The Linda Fanaka 6-in-1 bundle of insurance benefits

LIFE INSURANCE

While nothing can replace your presence in the hearts of your loved ones, a Life Insurance Policy will ensure that your dependents are financially secure after your death.


 

DIGNITY PLUS

No one likes to think about death and funerals, but planning for that eventuality eases the financial and emotional burden on your loved ones. BimaNet’s Dignity Plus plan enables you to adequately cover your funeral expenses so that your family can give you a distinguished send-off without the extra anxiety of organizing fundraisers.


 

CRITICAL ILLNESS

Living with a serious illness requires a long list of lifestyle changes and unexpected costs that your medical aid will not finance.BimaNet pays you a lump sum amount upon being diagnosed with any of the specified illnesses in our policy guidelines. This pay out will help you offset any additional expenses or reduced income as a result of the adjustments associated with your recovery.


 

PERSONAL ACCIDENT

This product compensates you in the event of injuries or disability caused by violent, accidental, external and visible events. We pay you a lump sum or a monthly benefit upon disability.


 

HOSPITAL CASH BACK

This feature is designed to help you cope with the extra financial burden when your life is disrupted by hospitalization. The money is paid directly into your account, which you can use to cover the shortfall of your medical cover or take care of other expenses from your hospital bed.


 

WELFARE FUND

We understand that it may take up to 3 years to recover from the loss of a breadwinner’s income, and that conventional insurance payouts are rarely sufficient to cushion loved ones throughout this period. We have therefore established a Benevolent Fund that doubles the sums assured below, pays you cash back for no claims and protects your income upon death or total permanent disability.

