PERSONAL
TULIZO BORA
TULIZO BORA

The MUA Tulizo Bora Health insurance product is designed for individuals and families looking for quality health insurance coverage to protect them against the high hospitalisation expenses arising from both illness and accident when they do occur.


The Policy covers hospitalisation expenses incurred during the period of admission, including Bed charges, Diagnostic services, Specialist doctors’ fee, Prescribed physiotherapy/Chemotherapy/radiology, Prescribed drugs/dressing, Operating theatre and ICU/HDU charges, among others. 


Benefits covered under the Policy include Pre-existing & Chronic conditions, HIV/AIDS, Psychiatric illness, emergency evacuation within East Africa, first emergency caesarean section, Post-hospitalisation follow up treatment, and Day care surgery for minor surgical treatment.


The maximum joining age is 60 years (Age next birthday). Eligible membership include the Applicant (Principal member),   spouse and children ( own, legally adopted and foster children).

 

GENERAL CONDITIONS

Eligibility

  • Age limits – 0 years to 65 years. Existing members above 65 years will be covered to 75 years, subject to medical underwriting. 
  • Definition of Dependents: spouse, biological children, legally adopted and foster children aged from 0 years to 21 years. 

Medical Examination

Principal members and spouses aged between 50 and 65 years must get a medical examination done at their cost from any of our panel doctors.

Onboarding Requirements 

  • Duly filled application form
  • Copies of national IDs for adults and birth certificates for children. 
  • Copy of principal member’s KRA pin
  • Full annual premium

Cover Confirmation

  • Subject to acceptance of duly signed and completed proposal form along with the premium cheque.
  • Attending doctor’s medical report should be attached to the proposal in case of any declared pre-existing condition.

Scope of Cover:  

  • Hospitalization and medical expenses including Surgeons, Physicians, Doctors & Anesthetist fees, Operating Theatre & ICU charges Diagnostic services, Physiotherapist’s fees, Prescribed drugs, Dressing, Surgical Appliances.  
  • Outpatient, dental & optical services for covered benefits. (if purchased)  

Waiting Period:  

  • For any hospitalization (except hospitalization due to accident), a waiting period of 60 Days from inception of the cover applies (the waiting period can be waived with proof of continuity of an earlier medical insurance cover).  
  • General Outpatient waiting period of 30 days on illness claims for new members.  
  • No waiting period for accident-related claims.  
  • Pre-existing & chronic conditions are subject to a 1 year waiting period.  
  • All other waiting periods as per the benefit schedule

Claims:  

  •  The insured is free to take treatment in any registered hospital in the country and submit documents pertaining to the said treatment to get reimbursement up to 70% subject   to prior approval by MUA. The Company has arranged credit facilities with certain hospitals in the country.  

Admission procedure:  

  • For emergency, the insured can be admitted by using biometric access, then our office will be contacted within 24 hours by the hospital to get pre-authorization.  
  • For non-emergency MUA Insurance Kenya (Ltd) should be provided with doctor’s appointment or Hospital’s admission medical report to enable us to authorize hospitalization. 

Reimbursement requirements:  

  • Duly filled claim form  
  • Original receipts  
  • Medical report & discharge summary  
  • Itemized hospital bill  
  • Prior written approval from MUA  

Summary of Exclusions:   

  • General Medical Health checkup unless covered  
  • Cosmetic surgery unless caused by accident.  
  • Pre-existing conditions within first year.  
  • Chronic conditions within first year.  
  • Age related senility, general debility.  
  • Chiropractic, Acupuncture, Herbalist treatment.  
  • Intentional self-injury, drunkenness, drug addiction.  
  • Naval, military or air force operations, civil war,rebellion.    
  • Expenses recoverable under any other insurance (or any other medical reimbursement scheme.  
  • Beauty treatment in nature cure clinics or health hydro’s.  
  • Sexually Transmitted Infection.  
  • Family planning/infertility.  
  • Maternity and related complications unless the maternity benefit is purchased. During the first 12 months of cover, the expenses on the treatment of diseases such as cataract, Benign Prostatic Hypertrophy, Gynecological conditions and surgeries, Fibromyoma, Hydrocoele, Fistula/Fissure in anus, Piles, Sinusitis and related disorders are not payable. Contact lenses, cost of hearing aids, braces, bridges and plates.        
  • Dangerous/Professional sports and activities exclusions.  

