STANBIC MEDIPROTECT

Individual Comprehensive Medical Cover (Voluntary Medical Cover)

Inpatient Maternity Funeral Outpatient Optical Dental Premium Premium Premium Premium
Cover Type
Benefits Benefits Benefits Benefits Benefits Benefits Per Life Per Life Per Life Per Life
Per Person Per Family Per Family Per Person Per Person Per Person (0-55 (56-64 (65-70 Above 70
Platinum Benefits Benefits Benefits Benefits Benefits Benefits years) years) years) years
Cover Ugx Ugx Ugx Ugx Ugx Ugx Ugx UGX UGX UGX
100,000,000 5,000,000 5,000,000 5,000,000 1,000,000 1,000,000 2,000,000 2,800,000 3,600,000 7,800,000

Per Person Per Family Per Family Per Person Per Person Per Person (0-55 (56-64 (65-70 Above 70
Benefits Benefits Benefits Benefits Benefits Benefits years) years) years) years
Gold Cover
Ugx Ugx Ugx Ugx Ugx Ugx Ugx UGX UGX UGX
50,000,000 3,500,000 2,500,000 3,500,000 500,000 500,000 1,000,000 1,400,000 1,800,000 3,900,000

Per Person Per Family Per Family Per Person Per Person Per Person (0-55 (56-64 (65-70 Above 70
Benefits Benefits Benefits Benefits Benefits Benefits years) years) years) years
Silver Cover
Ugx Ugx Ugx Ugx Ugx Ugx Ugx UGX UGX UGX
15,000,000 1,200,000 750,000 1,500,000 200,000 150,000 600,000 900,000 1,100,000 2,400,000
Inpatient Benefits
Benefit Description Platinum Gold Silver
• Hospitalisation benefits, accommodation in hospital
• Road ambulance evacuation
• The charges for medical practitioners, theatre, anaesthesia, theatre
and theatre medicines plus consumables, ward medicines, doctor’s
visits, nursing care, diagnostic tests (both laboratory tests and
100,000,000 50,000,000 15,000,000
radiology), “take home” medicines after discharge from hospital (up to
7 days)

• Acute illness – Treatment for common conditions that develop quickly,

are intense or severe and last for relatively short times and respond to
treatment

• ENT treatment and procedures including tonsillectomy & adnoidectomy

Inpatient Benefits
Benefit Description Platinum Gold Silver
• Accidents, emergencies and admission into high dependency units (HDU) and
Intensive care units (ICU) – includes admission in high care units of a hospital.
• Reconstructive surgeries – covering surgery to restore functionality of a body 25,000,000 25,000,000 15,000,000
part which may have been impaired by accident .

• Home nursing after discharge from hospital on doctor’s recommendation.

• Day case surgery – covering planned surgical procedures where the patient
returns home the same day.

Bed Limit
- Daily accommodation costs at a registered hospital.
500,000 400,000 150,000
- Includes cost of a parent/guardian accompanying a child aged 12 years and
below. Payable from the child’s inpatient benefit limit (if a bed is available).
Inpatient Benefits
Benefit Description Platinum Gold Silver
Preexisting / chronic conditions including HIV/AIDS & opportunistic infections
• Medical conditions that are existing at the start of the insurance policy and/or
have any of the following characteristics:- are usually long-term medical
conditions, have no cure, require prolonged medication or require the patient 20,000,000 10,000,000 3,000,000
to be trained to comply with a prescribed form of lifestyle to survive such a
condition e.g. asthma, hypertension. Including oncology/cancer treatment
including radiotherapy and chemotherapy to remove malignancy

Gynecological surgery
• covering surgery & procedures on the female reproductive system; including 10,000,000 5,000,000 1,500,000
myomectomy, hysterectomy
Illness related Inpatient ophthalmology surgery to the eyes to
• covering surgery correct trauma caused to the eyes by illness e.g. cataracts 10,000,000 5,000,000 1,500,000
surgery
Inpatient Benefits
Benefit Description Platinum Gold Silver
Maternity
• Covers childbearing expenses in-hospital
• Includes normal delivery / spontaneous vaginal delivery & elective and
emergency caesarean section delivery 5,000,000 3,500,000 1,200,000
• Complications arising out of pregnancy leading to hospitalization before,
during & after delivery e.g. preeclampsia, pregnancy loss/miscarriage, still
birth, preterm labour,gestational diabetes, ectopic pregnancy,
Newborn Baby cover ( within Maternity )
• Covers babies born premature (born before attainment of 34 weeks of
pregnancy
Covered Covered covered
• Newborn medical treatment required before discharge from hospital
• Congenital conditions – Covers hereditary and birth defects
10,000,000 5,000,000 1,500,000
Inpatient Benefits
Benefit Description Platinum Gold Silver
Illness related Inpatient dental surgery
• covering admission for purposes of dental reconstructive surgery caused 10,000,000 5,000,000 1,500,000
by illness e.g. impacted tooth in a child
Organs transplant surgery
• covers the cost of actual transplant surgery of a body organ 20,000,000 10,000,000 3,000,000

Internal surgical appliances

• covering devices; plastic or metallic in nature designed to support a body Within applicable benefit limit
part before, during or after surgery (post operative) or treatment .