TERMS & CONDITIONS

  1. Period of Insurance: This is the contract period and unless otherwise provided shall mean 12 months from commencement date. All benefits under the policy shall cease on the expiry of the duration of cover unless the policy is renewed.
  2. Maximum of 75 years of age at entry for a member to be eligible for the cover, members above this limit will be underwritten under special terms at the Underwriter’s discretion
  3. The policy covers all a Life Insured’s children between the age ranges of 3 months to 18 years. They are all entitled to a Funeral cover of Ksh 100,000 and a Critical Illness benefit equivalent to 50% of the Life Insured’s Critical Illness Benefit. Children who are above 18 years old, must be enrolled as full members to enjoy insurance cover.
  4. Each person whose life is proposed for assurance on his life shall provide a signed declaration of good health and such other evidence of his health as the Underwriter may require, except as provided by the Special Conditions, hereto and any endorsement subsequently placed upon this Policy and such signed declaration shall be deemed part of the proposal for such assurance.
  5. The applicant for insurance shall procure that the Underwriter shall be entitled to apply for information regarding a proposed person’s health past or present to any doctor or surgeon or other qualified person who has attended that person in a medical capacity and that each person concerned shall authorize the disclosure of such information to the authorized officer of the Underwriter.
  6. Any proposal which the Underwriter declines to accept at the ordinary rate of premium may be accepted on such terms and conditions as the Underwriter and BimaNet may agree without prejudice to the general application of the insurance contract.
  7. If the date of birth notified to the Underwriter in respect of any Life Assured proves to be significantly incorrect no greater benefit shall be payable by the Underwriter than would have been secured by the premiums paid in respect of such Life Assured had the date of birth been correctly stated.
  8. The benefits secured by this Policy are not assignable or chargeable by the Lives assured.
  9. The Underwriter reserves the right to vary from time to time the terms and provisions of this Policy on giving BimaNet three (3) months previous notice of its intention to do so.
  10. Risk covered arising directly or indirectly or traceable to any of the following events are excluded.
    1. Active participation in War whether declared or not, invasion, acts of foreign enemies, hostilities, acts of terrorism (active participation), civil war, rebellion, revolution, insurrection, military or usurped power, riot, civil commotion or any act of any person or persons acting on behalf of or in connection with any organization the object of which are to include the overthrowing or influence of any de jure or de facto government by terrorism or by any violent means or any other acts of violence originating from any political or civil unrest.
    2. Aviation, except for passengers and crew of airlines on scheduled flights and private flying purely for transport purposes.
    3. Atomic energy and/or nuclear fission or reaction.
    4. Intake of illegal drugs or drugs not prescribed by a Doctor.
    5. Participation, without prior notification to the underwriter, in any hazardous sport or pursuit including rock climbing. Scuba diving, hang-gliding and aided speed contests of any kind.
    6. Death arising from intentional self-inflicted injury, suicide or while under the influence of alcohol. A claim as a result of suicide shall not be admissible in the first year of cover, it shall be payable from the second year of cover onwards. Alcohol and self-inflicted injuries remain excluded
  11. Premiums under this Policy are payable annually in advance.
  12. The Policy is made under the laws of the Republic of Kenya and any payment in respect thereof whether premium or Sum Assured shall be made in the currency of Kenya shillings unless otherwise agreed by the Underwriter
  13. The Policy is not subject to an AIDS exclusion clause.
  14. This Policy shall be subject to the Laws of Kenya and shall be interpreted in accordance with those laws.
  15. Proof, satisfactory to the Underwriter, of the age of each Life Assured shall be furnished to the Underwriter.
  16. In respect of any person insured or intended to be insured under the Policy any statements made by that person to the Underwriter or to a medical examiner for the Underwriter in so far as they affect his eligibility for life assurance shall be deemed to be true.
  17. In respect of any person insured or intended to be insured any statements made by such person shall be deemed to be made to the best of the knowledge and belief of the person or persons making the statement
  18. Any disputes arising out of this Contract shall be referred to an arbitrator to be appointed by agreement of the parties and failing such agreement by the chairman of the Kenya Branch of the Chartered Institute of Arbitrators and shall be subject to the provisions of the Arbitration Act or any other statutory replacement or modification thereof for the time being in force in Kenya. The seat of such arbitration shall be Nairobi, Kenya.
  19. The insured persons or their dependents shall notify the Underwriter, through BimaNet, of any incident or accident which may result in a claim within thirty (30) days from the date of occurrence. Failure to furnish notice or proof of loss within the required time limits shall not invalidate or reduce any claim if it shall be shown not to have been reasonably possible to give such a notice or proof and that notice and proof were given as soon as was reasonably possible
  20. Disappearance clause
  21. It is hereby declared and agreed that if the insured (or insured person) disappears during the period of insurance and the body is not found within Seven (7) years after the disappearance and sufficient evidence is produced to the Insurer which leads the Insurer to the inevitable conclusion that the insured (or insured person) has sustained bodily injury and that such bodily injury has resulted in death in both cases as described in the policy then the underwriter shall forthwith pay the death benefit under the insurance provided that the party to whom the death benefit is paid shall sign an undertaking to refund such sum on demand should the insured (or insured person) subsequently be found to be living.
  22. World Wide Cover
  23. Subject to Employment Overseas Cover terms, cover is provided to Kenyan citizens anywhere in the world, twenty-four (24) hours per day. If an Assured Person suffers Total and Permanent Disablement whilst temporarily residing or travelling outside the country, we may require the Assured Person to return to the country, at his or her own expense, for assessment of the claim.

INSURANCE BENEFITS TERMS & CONDITIONS

Life Cover

The Death Benefit shall be payable in the event of the death of the Member arising from natural causes, illness and accidents whilst assured hereunder -
subject to the stated exclusions. The amount of such benefit will be defined in the membership tier selected.

Accidental Permanent & Total Disability

The Underwriter will pay the specified amount on confirmation of Accidental Permanent and Total Disability of an Insured member by a qualified medical practitioner supported by medical evidence acceptable to the Underwriter. The permanent disability condition must be confirmed by the underwriter’s specialized doctors and a decision made of the final settlement.