N.B – Please refer to the policy document for the full list of  

exclusions.

 

INPATIENT – (FAMILY SHARED)
Overall Benefit Limits in Kshs perinsured family per annum 5,000,000 3,000,000 2,000,000 1,000,000 500,000
Day CaseSurgeryunder generalanesthesia Covered within the applicable limit
Posthospitalization treatment – up to 3 weeks after dischargefrom hospital on reimbursement 40,000 35,000 20,000 20,000 15,000
Medically necessary home nursing on doctor’srecommendation after discharge from hospital 45days
Physicians,specialists,surgical feesincluding anesthetistsfees, theatre charges, HDU, CCU& ICU,Diagnostic tests, physiotherapy as part of Inpatient Treatment Upto full limit Upto full limit Upto full limit Upto full limit Upto full limit
Surgical appliances/Internal prosthesis Upto full limit Upto full limit Upto full limit Upto full limit Upto full limit
Inpatient diagnostic tests for therapeutic purposes(ECGs, MRI Scans, Xrays, Pathology (authorization required) Upto full limit Upto full limit Upto full limit Upto full limit Upto full limit
Reconstructivesurgerydue to anacciden Upto full limit Upto full limit Upto full limit Upto full limit Upto full limit
Other Benefits Included Within Inpatient Cove
Localroad and air ambulance to hospital for emergency caseswithin Kenya only Covered within the annual inpatient limit
Commercial Air Evacuation out of Kenya (must be pre-authorized) for treatment not available or not safeto undertake locally Economy return fare onlywithin Africa, India and Pakistan Not applicable
Funeral Expenses Cover per family 100,000 100,000 75,000 50,000 50,000
Pre -existing, Chronic Conditions, HIV/AIDs and related conditions (1 year waiting period) Cancer treatment (2 years waiting period) Organ transplant (1 year waiting period) Hospitalized covid-19 cases (30 days waiting period) 900,000 800,000 750,000 450,000 250,000
Newly diagnosed chronic conditions (1 year waiting period) 2,000,000 1,500,000 1,000,000 650,000 350,000
Psychiatric Conditions (1 year waiting period) 750,000 600,000 450,000 350,000 225,000
Congenital conditions, neonatal & Prematurity (1 year waiting period) 850,000 750,000 600,000 450,000 250,000
Bed limits per day net of NHIF Ensuite Room up to KShs. 18,000/= net of NHIF Private Standard Room up to KShs.15,000/= net of NHIF Private Standard Room up to KShs.12,500/= net of NHIF General Ward Bed net of NHIF
Lodger fees for parents accompanying sick child member Covered for a child below 12 yrs
Passive Terrorism Covered up to 50% inpatient limit
First emergency caesarean section in the lifetime of a female employee/spouse (delivery only) is covered within the inpatient limit subject to purchase of maternity cover (12 months waiting period) Covered at an extended Kshs. 50,000/= of the purchased maternity limit within Inpatient limit
Inpatient dental surgery from accident Paid in full
Inpatient ophthalmology surgery as a result of an accident Paid in full
Inpatient non-accident-related dental surgery/treatment (6 months waiting period) 150,000 100,000 100,000 100,000 100,000
Inpatient non-accident-related eye treatment (excluding correction of refractive errors and laser treatment) (6 months waiting period) 150,000 100,000 100,000 100,000 100,000
MATERNITY – OPTIONAL (PER FAMILY)
Overall Benefit Limits 150,000 150,000 100,000 50,000 50,000
Normal and Subsequent C-Section delivery. Recovery ward, professional fees, maternity related hospitalization, other related complications (12 month waiting period) Covered Covered Covered Covered Covered