Psychiatry & psychological conditions

• Treatment for mental health disorder including depression 10,000,000 5,000,000 1,500,000

Family Planning
Overall outpatient benefit limit
• Covers non-permanent procedures ( pills, injectaplan, Norplant and IUD )
Inpatient Benefits
Benefit Description Platinum Gold Silver
Temporary cover outside the geographical area

• The cover extends outside the set geographical boundaries up to

maximum of six (6) days on any one visit outside the set
geographical area. This benefit depends on the level of plan
chosen.

Over seas referral treatment Covered within Covered within Covered within
overall limit overall limit overall limit
• Prudential will pay for the cost of treatment outside Uganda
recommended by a qualified doctor and preauthorized by
Prudential. We shall reimburse the equivalent cost of a return
economy class air ticket. For treatment in India, Prudential will
offer credit services through accredited healthcare provider. All
other destinations are handled on pay-and-reimburse basis.
Outpatient Benefits
Benefit Description Platinum Gold Silver
• Day-to-day treatment at an outpatient department of a hospital or
registered health facility.
• Chronic limit capped to half of the outpatient limit.
• Consultation with a general practitioner or consultants/specialists.
• Prescribed diagnostic tests both laboratory & radiology.
• X Rays, CT Scans, PET, MRI & ultrasound scans (on preauthorization).
• Prescribed medicines and consumables.
• Minor outpatient procedures. 5,000,000 3,500,000 1,500,000
• Physiotherapy – ten sessions per prescription.
• Psychiatry & psychological treatment.
Telemedicine
• Consultations with doctors using your phone by calling a Toll free number
• Laboratory tests done from the comfort of your home or office
• Medicines delivered to your location
Outpatient Benefits
Benefit Description Platinum Gold Silver
Wellness Benefits

• Annual medical check up 300,000 200,000 100,000

• Vaccinations
• Diagnostic tests
• PSA for med aged above 40 years
• Mammogram for women PAP Smear

Maternity

• Prenatal & postnatal treatment services 1,000,000

• Three (3) ultrasound scans per antenatal package

External Prosthesis

• Appliances and devices prescribed to support post operation or other 1,000,000 500,000 300,000
treatment
• Includes prescribed crutches, corset, hire of wheel chair, hearing aids
Other Benefits
Benefit Description Platinum Gold Silver
Optical Benefits – Stand Alone
• Eyesight testing and prescription of spectacles once a year.
• Lenses covered to overall optical benefit limit. 1,000,000 500,000 200,000
• Includes contact lenses as an alternative to spectacles.
Dental Benefits – Stand Alone
• Treatment for natural teeth and gum diseases including as a result of
physical injury to teeth.
• X Rays & medication during and after treatment. 1,000,000 500,000 150,000
• Includes; cleaning, scaling, polishing, extractions, root canal & crowns.
• Braces covered for children up to 14 years of age.
Funeral Expenses – Within Overall Inpatient Benefit Limit
• Covering burial expenses and paid out upon death of the insured beneficiary
within 48 hours after evidence of death is presented; either death certificate 5,000,000 2,500,000 750,000
or death notification.
Covid-19 Benefits
Covid-19 Benefit Description Platinum Gold Silver
Covid-19 Testing ( With in the overall outpatient limit )
Ugx 360,000 Ugx 360,000 Ugx 150,000
• Subject to preauthorization :
• 2 (Two) PCR Tests for ONLY symptomatic cases following
preauthorization protocol
Covid-19 Outpatient Treatment
• 5 reviews with a doctor (via Telemedicine) Ugx 800,000 Ugx 500,000 Ugx 400,000
• Vitamin C
• Zinc
• Prescribed medication
Covid-19 Treatment – Inpatient Hospitalization
Ugx 10,000,000 Ugx 5,000,000 Ugx 1,500,000
• Testing & Treatment can be done at the following facilities:-
Case Hospital, IMC, UMC Victoria, Roswell, Platinum
Hospital & Rocket Health for those a round Kampala
• Includes emergency ambulance evacuation
Value Added Benefits
Benefit Description Platinum Gold Silver

