Transcription
MEDISTARfreedom to enjoy lifewww.medistarinsurance.com
CONTENT1. The best partner for your health care plan32. What is Medistar?53. About Goldstar Healthcare64. About Cigna75. Medistar features86. Medistar cover97. The benefits108. Optional benefits139. Additional services14www.medistarinsurance.com 2
THE BEST PARTNER FOR YOUR HEALTH CARE PLANMedistar is a benefits package with a wide range of benefits and different levels of cover, allowingyou to choose from 4 comprehensive plans. Not only do we give people access to the best possiblemedical treatment, each plan option provides peace of mind and security, leaving you safe in theknowledge that your medical needs and well-being will be taken care of.We are at your service when you need us most, providing comprehensive benefits, quick and efficientreimbursement of claims as well as facilitating easy access to health care.Additionally, our priority is to provide all our members with a holistic approach to help them managetheir health, well-being and lifestyle. Healthier and more productive employees. Lower sickness costs.Lower claims expenditure. These are just a few benefits of this innovative approach.Outstandingcare foroutstandingpeoplewww.medistarinsurance.com 3
WHAT IS MEDISTAR?Medistar is a private international medical insurance plan designed specifically for the African marketoffering a rare combination of quality and value. Devised by Goldstar Healthcare in conjunction withCigna using the wealth of experience that both companies have in Africa.››Competitively priced››Four levels of cover to suit your budget››Comprehensive range of benefits››Evacuation and repatriation cover as standard››Cancer and chronic conditions cover as standard››Flexibility to add Primary Select options to the Primary level of cover: Primary Enhanced foroutpatient treatment and Primary Plus for maternity benefits.››Underwritten by Cigna - one of the largest international medical insurance companies in the world››Worldwide 24 hour support››Worldwide hospital networkA uniqueprivateinternationalhealth plan.www.medistarinsurance.com 4
About Goldstar HealthcareGoldstar has been established for over 25 yearsand is recognised as being one of Kenya’s leadingindependent health care intermediaries. We adviseclients (corporate and individuals) on all mattersrelating to their International Private MedicalInsurance needs.Being independent means that we serve ourclients’ best interests by searching the marketplace for the right provider and the mostappropriate insurance solution to meet their needs.Instead of being tied to one insurance company orproduct, we offer impartial advice on a wide rangeof insurance plans and providers.Our business has grown and continues togrow because of our independence and ourreputation of trust. Our mission is to build winningrelationships with our clients.Our core business strength has always been ourability to deliver unbiased recommendations thatmeet both our clients’ needs and their budget.From the initial advice stages all the way throughto supporting you through any claims, serving ourclients is our number one priority.At Goldstar we work with many top InternationalHealth Insurance providers as our aim is to provideclients with choice, quality and value for money.All of the above is combined with our strongbelief in offering clients a personal service whichmeans that we are on hand to help you with yourinsurance needs at any time.Our experienced team based in our London andNairobi offices can be contacted by email orphone.Offering youa personalservice.www.medistarinsurance.com 5
About CIGNACigna Global Health Benefits (hereafter referred toas CGHB) is the dedicated international division ofCigna. With over 50 years of experience as a leadingglobal health-services provider, we continue toresearch and deliver quality health care to globallymobile employees in over 192 countries and maintainapproximately 1,000,000 individuals within globalplans of which 130,000 are local staff members.CGHB’s focus continues to be on the administrationof employee benefits plans for Corporate clients,IGO’s (intergovernmental organizations) and NGO’s(non-governmental organizations). We enjoy scaleadvantages in terms of medical services networkaccess and innovation and growth opportunitieson a global level with a specialized focus on Africathanks to our large membership through mainly theIGO segment in Africa.Our focus has always been on the design,implementation and management of global healthinsurance and employee benefits programs,for international organizations, multinationalcorporations and their workforce, while taking intoaccount and responding to the