KATABIMA MEDICAL INSURANCE TERMS AND CONDITIONS

1.1 Insurer – Pacific Insurance Brokers (E.A) Limited, a company registered and regulated by the Insurance Regulatory Authority.

1.2 Policyholder – The individual or entity that has purchased and holds this medical insurance policy.

1.3 Insured Person(s) – The person(s) entitled to medical coverage under this policy.

1.4 Premium – The amount payable by the policyholder in exchange for medical insurance coverage.

1.5 Coverage Period – The duration for which the insurance coverage remains valid, as specified in the policy document.

1.6 Medical Expenses – Costs incurred for hospitalization, medical treatment, consultations, prescribed medication, and other necessary healthcare services covered by this policy.

2.1 This policy provides coverage for medical expenses related to hospitalization, outpatient treatment, surgeries, prescribed medications, and other healthcare procedures as specified in the policy document.

2.2 Coverage includes medical conditions, illnesses, and accidents, subject to the policy's terms and exclusions.

2.3 The policy also covers emergency medical treatment, ambulance services, and specialist consultations, where applicable.

3.1 Pre-existing conditions, unless expressly stated in the policy schedule.

3.2 Cosmetic or elective procedures that are not deemed medically necessary.

3.3 Injuries resulting from self-inflicted harm, suicide attempts, or engagement in criminal activities.

3.4 Treatment for conditions related to alcohol or drug abuse.

3.5 Medical expenses incurred outside the approved provider network, unless pre-authorized by the insurer.

4.1 Premiums must be paid in full before the commencement of the coverage period.

4.2 Failure to pay premiums on time may result in policy suspension or cancellation.

4.3 Policy renewal is subject to review and may require updated medical information.

5.1 The policyholder must notify Pacific Insurance Brokers (E.A) Limited immediately after seeking medical treatment.

5.2 Claims must be submitted with all relevant supporting documents, including medical reports and receipts.

5.3 All claims are subject to verification and approval by the insurer.

5.4 Fraudulent claims will result in immediate policy termination and may lead to legal action.

6.1 The insurer reserves the right to cancel the policy in cases of non-disclosure, fraud, or non-payment of premiums.

6.2 The policyholder may request cancellation by submitting a written notice. Any refund of premiums will be subject to the terms specified in the policy schedule.

7.1 Any disputes arising under this policy shall first be resolved through negotiation or mediation in accordance with the laws governing insurance in Kenya.

7.2 If the dispute remains unresolved, the matter may be referred to a court of competent jurisdiction.

Pacific Insurance Brokers (E.A) Limited

Customer Support:

• Office Enquiries - +254 722 204 478
• General Insurance - +254 712 658 629
• Medical Insurance - +254 723 204 478/+254 790 870 870

Email: info@pacific-group.co.ke

Website: pacific-group.co.ke