Permanent and Total Disability is defined as disability resulting from bodily injury which disability wholly prevents the Life Assured from engaging in any and every business or occupation and from performing any work for compensation or profit and which disability has continued uninterruptedly for a period of at least six months (such disability of such duration being deemed to be permanent only for the purpose of determining the commencement of liability hereunder). The Underwriter, however, will recognize as permanent and total disability;

EXCLUSIONS: The Benefit does not apply to disability of the Life Assured caused:

  1. Directly or indirectly by active participation in war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, mutiny, revolution, insurrection, or military or usurped power, riot or civil commotion; The underwriter offers cover for passive participation but not active. If a member participates in causing riots or any of the mentioned activities in the clause, the claim shall not be admissible
  2. By the Life Assured whilst he is in or upon or entering or descending from or as a result of falling from an aircraft otherwise than as a fare-paying passenger on a recognized airline operating on regular scheduled air routes and air travel by any charter aircraft duly licensed as a recognized air carrier;
  3. Directly or indirectly by or contributed to, by, or arising from ionizing radiation or contamination by radioactivity from any nuclear fuel or any nuclear waste from the combustion of nuclear fuel;
  4. Whilst the Life Assured is engaged, for a gain/earnings, in hunting, steeple-chasing, mountaineering, winter sports, motor cycling (whether as driver or passenger), football, rugby, polo, racing of any kind other than on foot, wild beast or big game hunting or any other sporting activity, naval, military or air force service or operations; Please note the cover is extended to members participating in sports as pass time and do not earn a living out of the sport.
  5. whilst the Life Assured is under the influence of drugs or intoxicating drinks.
  6. by intentional self-injury or attempted suicide (whether felonious or not), provoked assault or fighting (except in bona fide self-defence); Once the scheme has been in force for more than a year onwards suicide is covered and this applies when the cover is renewed with the Underwriter.

Written notice of claim there under must be presented to and received by the Underwriter within three months of the occurrence of the accident.

When payable;

ITEM LOSS PERCENTAGE
1 Loss of both hands at or above wrist 100
2 Loss of both feet at or above the ankles 100
3 Loss of one hand at or above the wrist and one foot at or above the ankle 100
4 Loss of all fingers and thumbs of both hands 100
5 Total and irremediable Blindness in both eyes 100
6 Total and irremediable paralysis 100
  LOSS OF ARM-
7 at shoulder 60
8 between elbow and shoulder 50
9 at elbow 47.5
10 between wrist and elbow 45
11 loss of hand at wrist 42.5
12 Loss of four fingers and Thumb of one hand 42.5
13 Los of four fingers 35
  LOSS OF THUMB-
14 both phalanges 25
15 one phalanx 10
  LOSS OF INDEX FINGER-
16 three phalanges 10
17 two phalanges 8
18 one phalanx or 4
  LOSS OF MIDDLE FINGER-
19 three phalanges 6
20 two phalanges 4
21 one phalanx 2
  LOSS OF RING FINGER-
22 three phalanges 5
23 two phalanges 4
24 one phalanx loss of little finger 2
25 three phalanges 4
26 two phalanges 3
27 one phalanx 2
  LOSS OF METACARPALS
28 first or second (additional) 3
29 third fourth or fifth (additional) 2
  LOSS OF LEG-
30 at hip 70
31 between knee and hip 50
32 below knee 35  
33 loss of ankle 32.5
34 loss of all toes of both feet 15
  LOSS OF GREAT TOE-
35 both phalanges 5
36 one phalanx 2
37 Loss of toe other than great toe (provided more than one toe is lost) each 1
38 Loss of one whole eye or total and irremediable blindness in one eye 30
39 Irremediable loss of sight (except perception) 30
40 Loss of lens of one eye 20
  TOTAL AND IRREMEDIABLE DEAFNESS-
41 both ears 50
42 one ear 7

In case the permanent disability being assessed is not specified in this table, the percentage that closely approximates the degree of disability stated in the table will be used.