OUTPATIENT PER FAMILY BENEFITS
Outpatient Benefits (Optional) 200,000 (per family) 150,000 (per family) 100,000 (per family) 75,000 (per family)
Consultation fees (doctors on panel) Paid in full up to maximum of 3,000/- per consultation
Pathology, X-rays, MRI, CT scan and other necessary diagnostic tests Paid in full
Embedded Combined Dental & Optical (Cover provides dental consultations, cost of fillings, x-rays, extractions, prescriptions including surgical extraction together with anesthetics fees; Optical frames covered up to 50% of the limit to a maximum of KES 10,000) 30,000 20,000 10,000 5,000
Prescription drugs and dressings up to a maximum of 30 days dosage Paid in full
Pre-existing, chronic cover, psychiatric, congenital conditions and HIV AIDS and related treatment (1 year waiting period) Paid in full
Cancer treatment (2 years waiting period) Paid in full
Physiotherapy (preauthorization required) Paid in full – (maximum of 10 sessions)
Pre-scribed covid-19 tests and treatment Covered up to 7,000
KEPI Vaccination Paid in full within outpatient limit for child member up to 1.5 years
Routine medical check-up for Principal & Spouse Covered up to a max of KShs. 10,000 shared within outpatient limit for principal & spouse only. Not applicable Not applicable
Co-payment KShs. 1,000 at Nairobi, Aga Khan, Karen, MP Shah, AAR Hospitals Kshs. 500 at Mater, Mombasa and Avenue hospitals and their satellite clinics Co-payment of KES 200 for all other providers
OUTPATIENT PER PERSON BENEFITS
Outpatient Benefits (Optional) 200,000 (per family) 150,000 (per family) 100,000 (per family) 75,000 (per family)
Optical (Stand-alone - Optional) (Prescribed Optical frames up to 50% of the optical limit to a maximum of KES 10,000) 30,000 30,000 20,000 10,000
Prescription drugs and dressings up to a maximum of 30 days dosage Paid in full
Pre-existing, chronic cover, psychiatric, congenital conditions and HIV AIDS and related treatment (1 year waiting period) Paid in full
Cancer treatment (2 years waiting period) Paid in full
Physiotherapy (preauthorization required) Paid in full – (maximum of 10 sessions)
Pre-scribed covid-19 tests and treatment Covered up to 7,000
KEPI Vaccination Paid in full within outpatient limit for child members up to 1.5 years
Prenatal & post-natal outpatient visits Paid in full
Routine medical check-up for Principal & Spouse Covered up to a max of KShs. 10,000 shared within outpatient limit for principal & spouse only Not applicable Not applicable
Co-payment KShs. 1,000 at Nairobi, Aga Khan, AAR Hospitals Kshs. 500 at Mombasa and Avenue hospitals and their satellite clinics
INPATIENT – (FAMILY SHARED)
1. KES 5,000,000
From M M+1 M+2 M+3 M+4 M+5
18 to 29 35,980 66,000 83,420 102,784 121,044 139,304
30 to 39 38,789 69,000 96,513 118,013 139,513 161,013
40 to 49 46,500 83,505 110,800 136,300 161,149 182,649
50 to 59 65,100 116,366 132,936 158,263 183,068 202,177
60 to 64 74,319 120,174 157,093 187,181 206,290 225,399
65 to 69 74,319 120,174 157,093 187,181 206,290 225,399
2. KES 3, 000, 000
Age Band M M+1 M+2 M+3 M+4 M+5
18 to 29 30,250 56,000 73,300 90,600 107,900 125,200
30 to 39 32,800 60,310 79,485 97,799 112,519 130,217
40 to 49 38,991 72,000 91,698 110,774 127,447 146,091
50 to 59 54,587 96,957 120,192 143,427 166,662 189,897
60 to 64 62,963 100,202 120,192 143,427 166,662 189,897
65 to 69 62,963 100,202 120,192 143,427 166,662 189,897
3. KES 2,000,000