local reality of eachand every location where the workforce is active.Top quality customized services, innovation and acontinuous focus on our customers have broughtus to a market leading position. Those are theareas in which we distinguish ourselves now andin the future. As a part of Cigna, a global healthservice company, we offer a truly global service,enhanced by cost reduction capabilities and fullytailored to the local needs of our customers. Directbenefits include access to a combined and unrivalledworldwide network of medical providers and thedevelopment of a culture of health within our clients’organization e.g. health and well-being coaching.More than ever, we keep our promise to offer easyand affordable global access to health care.We have our main service center in Belgium, andoffices and representations in Africa (Kenya andSouth Africa), Asia (Malaysia), Latin America (Chile),Europe (Madrid and Switzerland) and theUSA (Florida). Our headquarters are located inWilmington DE, USA.Innovativeinsurancesolutionsdesignedfor you.www.medistarinsurance.com 6
Medistar Features››Worldwide medical cover››Company schemes both small and large››Network of over 11,500 hospitals worldwide››Payment options››Comprehensive range of benefits››Multilingual support 24/7 by email, phoneor online››Cover on all plans for:- Emergency evacuation & repatriation- Cancer and chronic conditions- Congenital conditions and HIV››Local support in Nairobi and London››In & outpatient bills settled directlywith provider››Underwrite existing conditions››No policy cancellation due to age or illness››Competitively priced premiums reflectingthe lower costs in Africa››Cigna Health Benefits Mobile app››Suitable for Kenyan residents or expatriates››Health check ups››Individual and family cover››Health risk assessments››Online 2nd medical opinionHealth check upsa unique feature.www.medistarinsurance.com 7
PRIMARYELITEMost popular plan providing an extensiverange of features at very competitive pricethat meets most people’s needsOur top level plan with higher financial limitsand the benefit of dental and optical coverfor those that require a complete ��Maximum annual reimbursement 950.000 / 1.400.000Inpatient treatmentOutpatient treatment (if pre- orpost-operative care)Evacuation and RepatriationPsychiatric careCancer and chronic conditionscoveredAccident related dental treatmentLocal ambulanceRepatriation of mortal remainsDelivery of essential medicinesKidney dialysisHIV/AIDSHospital cash benefitCT, MRI and PET ScansFlexibility to add Primary Select options tothe Primary level of cover: Primary Enhancedfor outpatient treatment and Primary Plusfor maternity benefits.››››››ELITE This is the cream of our plans giving you evenhigher financial limits and outpatient limitswith the luxury of an upgrade to your room inAKUH and Nairobi hospitals.››››››For those that feel they need higher financiallimits and better outpatient cover than thatprovided with Primary cover.››››››››Maximum annual reimbursement 2.200.000 / 3.300.000Hospital room & boardExecutive Room (AKUH)Deluxe Room (Nairobi Hospital)Unlimited outpatient treatmentExisting Medical ConditionsIf you have any existing medical conditionsthese are treated in a number of waysdepending on whether you join as a newmember or you are transferring from anexisting one.ADVANTAGE››Maximum annual reimbursement 1.550.000 / 2.300.000Basic dental care coveredVision screeningVision aids (glasses, frames and contactlenses)Geographical Areas of CoverSelect from a range:›› Africa and India, Bangladesh, Pakistan and Sri Lanka6 weeks worldwide accident and emergency cover.›› Worldwide excluding USA6 weeks USA accident and emergency cover.›› WorldwideFull worldwide cover.Maximum annual reimbursement 1.200.000 / 1.800.000Outpatient treatment covered including costof GP consultations and prescribed drugsVaccinations and health checksPregnancy and childbirthOptional dental coverThe purpose of this document is to give general information about the Medistar product. Neither is this brochure an alternative contract to the terms and conditionsmentioned in the General Conditions nor does it constitute part of it. In any dispute between this brochure and the General Conditions, the General Conditions shall prevail.www.medistarinsurance.com 8
