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CoopCare

A Health Insurance solution built for Cooperative Members

We do health insurance differently - with more coverage,
less hassle, and perks that give you the most out of your premium.

What is CoopCare?

This is a medical product tailormade for Cooperative members and affiliates with a minimum membership of 4 principal members. The product allows members for a cooperative to enjoy a group cover on fairly priced group terms. The product covers Inpatient, Outpatient, Maternity, Dental, Optical and Last Expense benefits. One may choose to purchase Inpatient only or both Inpatient and Outpatient benefits.

Affordability is at the center of this product with a carefully selected low-cost provider panel mainly encompassing mission hospitals and low-cost private hospitals.

Members can take up the product as a family package allowing up to six dependents or as a member only. Any family beyond the member and six dependents category will attract a minimal additional premium to cover the extra dependents.

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How it Works

Product type: micro health insurance
The product allows members of a cooperative to enjoy a group cover on fairly priced group terms.
This is a medical product tailor-made for registered Cooperative members with a minimum membership of 4 principal members.
Once a Cooperative hit the threshold count of 4 principal members or more, the relevant Cooperative administrator verifies the details and submits to CIC for policy creation.
Once the registered members are verified and premium settled by the Cooperative, the member policies are activated and begin running at the start of the following month.
CoopCare Health insurance photo cards will be issued within 5 workings days on submission of full documentation from the Cooperative.
Where the threshold of the minimum number of 4 verified members isn’t met or payment from the Cooperative isn’t received, the members are pushed to the next month for verification and activation of their policies.

Benefits Summary

CoopCare Benefit

Benefit	Inpatient	Outpatient	Maternity	Dental	Optical	Last Expense	Accomodation (Net of NHIF)
Family/ Person	Family	Family	Family	Family	Family	Family	Bed Type
Option 1	100,000	30,000	15,000	5,000	5,000	50,000	Ward Bed
Option 2	200,000	40,000	20,000	5,000	5,000	50,000	Ward Bed
Option 3	300,000	50,000	25,000	7,500	7,500	50,000	Ward Bed

CoopCare Benefit Summary

Benefits Cover Summary	Limit of Cover	Sublimit/ Stand Alone
Inpatient maternity complications	Maternity and 1st ever emergency caesarian section are mutually exclusive and cannot both be accessed in the same policy year.
1st Ever Emergency Caesarian	Up to Kes. 30,000	Sublimit of inpatient
Antenatal and postnatal	Covered within the outpatient up to the full limit	Sub limit of inpatient
Inpatient pre-existing Conditions/pre-existing Chronic conditions	Up to 50% of the Inpatient cover limit Newly diagnosed to be covered up to the full limit.	Sub limit of inpatient
Congenital and prematurity conditions	Up to Kes. 50,000 per family	Sub limit of inpatient
Accommodation/Bed Capacity	As per table above net of NHIF Where a member does does not have NHIF, the member shall be required to copay Kes 500 for every day of admission.	Sub limit of inpatient
Last Expense	As per table above	Stand alone
Inpatient psychiatry	Kes. 20% of overall inpatient cover	Sublimit of inpatient
Inpatient Non-accidental Dental Surgery	Kes. 30,000 of overall inpatient cover	Sublimit of inpatient
Inpatient Non-accidental Opthalmological Surgery	Kes. 30,000 of overall inpatient cover	Sublimit of inpatient
Posthospitalization	Covered up to Kes 20,000 within Inpatient on reimbursement basis up to 4 weeks post discharge.	Sublimit of inpatient
Terrorism, Political war and Violence	Covered up to the full limit subject to the claimant not being an active participant.	Sublimit of both inpatient and outpatient.
Vaccines	KEPI vaccines.	Sub limit of outpatient
Outpatient Chronic conditions	Covered within the outpatient up to the full limit.	Sublimit of outpatient
Outpatient congenital conditions	Covered within the outpatient up to the full limit.	Sublimit of outpatient
Outpatient HIV/AIDS and related conditions	Covered within the outpatient up to the full limit.	Sublimit of outpatient
Lodger fees	Payable up to 12 years	Inpatient
ICU and HDU cover	Covered within the applicable benefit limit	Sublimit of inpatient
External aids including corsets, walking frames, wheelchairs	Covered within Inpatient up to Kes 30,000	Sublimit of inpatient
Air evacuation	Not covered	N/A
Outpatient Ambulance services	Not covered	N/A
Health Check-up	Not covered	N/A
Joining age	37 weeks subject to discharge	N/A
Overseas referral	Not covered	N/A
Covid - 19	Covered up to full Inpatient for Option 1, Covered up to Kes 150,000 for Option 2, within Inpatient Covered up to Kes 200,000 for Option 3, within Inpatient. Outpatient treatment is covered up to full Outpatient limit. Outpatient tests are capped at Kes 6,000 per test within Outpatient. The test must be prescribed by a doctor. Covid testing for purposes of travel is excluded.	Inpatient and Outpatient as applicable