Non-UNEPI Vaccinations ( Covered within outpatient limit ) 500,000 300,000 200,000

Total Permanent Disability ( Cash back benefit ) 5,000,000 2,500,000 750,000

Non claim discount ( Applicable to the lives that did not claim during the policy Covered
year, a 10% automatic discount at renewal )

Telemedicine ( Covered in partnership with rocket health, within applicable 1,000,000 500,000 300,000
limits )
Covid-19 Exclusions
• Mass testing and testing for asymptomatic tests

• Expenses associated with quarantine and isolation of positive cases

• Costs of contact tracing

• Testing for purposes of travel

• Admission outside agreed panel of hospitals (unless preauthorised)

• Treatment that was not preauthorised unless in the case of emergency (in
emergency cases, Prudential to be notified within 48 hours of admission)
General Exclusions
• Self-referred and patient preferred treatments.

• Use of alcohol, drug or other intoxicating substances

• Sex Hormones and Replacement Therapy (HRT)

• Treatment infertility or sexual impotence & Permanent family planning methods

• Cosmetic reconstructive & Dental treatments like dentures, false teeth, crowns or other processes.

• health nature cure clinics e.g spurs, herbalists

• Participation in any military & riots

• Attempted suicide and or any self-inflicted medical condition

• Participation in dangerous and professional sports

• Vitamins, mineral or organic supplements

• Circumcision unless as part of medical Treatment

Moratorium ( Waiting Periods )
• Illness /Covid-19 Hospitalisations 3 months.

• Maternity, new-born baby and congenital cover, 12 months.

• Organ transplant, 24 months.

• Chronic conditions acquired on cover, 12 months.

• Elective surgeries , 12 months

Important Terms and Conditions
• Eligibility:
– All dependants (Spouses inclusive) have to be on the same or lower cover to that of the principal member.
– Premiums for lives aged above 64 years are not absolutes and will be subject to medical underwriting protocols. Extra tests may be
recommended by PAUL at selected facilities, at PAUL’s Cost, to assess the inherent risk.
– Unsuccessful applicants will be re-imbursed 100%..
• Reimbursement: Reimbursement for non-designated or out of panel providers subject to prior approval from the Company - 100% of
treatment cost covered within the limits of cover at customary and reasonable rates
• Bed Limit
– In addition the overall inpatient limit, the daily bed limit applies to all sub limits e.g. pre-existing & chronic benefit, maternity etc..
• Maternity
– Prudential liability will be limited to the applicable bed limit package regardless of the overall maternity limit.
– The member will be responsible for all costs that are in excess of the applicable bed limit package
• Deductible/Co – Pay: As Per HCP List
• Geographical Cover: Uganda plus temporary cover broad for six (6) weeks on any one visit.
• Validity period . The quotation is valid for 60 days.
• 90% of the lives quoted for, are required to enable the scheme commence.
Value Addition

1. 10% Non-claim discount for lives that did not claim, at renewal.

2. Monthly scheme performance in process of implementation.

3. Quarterly scheme performance reviews with scheme management panel.

4. Hospital visits by our care manager in Kampala

5. Toll Free line in case of any query / assistance at point of service.

6. Health sensitisations on various topics subject to staff availability.

7. Membership guide for all principal members.

Eligibility and Enrollment
• Principal members:- Minimum aged 18 years

• Spouses' :- Minimum aged 18 years

• Children aged 0 (subject to 34-week term baby &

discharge from hospital up to 25 years if still in school
or college, unmarried & under the control of parents.

• All new members required to fill out an application

form and include bio-data plus medical history.

• A schedule of all beneficiaries is also required to verify

all eligible members.
Eligibility and Enrollment

The Fingerprint & Smart Card Readers

• These are the fingerprint and Smart card
readers available at all the facilities
installed with the Smart system.

• Card Reader – used to read and write

information in the smart card.

• Fingerprint reader -used for registration

of fingerprints and authentication of
subsequent bills at the Hospital.
 New Client Onboarding

Log onto Stanbic Website or Add Dependants Premium Payment

https://bit.ly/stanbicmediprotect
Add any number of Client pays annual
Read the T&Cs then dependants. Skip premium using their
0% 50% step if you have no
80%
click Apply Now if visa card.
you agree. dependant to add.

Payment Confirmation
Applicant Details Next Of Kin
Enter the details of Client receives
Enter bio data of payment receipt on
30% the principal 60% the Next of Kin. 90%
their email.
member and attach
ID.

Health Questionnaire Card Issuance

Plan Selection
Select preferred Provide details on Upon review and
40% package from 3 70% the health of the 100% acceptance by the
options. principal member medical underwriting
and dependants if team within 5
any. working days