FAMILY

MEDICAL
INSURANCE
ABOUT JUBILEE
Jubilee Insurance was incorporated on 3rd August 1937, in a small office in Mombasa and is one of the pioneers in the establishment of a local
composite insurance company.
In keeping with our mission of contributing to the economic growth of the region, Jubilee Insurance took the bold step of converting itself into a
public Company in 1984, to broaden its ownership base locally which now consists of over 5,000 shareholders. Today more than seventy five
years since inception Jubilee Insurance is a leading insurance company in East Africa with the largest shareholders’ funds and solid emphasis
on security for policyholders, information technology, committed, knowledgeable & professional staff, and a reputation for superior customer
service.
Currently, the Jubilee Insurance group is the largest medical insurance underwriter in East Africa.
KEY BENEFITS
1. 5 Levels of Comprehensive cover with optional benefits (Maternity, Outpatient, Dental and Optical). Select the plan and options to suit your
medical insurance needs and budget
2. Cover for Pre-Existing, Chronic, Psychiatric , congenital and HIV/AIDS including related conditions
3. Country wide Provider Network
4. Overseas inpatient referrals covered on credit under listed hospitals
5. Cover for inpatient dental and optical treatment
6. Post hospitalisation benefit
7. Funeral expenses benefit
8. Free Personal Accident benefit for Principle member
9. Direct access to treatment within East Africa
PLAN SUMMARY
J-CARE
INDIVIDUAL/FAMILY MEDICAL INSURANCE

INPATIENT BENEFITS (CORE PRODUCT - COMPULSORY)

All inpatient treatment is subject to pre-authorisation
All benefits are subject to overall annual benefit unless specified otherwise
PLANS CLASSIC PREMIER ADVANCED EXECUTIVE ROYAL
Overall benefit limits in UGX per insured family per 15,000,000 30,000,000 60,000,000 90,000,000 150,000,000
annum
Pre -existing, Chronic, Congenital Conditions, HIV/AIDS
and related conditions existing/not existing and/or not
diagnosed at the time of joining. Subject to full disclosure
at the time of joining (1 year waiting period) 7,500,000 9,000,000 12,000,000 15,000,000 30,000,000
Cancer treatment (2 years waiting period)
Organ Transplant (1 year waiting period)
Psychiatric conditions under inpatient limit (1 year waiting 3,000,000 6,000,000 7,500,000 9,000,000 15,000,000
period)
Bed limits per day General Ward General Ward General Ward Standard Private Standard Private
Bed Bed Bed room up to room up to
UGX.375,000 UGX.500,000
Lodger Fees for parent accompanying sick child member Covered for Covered for Covered for Covered for Covered for
Child under 8 Child under 8 Child under 8 Child under 8 Child under 8
years years years years years
Physicians, specialists, surgical fees including anaesthetist Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
fees, theatre charges, HDU, CCU & ICU, Diagnostic Tests,
physiotherapy as part of treatment
Inpatient MRI/CT Scans and PET Scans (authorisation Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
required)
Surgical appliances/internal prosthesis Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Reconstructive surgery following an accident Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Inpatient non accident related dental surgery/treatment (1 3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
year waiting period)
Inpatient dental surgery from an accident Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Inpatient opthalmology surgery as a result of an accident Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Inpatient non accident related eye treatment (excluding 3,000,000 3,000,000 3,000,000 3,000,000 3,000,000
correction of refractive errors and laser treatment) (1 year
waiting period)
Day case surgery under general anaesthesia Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Medically necessary home nursing on doctor’s recommen- 90 days 90 days 90 days 90 days 90 days
dation after discharge from hospital
Post hospitalisation treatment (where there is no outpatient 300,000 up to 450,000 up to 600,000 up to 750,000 up to 900,000 up to
cover) 3 weeks after 3 weeks after 3 weeks after 3 weeks after 3 weeks after
discharge discharge discharge discharge discharge
Discharge take home medication Up to 30 days Up to 30 days Up to 30 days Up to 30 days Up to 30 days
after discharge after discharge after discharge after discharge after discharge

