Over 95 % of the Kenyan population is not covered by any form of insurance. The lack of insurance leaves people vulnerable to financial shocks such as medical costs and funeral expenses. The appropriate insurance policy provides people with the assurance they need to better cope with life's challenges.

BIMA YA JAMII has been developed out of a strategic partnership between: The Co-operative Insurance Company of Kenya Limited (CIC) & The National Hospital Insurance Fund (NHIF) for the uninsured population in Kenya.



BIMA YA JAMII - A revolutionary comprehensive insurance package at only 3,650 KSH per family per year, which is 10 KSH per day.


Benefits:
• No upper age limit
• Ensures there are no deposits required at admission to hospital
• Covers principal member and family members
• Pays all doctor fees, bed charges, including food, X-ray and laboratory costs, all prescribed drugs, dressings, ICU charges and any other in-patient procedure
• Pays maternity costs for normal and caesarean births
• Pays for treatment of chronic and pre-existing medical conditions
• All surgeries carried out in government hospitals (Category A) are fully covered. For surgeries carried out in Category B hospitals i.e. mission hospitals, Kenyatta Hospital and Moi Referral, there will be a charge of 1 KSH to a maximum of 15,000 KSH depending on the nature of the surgery
• Guaranteed quality treatment
• Rebates at high-cost private hospitals

Hospital service providers(General ward only):
• The inpatient services are accessible from a list of over 200 hospitals spread through out the country
• The hospitals are mainly mission (faith based) hospitals, with some low cost private hospitals and all government hospitals.
• All hospitals in the list offer quality services for all basic treatment procedures.

See hospital categories as hereunder and note the attached List of Hospitals.
Category A – Government hospitals (General ward only): members have full and comprehensive cover for all maternity and medical in-patient medical treatment including surgery.
Category B – Private and faith-based (General ward only): members have full and comprehensive cover as in Category A BUT when surgery is concerned, the member may be requested to pay up to a maximum of 15,000 KSH depending on the nature of the surgery.


Disability, accidental death and funeral benefits:
• Loss of income benefit for principal member: Pays 2,000 KSH per week for the duration the member is hospitalised following an accident up to a maximum period of 25 weeks.
• Total permanent disability of the principal member: Pays 100,000 KSH in case the member becomes permanently disabled as a result of an accident.
• Accidental death for the principal member: Pays 100,000 KSH to the family in case of death of the principal member through an accident.
• Funeral expenses for the principal member: Pays 30,000 KSH to the family in case of death of the principal member from any cause. The amount is paid within 48 hours of reporting to CIC.
• Funeral expenses extension to additional family members allowed at a cost of 270 KSH for spouse and 210 KSH per child per year.

General Terms:
• The principal member is the contributor.
• Children are covered from one-day to 18-years old. Children between 18 and 25 years are covered where they are still dependant on their parents (college, disability etc.)
• Has no exclusion clause for HIV/Aids or other pre-existing conditions
• Policy has no upper age limit for principal member and spouse
• Policy is effective 30 days from date of payment
• The policy is renewable every year

The last respect (funeral expense) options are:
• Policy holder alone
• Policy Holder with spouse
• Policy holder +Spouse+ children
• Policy Holder+ Children only.


The policy is renewable every year immediately after expiry. It is the policy holder's personal responsibility to renew the cover by paying the premium.


How to enrol:
The Bima ya Jamii is sold through SACCO Societies, Welfare Groups and Microfinance Institutions. If you are not a member of one of these you may register individually at the CIC office near you. When you fill in the BIMA YA JAMII form you need to attach the following:
• Copies of ID of the principal member and spouse
• Passport size colour photo for principal member, spouse and dependants (to be glued to the forms in the spaces provided)
• Copy of student ID for dependants between the age of 18 and 25 years
• Proof of disability for dependants above the age of 18 years in case of permanent physical or mental disability
• Proof of dependency from Local Children's Office for non-biological dependents

Once the form is duly completed the policy holder will pay the premium of 3,650 KSH as well as the extra premium if additional cover for funeral expense is required: 270 KSH for spouse and 210 KSH per child.


Admission procedures:
• Admission shall take place on the strength of the BIMA YA JAMII medical card that should be issued 30 days after remittance of payment to CIC.
• In an event, which is unlikely, that a patient has no card yet, they should immediately inform the institution from which they bought the cover who shall liaise with CIC.
• At discharge, next of kin shall request a letter from nearest NHIF offices that authenticates the validity of the card. The bills incurred shall be settled on the strength of the NHIF letter. NHIF shall settle all the bills comprehensively for the category A & B hospitals so long as the patient is admitted in the general ward. The 15,000 KSH in Category B hospital still applies.