Age Band M M+1 M+2 M+3 M+4 M+5
18 to 29 26,503 46,100 60,000 74,000 88,000 102,000
30 to 39 28,904 51,280 69,126 83,726 100,000 116,700
40 to 49 34,860 62,936 82,270 98,834 114,420 133,020
50 to 59 48,804 85,328 96,962 108,173 119,383 130,593
60 to 64 58,565 95,170 112,479 125,660 138,841 152,022
65 to 69 58,565 95,170 112,479 125,660 138,841 152,022
4. KES 1, 000, 000
Age Band M M+1 M+2 M+3 M+4 M+5
18 to 29 21,200 37,550 48,143 58,736 69,329 79,922
30 to 39 23,915 41,900 56,065 67,300 80,000 92,700
40 to 49 28,000 50,300 67,899 80,291 94,177 108,063
50 to 59 43,400 75,880 86,226 96,195 106,164 116,133
60 to 64 52,080 85,860 100,046 111,373 122,700 138,573
65 to 69 52,080 85,860 100,046 111,373 122,700 138,573
5. KES 500,000
Age Band M M+1 M+2 M+3 M+4 M+5
18 to 29 17,492 29,500 36,195 42,231 49,313 57,431
30 to 39 18,638 33,264 45,687 56,708 67,729 78,750
40 to 49 23,157 41,686 56,633 64,233 74,749 85,770
50 to 59 39,367 68,349 75,771 83,193 90,614 98,036
60 to 64 46,072 74,498 86,307 97,407 111,009 124,611
65 to 69 46,072 74,498 86,307 97,407 111,009 124,611
OUTPATIENT – (FAMILY SHARED)
1. KES 200,000 (Applies for 3M & 5M)
Age Band M+1 M+2 M+3 M+4 M+5
18 to 29 77,987 92,489 111,223 129,200 151,000
30 to 39 77,987 92,489 111,223 132,700 154,400
40 to 49 77,987 93,000 114,700 136,500 158,200
50 to 59 79,600 101,300 123,000 144,800 166,500
60 to 64 79,600 101,300 123,000 144,800 166,500
65 to 69 128,095 151,915 182,686 195,000 195,000
2. KES 150,000 (Applies for 2M,3M & 5M)
Age Band M+1 M+2 M+3 M+4 M+5
18 to 29 56,100 73,800 91,500 121,829 136,895
30 to 39 70,452 88,794 106,762 121,829 136,895
40 to 49 70,452 88,794 106,762 121,829 136,895
50 to 59 71,600 89,300 107,000 124,800 142,500
60 to 64 71,600 89,300 107,000 124,800 142,500
65 to 69 107,250 135,172 148,900 148,900 148,900
3. KES 100,000 (Applies for 1M & 2M)
Age Band M+1 M+2 M+3 M+4 M+5
18 to 29 48,100 61,800 75,500 89,200 99,028
30 to 39 51,500 65,200 79,000 92,700 99,028
40 to 49 55,300 69,000 82,700 96,500 99,028
50 to 59 63,600 77,300 91,000 98,245 99,028
60 to 64 63,600 77,300 91,000 98,245 99,028
65 to 69 71,024 86,622 99,500 99,500 99,500
4. KES 75,000(Applies for 500K & 1M)
Age Band M+1 M+2 M+3 M+4 M+5
18 to 29 32,621 41,913 51,204 60,495 67,161
30 to 39 34,927 44,218 53,578 62,869 67,161
40 to 49 38,405 47,919 57,434 67,018 68,773
50 to 59 45,230 54,973 64,715 69,868 70,425
60 to 64 52,067 63,282 74,498 74,890 74,890
65 to 69 66,933 74,890 74,890 74,890 74,890
OUTPATIENT – (PER PERSON)
Age Band 200,000 150,000 100,000 50,000
18 to 29 42,200 37,892 34,400 20,389
30 to 39 45,800 41,800 35,226 28,376
40 to 49 49,600 45,600 35,226 32,934
50 to 59 57,900 53,900 39,600 32,934
60 to 64 57,900 53,900 39,600 34,500
65 to 69 69,643 63,632 44,222 34,500
DENTAL - (PER PERSON)
Limit 30,000 20,000 15,000 10,000
Rate 9,100 6,233 5,000 3,333
OPTICAL - (PER PERSON)
Limit 30,000 20,000 15,000 10,000
Rate 9,809 6,667 5,160 3,440
M ATERNITY - (PER FAMILY)
Limit 150,000 100,000 50,000
Rate 35,500 27,600 16,667
On boarding requirements

The following documents are required to enable MUA process the application and confirm cover:
 

  • Medical Application Form(Fully filled)
  • Copies of National ID for Applicant and spouse, and birth certificates for children.
  • Copy of Applicant’s KRA PIN
  • Full annual premium payment.


Note:  The start of cover is subject to submission of all the requirements above and confirmation by MUA in writing.

For more information

CONTACT US