Special Terms

Waiting periods
• No waiting period for accident related admissions
• 1 year for pre existing & chronic conditions treatment.
• 1 year waiting period for maternity related treatment.
Eligible age for Children from birth (born at full term of 37 weeks) to 18 years; 21 years up to 25 years subject to proof of full time learning with proof from the learning institution.
Eligible age for Principle member and spouse – up to 70 years.
Geographical limit is Kenya only.
Lodging facilities for parent accompanying a child below 12 years being admitted
Copay of Kes 100 applies to every outpatient visit.
Members without NHIF shall be required to copay Kes 500 for every day of admission
Access is strictly within the designated panel provided.
Members will access services through Photo cards. Cost of card replacement for lost or damaged card is Kes 300 per card.

10. Dental benefits which covers;

Cost of fillings
Root canal
X-rays
Polishing and scaling necessitated by a prevailing medical conditions and authorized by a doctor.
Tooth extractions including surgical extraction together with anesthetics fees
Decay
Accidental dental injury.
Consultation

11. Optical benefits which covers;

Expenses relating to eye treatment
Accidental eye injury.
Consultation.
Eye testing
Treatment arising from injury to the eyes caused solely and directly by accident external and visible means or arising from a disease affecting the eye or optical nerve.
The supply of Lenses
The prescribed spectacles will be acquired from an approved optician limited to one pair every two years.

Exclusions

Cosmetic surgery unless caused by accident
Weight management treatments and drugs.
Hazardous sports e.g., bungee jumping, paragliding
Family planning/infertility related treatment
Treatment other than by registered medical practitioner
Self-referred or self-prescribed treatment.
Scaling, crowns, bridges, orthodontics, and dentures.
Nutritional supplements unless prescribed as part of medical treatment.
Specialists Fees.
Alternative treatment – Chiropractors, Acupuncturist, Herbalist.
Drunkenness, drug addiction, Intentional self-injury, attempted suicide.
War and Kindred risks (whether war be declared or not).
Participation in Riot, Strike and Civil commotion.
Naval, Military or Air force operations.
Expenses recoverable under any other insurance e.g. NHIF, GPA, WIBA.
Beauty treatment in nature cures clinics or health hydro’s.

17. External surgical appliances – unless benefit has been provided for.
18. Diagnostic equipment (e.g. Glucometers, BP machines etc.) and hearing aids.
19. Experimental treatment.
20. Contamination by radio activity from nuclear fuel, waste or fission.
21. Laser correction of eye sight
22. Pregnancy related treatment for dependants other than the spouse if covered on the benefit schedule.
23. Optical exclusions – Plano prescriptions, +/-0.25 prescriptions, photo chromatic lenses, antiglare coatings.
24. Bills incurred by doctors/hospitals outside the CIC designated panel.
25. Pandemic & Epidemic occurrence.

Expenses relating to eye treatment
Accidental eye injury.
Consultation.
Eye testing
Treatment arising from injury to the eyes caused solely and directly by accident external and visible means or arising from a disease affecting the eye or optical nerve.
The supply of Lenses The prescribed spectacles will be acquired from an approved optician limited to one pair every two years.

Coop Care Medical Providers Panel

CoopCare Provider Panel

Frequently Asked Question on CIC Coop Care

What is Coop Care?

This is tailormade for cooperative members and affiliates with a minimum membership of 4 principal members.

Can a welfare member join Coop Care product?

No, this is tailormade for cooperative members and affiliates.

What is the maximum joining age?

The maximum joining age is 70 years and the product is available either as a family package allowing up to 6 dependents or as Member only. Any extra dependent will attract a minimal premium to cover.

Can I join directly as an Individual member?

No, Joining is through applicable Sacco Admin upon document scrutiny and settlement of premiums to the Sacco.

What is the cover period?

This is an annual cover renewal on expiry subject to scheme performance.

Is there any copayment?

Yes, a Copay of Kes100 applicable for every outpatient visit and Kes500. Members without NHIF shall be required to copay Kes500 for every day of admission

What is the geographical coverage of this product?

Geographical coverage is limited to Kenya only.

Are there waiting periods applicable?

No waiting period for accident-related admissions. 1 year waiting period for pre-existing & chronic conditions treatment, 10months waiting period for maternity and maternity related complications.

What will happen when my card is lost?

Report to Sacco Admin immediately you realize the loss. Cost of card replacement for lost or damaged card is Kes300 per card payable by the members. The card however cannot be used by any other person provided the photo/ID number have been saved onto the card.