THE BENEFITSIn the tables below we have summarised the benefits applicable for each product option. Please refer to the wordingof the general conditions for full benefit details and definitions. All benefits shown are per insured person, perinsurance year (unless specifically stated).Maximum annual reimbursementper insuredTerritorial scope of coverPRIMARYADVANTAGEELITEELITE 950.000 1.400.000 1.200.000 1.800.000 1.550.000 2.300.000 2.200.000 3.300.000Zone A: WorldwideZone B: Worldwide excluding USA (but six (6) weeks USA accident and emergency cover)Zone C: Africa and India, Bangladesh, Pakistan and Sri Lanka (but six (6) weeks worldwide accident andemergency cover)Hospitalisation inpatient treatment (day-patient and with overnight stay in hospital)Hospital room & board(pre-certification required)Full refund(standard privateroom)Full refund(standard privateroom)Full refund(standard privateroom)Full refundExecutive Room(AKUH)Deluxe Room(Nairobi Hospital)Doctor’s fees (surgeon,anaesthesist and physician)Full refundFull refundFull refundFull refundOther medical expenses(medical imaging, drugs anddressings, use of operatingroom,nursing care, medical aids,physiotherapy etc.)Full refundFull refundFull refundFull refundRehabilitation and convalescencerest/care (when the admissionimmediately follows hospitalisation, pre-certification required)100%(max. 28 days)100%(max. 28 days)100%(max. 28 days)Full refundFull refundFull refundFull refundFull refundParent accommodation of 1 parentfor child 16100% up to 1,000 / 1,500100% up to 1,000 / 1,500100% up to 1,000 / 1,500100% up to 2,000 / 3,000Newborn accommodation inhospital (for newborns up to 16weeks old) to accompany itsmother while she is receiving inpatient treatment in a HospitalFull refundFull refundFull refundFull refund 5,750 / 8,625 8,000 / 12,000Full refundFull refund (withinthe overall limit foroutpatient treatment)Full refund (withinthe overall limit foroutpatient treatment)Full refundFull refund up to 740 / 1,100 (withinthe overall limit foroutpatient treatment)Full refund up to 1.190 / 1.775 (withinthe overall limit foroutpatient treatment)Full refundFull refund up to 700 / 1,050 (withinthe overall limit foroutpatient treatment)Full refund up to 1,400 / 2,100(within the overalllimit for outpatienttreatment)Hospital accommodation inintensive care unit (ICU)Outpatient treatmentOverall limit for outpatienttreatmentDoctor’s fees (generalist,specialist)Diagnostic tests, lab tests,medical imaging (x-ray, precertification required)Prescribed drugsAlternative treatment such ashomeopathy, acupuncture,chiropracy, osteopathy, dietitian,podology, chiropody, andayurvedic medication andconsultationsTherapy ErgotherapyCovered if pre- or postoperative care up to 1,650 or 2,500(per condition)during maximum 48working hours priorto the operation andmaximum 60 daysfollowing the dismissalfrom hospital. Logopaedics and/or Speechtherapy Physiotherapywww.medistarinsurance.com 9 Full refund up to 4,000 / 6,000
Psychiatric outpatient carePRIMARYADVANTAGEELITEELITE Covered if pre- or postoperative care up to 1,650 or 2,500 (percondition) during maximum 48 working hoursprior to the operationand maximum 60 daysfollowing the dismissalfrom hospital.Full refund up to 700 / 1,050 (withinthe overall limit foroutpatient treatment)Full refund up to 1,400 / 2,100(within the overalllimit for outpatienttreatment)Full refund up to 4,000 / 6,000 butlimited to 40 sessionsNot coveredFull refund up to 190 / 275 (withinthe overall limit foroutpatient treatment)Full refund up to 240 / 350 (withinthe overall limit foroutpatient treatment)Full refund up to 300 / 450Not coveredFull refund up to 300 / 450 (withinthe overall limit foroutpatient treatment)Full refund up to 300 / 450 (withinthe overall limit foroutpatient treatment)Full refund up to 400 / 600Not covered50% up to 350 / 525 (within theoverall limit foroutpatient treatment)50% up 350 / 525VaccinationsHealth screen (check-up) andwell-baby careBasic dental care (check-ups,basic treatments)Not coveredOther medical treatment Maternity (waiting period of 10 months applies1)Newborn cover : Full refund for all plans2 Pregnancy and childbirth(without complications)pre and post natal careNot coveredFull refund up to 3,000 / 4,500 perpregnancyFull refund up to 5,000 / 7,500 perpregnancyFull refund up to 8,000 / 12,000 perpregnancy Childbirth (withcomplications)Not coveredReimbursementaccording to type oftreatmentReimbursementaccording to type oftreatmentReimbursementaccording to type oftreatmentCancer treatment (excludingexperimental treatments)(hospitalisation and outpatienttreatment) (excludingexperimental treatments)Full refundFull refundFull refundFull refundOut-patient surgeryFull refundFull refundFull refundFull refundCoveredCoveredCoveredCoveredup to 40.000 / 60.000up to 40.000 / 60.000up to 40.000 / 60.000up to 40.000 / 60.000Full refundFull refundFull refundFull refundFull refundFull refundFull refundFull refundReimbursementaccording to typeReimbursementaccording to typeReimbursementaccording to typeReimbursementaccording