Proof of Permanent and Total Disability;

Immediately and after the happening of an event that may lead to a claim by Total and Permanent Disability:

  1. Full particulars of the event including the whereabouts of the Member must be given to the Underwriter within thirty days.
  2. All certificates, information and evidence required by the Underwriter shall be furnished free of expense to and in such a form, as the Underwriter shall prescribe.
  3. Any medical examiner nominated by the Underwriter shall be allowed to examine the Member in respect of Total and Permanent Disability claimed at such times after the occurrence of disability as the Underwriter may deem necessary.

Critical Illness Benefit

The Underwriter will pay the specified amount on first positive diagnosis of any of the listed diseases below by a registered qualified medical practitioner supported by medical evidence acceptable to the Underwriter. The critical illness condition must be confirmed by our specialized doctors and a decision made on the settlement.

  1. Heart Attack – Death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. This diagnosis must be supported by three or more of the following five criteria which are consistent with a new heart attack:
    1. History of typical chest pain;
    2. New electrocardiogram (ECG) changes proving infarction
    3. Diagnostic elevation of cardiac enzyme CK-MB
    4. Left ventricular ejection fraction less than 50% measured 3 months or more after the event.
    5. Diagnostic elevation of Troponin (T or I)
  2. Coronary Artery By-pass Surgery – The actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist. Angioplasty and all other intra-arterial, catheter based techniques, ‘keyhole’ or laser procedures are excluded.
  3. Stroke – Stroke is any cerebrovascular incident producing neurological sequelae lasting more than twenty-four hours and including infarction of brain tissue, haemorrhage and immobilisation from an extra cranial source. This diagnosis must be supported by all of the following conditions:
    • Evidence of permanent neurological damage confirmed by a neurologist at least 6 weeks after the event
    • Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.The following are excluded
    • Transient Ischaemic Attacks;
    • Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease; Vascular disease affecting the eye or optic nerve; and
    • Ischaemic disorders of the vestibular system.
  4. Cancer – A disease manifested by the presence of a malignant tumour characterised by the uncontrolled growth and spread of malignant cells and the invasion of normal surrounding tissue. This includes leukaemia, lymphoma, Hodgkin’s disease and mixed tumours of the parotid gland. Such cancer as defined above must be positively diagnosed by a Medical Practitioner qualified in the appropriate speciality of pathology.All skin cancers, cancer in situ and melanoma in situ and tumours in the presence of any human immuno-deficiency virus are excluded.
  5. Kidney Failure – Being end stage renal failure presented as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis initiated, or renal transplant is carried out.
  6. Paraplegia – Total loss of muscle function or sensation to the whole of both lower limbs and/or both the upper limbs as a result of injury or disease. Disability must be established for a continuous period of twelve (12) calendar months and the supported by acceptable neurological evidence.
  7. Major Organ Transplant – The human to human organ transplant from a donor to the Assured Person of one or more of the following organs that resulted from irreversible end stage failure of the relevant organ: Kidney, Heart, Lung, Liver or Pancreas. The transplant of Bone Marrow is included. The transplantation of all or other organs, parts of organs or any other stem cell transplants are excluded.

The payment of the Critical Illness benefit is subject to the following;

  1. The first day of the critical illness diagnosis occurred prior to attainment of age 75 years;
  2. The policy was in force and the insured person was a BimaNet member at the date of occurrence of the sickness

Exclusions;

Funeral / Last Expense Benefit

The Underwriter shall pay the specified amount within forty-eight (48) hours (of provision of relevant documents) to meet the cost of Funeral Expense of a member.

Temporary Total Disability (Disability Income)

The benefit amount as specified in the schedule, together with any benefit increases, shall be payable at a rate of 2% of the total benefit, calculated on weekly basis for a maximum of 52 weeks, following the expiry of the waiting period while the Member is disabled and unable to perform his / her own occupation due to an accidental injury. The payment will be made on monthly basis.