OTHER BENEFITS INCLUDED WITHIN INPATIENT COVER

Local road ambulance to hospital for emergency cases Covered Covered Covered Covered Covered
Commercial Air Evacuation out of Uganda (must be pre Not applicable Not applicable Economy return Economy return Economy return
authorised) for treatment not available or not safe to fare only within fare only within fare only within
undertake locally Africa, India Africa, India Africa, India
and Pakistan and Pakistan and Pakistan
Funeral expenses - benefit is per family shared 1.500,000 1,500,000 2,250,000 3,000,000 3,000,000
Personal Accident (Free for Principal Member. Optional 15,000,000 15,000,000 15,000,000 15,000,000 15,000,000
for dependents)

OUTPATIENT BENEFITS (OPTIONAL)

Annual limits 1,500,000 1,500,000 2,400,000 3,000,000 4,500,000
Consultation fees (doctors on panel) Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Pathology, Xrays, MRI, CT Scan and other necessary Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
diagnostic tests *1
Prescription drugs and dressings upto a maximum of 30 Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
days dosage
Gynacological illness and treatment*2 Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Pre-existing, chronic cover, Psychiatric, Congenital Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
conditions and HIV/AIDS and related treatment ( 1 year
waiting period)
Cancer treatment (2 year waiting period) Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full
Physiotherapy (pre authorisation required) Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full

ROUTINE MATERNITY BENEFITS (OPTIONAL)

Annual limit per member/spouse 2,400,000 3,000,000 3,600,000 3,00,000 4,500,000
UNEPI Vaccinations (within maternity limit and subject to up to 150,000 up to 150,000 up to 150,000 up to 150,000 up to 150,000
pre-authorisation)
Pre-natal & Ante-natal outpatient treatment ( 1 year Covered under Covered under Covered under Covered under Covered under
waiting period) maternity limit maternity limit maternity limit maternity limit maternity limit
Benefits covered under maternity limit (1 year waiting Normal and Normal and Normal and Normal and Normal and
period) C- Section C- Section C- Section C- Section C- Section
delivery. Labour/ delivery. Labour/ delivery. Labour/ delivery. Labour/ delivery. Labour/
recovery ward, recovery ward, recovery ward, recovery ward, recovery ward,
professional professional professional professional professional
fees, pregnancy/ fees, pregnancy/ fees, pregnancy/ fees, pregnancy/ fees, pregnancy/
maternity related maternity related maternity related maternity related maternity related
hospitalisation, hospitalisation, hospitalisation, hospitalisation, hospitalisation,
other related other related other related other related other related
ailments & ailments & ailments & ailments & ailments &
complications complications complications complications complications
including etopic including etopic including etopic including etopic including etopic
pregnancy and pregnancy and pregnancy and pregnancy and pregnancy and
miscarriage miscarriage miscarriage miscarriage miscarriage

ROUTINE DENTAL BENEFITS (OPTIONAL)

Annual Limit per person 150,000 300,000 600,000 900,000 1,200,000
Benefits covered (pre-authorisation required) Dental Dental Dental Dental Dental
Consultations, Consultations, Consultations, Consultations, Consultations,
Extractions, Extractions, Extractions, Extractions, Extractions,
Fillings, Dental Fillings, Dental Fillings, Dental Fillings, Dental Fillings, Dental
Xrays and Xrays and Xrays and Xrays and Xrays and
Prescriptions Prescriptions Prescriptions Prescriptions Prescriptions

ROUTINE OPTICAL BENEFITS (OPTIONAL)