to typeNursing at home after in-patienttreatment (prior approvalrequired)Full refund up toup to 90 days peradmissionFull refund up toup to 90 days peradmissionFull refund up toup to 90 days peradmissionFull refund up toup to 90 days peradmissionOrgan transplant (excludingcosts for donor – prior approvalrequired)Full refundFull refundFull refundFull refundChronic and pre-existingconditions3Palliative treatment/hospice care(prior approval required)CT-, MRI- and PET scansAIDS / HIV Treatment (waitingperiod of 24 months applies1) Inpatient Outpatient1 Unless waived in the special conditions.2 Provided that the newborn is affiliated as from his date of birth3 Acceptance of your application is subject to a medical questionnaire and approval by the medical consultant. Unless waived in the Insurance certificate.Pre-existing and chronic conditions are covered within the limits of your plan if accepted by the medical consultant at the time of your enrolment.www.medistarinsurance.com 10
PRIMARYADVANTAGEELITEELITE Kidney dialysis (excludingexperimental treatments)Full refundFull refundFull refundFull refundLocal ambulance (to nearesthospital)Full refundFull refundFull refundFull refundEmergency Dental treatmentfollowing accidentFull refund up to 500/ 750Full refund up to 500/ 750Full refund up to 500/ 750Full refund up to 500/ 750Full refund up to 6,500 / 9,750Full refund up to 6,500 / 9,750Full refund up to 6,500 / 9,750Full refund up to 6,500 / 9,750Not coveredsee Therapy(psychiatric outpatientcare)see Therapy(psychiatric outpatientcare)see Therapy(psychiatric outpatientcare) 100 or 150 pernightup to 30 days 100 or 150 pernightup to 30 days 100 or 150 pernightup to 30 days 100 or 150 pernightup to 30 daysVision screeningNot coveredNot coveredOne screening perinsured per yearOne screening perinsured per yearVision aids (glasses, frames,contact lenses)Not coveredNot coveredFull refund up to 100 / 150Full refund up to 100 / 150Ancillary charges (eg. wheelchair,crutches)Full refund up to 1,000/ 1,500Full refund up to 1,000/ 1,500Full refund up to 1,000/ 1,500Full refund up to 1,000/ 1,500Bariatric surgery (waiting periodof 24 months applies and cannot be waived. Pre-certificationrequired)Full refund up to 2,000/ 3,000Full refund up to 2,000/ 3,000Full refund up to 2,000/ 3,000Full refund up to 2,000/ 3,000Psychiatric care (waiting period of 24 months applies 4) Inpatient OutpatientHospital cash benefit4 Unless waived in the special conditions.www.medistarinsurance.com 11
AssistancEPRIMARYMedical emergency evacuation and repatriationADVANTAGEELITEELITE 5Repatriation Assistance organising and paying the cost of transportationto a hospital and the return to the country ofresidence100% organising and paying the cost of a trip of aninsured person and minor children100% reimbursement of the accommodation costsincurred by the insured patient or the insuredperson(s) travelling with him/herup to 65 / 125 / day up to a maximum of 1.300 / 2.500Hospitalisation in situ: organizing and paying the costs of the outward/return journey to enable a member of your familyto get to you in the hospitalcost of accommodation locally100%up to 65 / 125 / day up to a maximum of 1.300 / 2.500Search and/or Rescue costs 1,000 / 1,875Assistance in the event of your business assignmentbeing curtailed: paying the travel costs (one way) of yourreplacement colleague100%Despatch of medicines unavailable locally100%Unforeseen assistance100% up to 260 / 500 communication with your family or your company theft of your identity documents, credit cards,travel tickets or business documents:advance of funds abroadPsychological support:in the event of severe trauma as a result of a covered‘illness or accident’two (2) telephone calls per insured person and per insurance yearAssistance in the event of an insured person’s death transporting the body to the home country orburial at the location100% funeral costs necessary for transportation 2,000 / 3,750 additional costs for the transportation of theinsured members of the deceased’s family or aninsured person100%Definition medical emergency evacuation and repatriationEvacuation in case of an accidental Injury or a sudden and unexpected onset of a change in a person’s physicalcondition which, if the procedure or Treatment was not performed immediately could reasonably be expected toresult in loss of life or limb or significant impairment to bodily function or permanent dysfunction of a body part, asdetermined by the AP.5 The benefits of Medical Evacuation and Assistance Services apply per insured person / per claim and per insurance year, unless mentioned otherwise.www.medistarinsurance.com 12