PAYMENT OF BENEFIT

A claim will only be admitted once the Underwriter has received proof that the Member has been totally and continuously incapacitated and unable to follow his / her own occupation for remuneration or reward due to an accidental injury. The condition must be confirmed by the Underwriter’s specialized doctors whose decision is final.

Claim payments shall be made at the end of each calendar month. Proportional payments shall be made in respect of the first and last month of any claim, based on the proportion of that month that the Life Insured was entitled to claim for.

Payment of a claim shall cease on the earliest date, as determined by the Underwriter, on which the Member:

  1. Becomes able to perform the normal duties of his/ her own occupation;
  2. Has been disabled for a period of 12 months;
  3. Ceases to suffer a reduction in income attributable solely to the injury which gave rise to the claim;
  4. Refuses to follow medical treatment as recommended by his / her own medical practitioner or Underwriter’s Chief medical officer or specialized doctors;
  5. Fails to provide evidence, satisfactory to and as requested by the Underwriter from time to time, of the continuance of incapacity justifying the continuance of the claim. The Life Insured shall as often as may be reasonably required submit to physical examinations and tests at the request of and at the expense of the Underwriter
  6. Reaches the benefit cease date or on the death of the Life Insured

In-hospital cash back Benefit

The Underwriter agrees to offer an In-Hospital Cash Back benefit subject to the following terms and conditions.

Provided always that: -

  1. No compensation shall be payable if the date of accident or illness leading to bodily injury which leads to claim falls before the date of commencement.
  2. The in-hospital cash back benefit shall be payable upon hospitalization from an accident or illness at a registered NHIF inpatient hospital for more than 2 consecutive nights and payable for a maximum of 28 nights in a year. The payment will be made as a cash back at the end of the hospitalization period or 28 nights, whichever comes first.

PROOF OF CLAIM

Immediately and after the happening of an event that may lead to a claim under:

  1. Full particulars of the event including the whereabouts of the Member must be given to the Underwriter within thirty days.
  2. All certificates, information, receipts and evidence required by the Underwriter shall be furnished free of expense to and in such a form, as the Underwriter shall prescribe.
  3. Any medical examiner nominated by the Underwriter shall be allowed to examine the Member in respect of injuries from which the charges are drawn at such times after the occurrence of the event as the Underwriter may deem necessary.

CLAIM PROCESS

The insured persons or their dependents shall notify the Underwriter, through BimaNet, of any incident or accident which may result in a claim within thirty (30) days from the date of occurrence. Failure to furnish notice or proof of loss within the required time limits shall not invalidate or reduce any claim if it shall be shown not to have been reasonably possible to give such a notice or proof and that notice and proof were given as soon as was reasonably possible

In order to process payment, the Life assured or their dependents shall furnish the Underwriter, through BimaNet, with the following Documents:

  1. Death claims:
    • Official notification letter/email
    • Original or Certified copy of death certificate
    • Original or certified copy of National ID card/Surrender of ID card Form
    • Original burial permit
    • Duly completed death claim form Original Police abstract in the event that death is accidental
    • Duly completed claim form
    • Injury Claims: (PTD & TTD)
    • Official notification letter/email
    • Personal Medical Attendant’s Report
    • Underwriter’s Specialist Opinion
    • Duly completed claim form
    • Funeral Benefits claims:
    • Official notification letter/email
    • Original or Certified copy of the Burial Permit
    • Duly completed death claim form
  2. Critical Illness claims:
    • Official notification letter/email
    • Original copy of the supporting medical reports
    • Must seek Underwriter’s Doctor’s opinion
    • Copy of national ID card
    • Duly completed claim form
  3. In-Hospital Cash Back Benefit:
    • Official notification letter/email
    • Original Medical receipts/Proof of hospitalization (e.g. admission & discharge reports)
    • Duly completed claim form

Any other claim document as required by underwriter.