Annual Limit per person 150,000 300,000 600,000 900,000 1,200,000
Benefits covered (pre-authorisation required) 1 eye test per 1 eye test per 1 eye test per 1 eye test per 1 eye test per
person per person per person per person per person per
annum. Frames annum. Frames annum. Frames annum. Frames annum. Frames
and prescription and prescription and prescription and prescription and prescription
lenses. Frames lenses. Frames lenses. Frames lenses. Frames lenses. Frames
limit - UGX. limit - UGX. limit - UGX. limit - UGX. limit - UGX.
300,000/- 300,000/- 300,000/- 300,000/- 300,000/-
every 2 years every 2 years every 2 years every 2 years every 2 years
This is only a summary of the benefits for more details refer to the policy document
GENERAL CONDITIONS

1. General waiting period of 30 days for new entrants on illness claims. No waiting period for accident related treatment.
2. *(1) MRI, CT scan on pre authorisation.
3. *(2) Fibroids, Adenoidectomy, Haemorrhoidectomy and Tonsillectomy procedures shall have a waiting period of 1 year.
4. Cancer treatment will be subject to 2 years waiting period.
5. Pre-existing, Chronic, Psychiatric, Congenital, Organ Transplant, HIV/Aids and related treatment, Maternity and related
complications, inpatient non accident related ophthalmology and dental surgery shall be subject to 1 year waiting period.
6. Eligible for the main member and his/her legal dependents from the age of 1 month to 60 years. Existing members can continue
on cover up to age of 65 years. Children above 18 years will enjoy their own cover as principle members.
7. New applicants aged 50 years and over will be required to undergo a medical examination at specific providers, before
membership and eligibility of cover can be confirmed. Please note that this will be at applicants cost.
8. Cover must be confirmed in writing and premiums paid to Jubilee Insurance for the benefits to be effective.
9. All scheduled admissions must be pre authorised at least 48 hours prior to admission.
10. For emergency admission the hospital will contact Jubilee Insurance within 48 hours of admission.
11. Medical cards must be presented at the accredited panel of providers for access to service. Each member will also be required to
complete and sign a claim form.
EXCLUSIONS
1. Treatment for pre-existing chronic conditions, congenital and psychiatric conditions (within the first year)
2. Treatment for HIV/AIDS and related ailments (within the first year)
3. Treatment of Cancer (within the first two years)
4. Sexually transmitted diseases except HIV/AIDS
5. Peri-Menopause, Menopause, andro-pause ,hormone replacement therapy, age and puberty related treatment Organ transplant
(within the first year)
6. Treatment of Haemorrhoids, Fibroids, Hernia (except congenital), Adenoidectomy (within the first year).
7. Genetic disorders and related conditions.
8. Cosmetic or plastic surgery unless necessitated by an accidental injury that occurs while the insured is covered under this contract;
9. Riding or driving in any kind of race
10. Beauty treatment or massage
11. Naval, military and air force operations
12. Stays at sanatoria, old age homes, places of rest etc.
13. Medical check-up, general health examinations, prophylactic treatment, vaccinations except for KEPI vaccinations.
14. Transportation other than a licensed ambulance, as provided for under the in-patient coverage of this contract
15. Hearing tests or cost of hearing aids unless resulting from an accidental injury
16. Nutritional food supplements or replacements.
17. Injury or illness resulting from insurrection or war, civil commotion or an act of terrorism, whether declared or undeclared
18. Injury as a result of participating in riot, strike
19. Alternative treatment such as herbal treatment, acupuncture treatment, chiropractors etc.
20. Expenses resulting from the insured participating in extreme/hazardous sports and activities
21. Pain management
22. Dental treatment including teeth extractions, fillings, teeth scaling, etc. unless the dental cover has been purchased.
23. Optical treatment relating to correction of eyesight e.g. eye glasses, contact lenses, laser eye treatment unless the optical cover has
been purchased.
24. ntentional self-injury while sane or insane, suicide or attempted suicide, treatment of acute or chronic alcoholism and drug
addiction
25. Expenses recoverable under any other insurance e.g. NHIF
26. Treatment required as a result of noncompliance, failure or refusal to comply with medical advice
27. Pregnancy, childbirth, maternity benefits, medically necessary abortion, miscarriage, antenatal or postnatal care, caesarean
operation except where purchased and subject to twelve months waiting period
28. Contraceptive services and supplies, family planning and fertility treatment e.g. costs of treatment related to infertility and
impotence, any injury, illness or disease specified as exclusion and complications caused by a condition that is excluded.
29. Services primarily for weight reduction or treatment of obesity and slimming preparations or any care which involves weight
reduction as a main method of treatment.
30. Epidemics, pandemics or unknown diseases