Optional benefitsDENTALADVANTAGEELITEELITE Dental Insurance (Optional)Maximum Annual Reimbursement perInsured 1,000 / 1,500Basic Dental Care (check-ups, basictreatments)80%Major dentistry (orthodontic,prostheses, bridges, implants)Orthodontic Treatment is only coveredif started before age fifteen (15).A waiting period of twelve (12) monthsapplies to all major dentistry forindividuals.80%PRIMARY SELECT OPTIONS 1PRIMARY PLUSPRIMARYPRIMARY PLUS Primary EnhancedPrimary EnhancedORPRIMARYORPRIMARYPrimary EnhancedPrimary EnhancedOutpatientMaximum overall annual reimbursement per insured 665 / 1,000Doctor’s fees (generalist, specialist) (part of the overall limit)Diagnostic tests, lab tests, medical imaging (x-ray)Prescribed drugs (part of the overall limit)Full refund up to 465 / 700Full refund up to 240 / 350primary plusPRIMARY PLUSMaternityMaternity (waiting period of 10 months applies2)PregnancyFull refund up to 1,667 / 2,500Childbirth (without complications)Childbirth (with complications)1Primary Select is only available for large corporate schemes.2Unless waived in the special conditions.www.medistarinsurance.com 13
additional servicesHealth & well-beingPeace of mind may be hard to come by when trying to balance the demands of work and personal life. That’s where wecan help. With our health and well-being programmes, you can access valuable services tailored to your needs. Theseprogrammes offer a comprehensive approach to create a healthier, more engaged and more productive lifestyle.Health risk assessmentThe health and well-being assessment, offers a measurable approach to health. It gives you the power to measureyour health status and target interventions into the areas where they need it most. By filling in an individual onlineassessment, you have the tools they need to measure and monitor your health and well-being. Based on the fourpillars of health – sleep, stress, nutrition and physical activity - the assessment goes through a series of questions thatestablish the current health and well-being status of the user.Online 2nd Medical OpinionReceiving a serious diagnosis can be a frightening experience. What’s more, treatment decisions that are difficult tomake at home can become even more difficult in a foreign country. To help ease concerns during this difficult time,we developed the MyConsult programme to help make informed and educated decisions regarding diagnosis andtreatment. It gives patients secure, online access to specialists all with the click of a mouse.Chronic condition managementThrough a patient-centred approach, this programme aims at training, steering and coaching employees with diabetesor cardiovascular disease. Employees suffering from one of these two chronic conditions receive a personalised careplan, which addresses multiple needs and incorporates multiple resources adapted to their condition.Introducing the Cigna Health Benefits AppWe want to make sure that our customers worldwide have quick and easy access to our services anytime and anywherethey need them. That’s why we created the Cigna Health Benefits mobile app, so they can manage their health planright from their smartphone.Little app. BIG FEATURES.Health care provider search›Search for a doctor, hospital or facility›Easy to locate using Google maps›Download and save search resultsMembership cards›Download or send electronic membership cardsClaims›View past claims›Review and check the status of claims instantlyContact details›Contact us with the tap of a fingerThe Cigna Health Benefits app is free to download from the App StoreSM or Google PlayTM.www.medistarinsurance.com 14
WHAT TO DO NEXTIf you are able to decide on the level of cover required then just ask us for a quotation.If you would like some assistance in deciding the level of cover then call and one of our staffwill be happy to discuss your requirements with you.Which ever it is call us on 254 (0) 20 3754 770/779/782 or 254 (0) 20 2431565 or emailinfo@medistarinsurance.comAny more questions? Just ask us.www.medistarinsurance.com 15
MEDISTARGoldstar Healthcare Ltd.PO BOX 1017, 00606 Sarit Centre5th FloorMayfair SuitesParklands RoadNairobiKenya5.90.561 (1216)Tel: 254 (0) 20 3754 770/779/782Tel: 254 (0) 20 2431565Office mobile number: 254 (0) 722 592 839Fax: 254 (0) 20 3754 784Email: info@medistarinsurance.comWeb: www.medistarinsurance.comwww.medistarinsurance.com 16
› Optional dental cover ELITE Our top level plan with higher financial limits and the benefit of dental and optical cover for those that require a complete cover. › Maximum annual reimbursement 1.550.000 / 2.300.000 › Basic dental care covered › Vision screening › Vision aids (glasses, frames and contact lenses)