Please note that the following medical expenses are not paid by BIMA YA JAMII cover:
• Costs of hospitalisation in the amenity or private wing wards (the daily rebate applies)
• Costs of organ transplant is paid for if everything is available locally and in a local hospital as any other medical procedure
• Transport costs to the hospital
• Treatment outside Kenya. A certain limit applies
• Costs incurred without a valid cover
• Optical and dental expenses unless occasioned by accidental injury
• General medical examinations/check ups and vaccinations
• Claims arising from herbalists
• Cosmetic surgery, massage or beauty treatment.
• Costs arising from a member receiving experimental treatment or being a subject of medical research.
• Claims arising from non registered practitioner or institution
• Claims arising from non registered members such as relatives etc.

Please also note that if the member pays for hospital treatment in cash instead of using the BIMA YA JAMII card, the reimbursement will be based on the daily rebate agreed with the particular hospital and not necessarily cover all costs.

Here's the HOSPITALS LIST for download

For further information or assistance please contact:
Gilbert Ng'etich, CIC: 020 – 2823 226
Freshia Kinani, CIC: 020 – 2823 357

[B BIMA YA JAMII– Frequently asked questions(FAQs) B]


What is an accident?
An accident is defined as a sudden, violent and external action that leads to harm. Examples of accidents include road accidents, domestic violence, snake bites, etc

What is permanent disability?
Permanent disability will be determined by the treating doctor's report, but it is defined as a situation where the result of an accident leads to a member being immobilised and unable to carry on with their previous income generating activities. Examples are loss of sight on both eyes, or hearing on both ears, or loss of two limbs, etc.

How do you ensure that payment of last respects is made in time to cater for funeral costs?
The last respect benefit is paid within 48 hours after CIC received the notification of death. The one making the notification must come with a copy of the departed's documents ID and a burial permit.

What happens when a member seeks admission in a hospital that is not in the provided list? How much are the rebates at the private high-cost hospitals?
The daily rebate applies and ranges from 800 to 2,400 KSH per day of admission depending on previous agreement between the hospital and NHIF. The member is recommended to enquire with the hospital to find out which amount is applicable.

Can I be admitted in any ward of my choice in the listed hospitals?
No. The Bima Ya jamii card only gives comprehensive cover for general ward hospitalisations.

Who qualifies as dependants? Can I cover my parents and siblings with my cover?
Children are covered from one-day to 18-years old. Children between 18 and 25 years are covered where they are still dependant on their parents by either being students or disabled. Parents and siblings are not considered as dependents but a separate BIMA YA JAMII cover can be bought for them.

What happens when a new child is born in the family?
The member will inform the institution from which the cover was bought and present them with a passport colour photograph of the baby. The baby will automatically be included on the comprehensive in-patient cover within 14 days of such notification, at no charge.

What if I have more than one wife?
Only one spouse can be declared in the policy. A separate cover can be bought for the other spouses.

What if I have children in my care that are my dependants but not my biological children?
Non-biological children are considered as dependants if a letter from the Local Children's Office can confirm this.

Is the cost of medication covered in case the hospital can not provide?
No.

Are out-patient consultations covered?
No.

Are transfers between hospitals covered?
Transfer between hospitals is covered when considered as necessary by the treating doctors and the transport is organised by the hospital.

Are emergencies covered?
Emergencies are covered for treatment in Category A and B hospitals in the list provided. In other cases the daily rebate is applicable. Ambulance transport is not covered.

What is the maximum medical bill insurable?
There is no monetary limit but there is a limit of 180 days of admission which are cumulative for all members insured under the same card.

Is the policy active before I receive the card?
The cover is valid 32 days after CIC receives the payment. If the member needs to be admitted to hospital but the card has been delayed, please contact CIC hotline 0716 – 616 641.

What is the expiring time before the card needs to be renewed?
The BIMA YA JAMII cover is valid 365 days, i.e. one year. Please contact the institution from which you bought the cover one month before renewal due date.

What happens if I lose my card?
Please contact the institution from which you bought the cover.

Is it possible to pay in instalments?
CIC needs to receive the full amount at the moment of purchase but you may apply for a loan from your financial institution (SACCO, MFI, Self-Help Group, Welfare Association…) in order to pay in instalments.

What if I am already covered by NHIF?
If you are already covered by NHIF the BIMA YA JAMII cover is not applicable but you may purchase a Personal Accident and Funeral Expense Cover separately from CIC in order to benefit from these.

What happens if I'm refused admission to the hospital?
If your BIMA YA JAMII card is not recognised by the hospital please contact the CIC hotline 0716 – 616 641 or the institution from which you bought the cover.

What if I forgot my card upon admission?
There is a provision to submit a card within 24 hours upon admission. Beyond this time you will be requested to pay admission and treatment fees which can only be refunded as per the daily rebate previously agreed upon between that particular hospital and NHIF.


Download Bima Ya Jamii Proposal form