
Call Centre Numbers
We are committed to making your
experience pleasant.

Contact us on;
Safaricom - 0703 099 999
Airtel - 0732 179 999
Orange - 0202 823 999
Email: care.managers@cic.co.ke

GENERAL •LIFE •HEALTH •ASSET | We keep our word

44 CIC GROUP | Medical Insurance GENERAL •LIFE •HEALTH •ASSET | We keep our word

Thank You