PROVIDER PANEL
Jubilee Insurance’s provider panel allows members access to the medical care they require. The panel is on credit basis, which means
that provided the treatment is covered and has been pre authorised where necessary, the bill will be settled directly with the service
provider. This allows members to get quality care when required.
The provider panel will be in the membership pack upon purchase of the policy and the same can also be accessed via the Jubilee
Insurance website www.jubileeinsurance.com
APPLYING FOR COVER
To apply for cover, complete and sign the member application form. Submit it together with the required supporting documents. Jubilee
Insurance shall revert within 3 working days of receipt of your application and confirm the terms and conditions applicable.
The policy will be effective from the date the premium is paid. Waiting periods where applicable will start from the date the policy is
effective.

POLICY DOCUMENTS
Once the policy commences, you will receive a membership pack within 30 days which will include:-
• Membership Card (s)
• Welcome Letter confirming the plan and benefits purchased
• Policy document
• List of providers

FREQUENTLY ASKED QUESTIONS

When does my cover commence?
The cover commences once Jubilee Insurance provides you with an acceptance letter and once premium is fully paid.
To whom should premiums be paid to once I have received confirmation that my application has been
accepted?
Payment should be made directly to Jubilee Insurance by the following means:
• Cheque
• Cash payment to our Head office or any of our branches
What am I covered for?
The benefit options are provided in this brochure and the further details will also be provided in the policy document
Which hospitals can I go to?
A list of providers and specialists will be provided in your membership pack. The same can be accessed on the Jubilee Insurance
website. You can also call our offices directly for further assistance.
What do I need in order to access a credit facility?
Remember to always carry your Jubilee Insurance medical card and your national ID/ Passport in case further verification is required.
What is the procedure of enrolling a new born child?
Inform Jubilee Insurance immediately the child is born and provide all documentation (application form and passport size photo) as
soon as possible. Cover commences once Jubilee Insurance confirms acceptance and full premium is paid.
What does the policy say about treatment abroad?
A member is covered whilst temporarily abroad and requiring emergency treatment for an illness or injury that occurs during the
period of travel provided that such period does not exceed six weeks in any one visit and will be covered on reimbursement. Travel and
accommodation costs are not covered.
How do I change my policy if I am covered with another Insurer?
Provided there is no break in cover, and subject to the underwriting procedures some of the waiting periods may be waived allowing
for a seamless transition.
Once I have the initial medical examination having joined after the age of 50 years, will I need to go for an
examination at each renewal?
Jubilee Insurance may require medical examination when necessary. Communication will be provided in writing at the policy renewal.
 OUR CONTACTS

HEAD OFFICE:
Jubilee Insurance Centre,
Plot 14, Parliament Avenue, Kampala
Tel: 0414 311 701
jicug@jubileeuganda.com

AGENCY OFFICES:
Jinja Mbarara
Visvar Mall Building, Room 9, Room 28, 2nd floor
Plot 54, Lubas Road, Jinja Nakumatt Building, Mbarara
Tel: 0434 122 369 Tel: 0392 175 439

Mbale Gulu
Room 206, 2 floor
nd
Mark-Kweli Building, 2nd Floor
B.C.U (Bugisu Cooperative Union) Plot 20, Gulu Avenue
Republic Street, Mbale Gulu
Tel: 0454 431 234
Hoima
Entebbe Plot 32, Kampala Road
Plot 19, Portal Road Hoima Municipality
Entebbe

J CARE/2015/07/01-B1