BENEFIT TABLE FOR RAMANI IO COMPANY LIMITED

Please refer to the Policy Document for Detailed informaton

Policy Period:01-01-2023 to 31-12-2023
Annual benefits limit In Tanzania Shillings per insured member per year
PRODUCT OPTION CLASSIC EXECUTIVE
Region of Cover Tanzania and India on referral East Africa and India on referral
Network of Providers Enhanced Network only. No Enhanced Network only. No reimbursements
reimbursements for services outside for services outside network
network
IN-PATIENT BENEFITS Subject to approval and preauthorisation (within In patient limits and subject to limit per benefit)
Overall In Patient Benefit Limit: 50,000,000 100,000,000
In-hospital accommodation, specialists, theatre, ward, and medicines Private Room - Covered up to 350,000 per Private Room - Covered up to 350,000 per day
day
Internal Prostheses (Total benefit) subject to Overral benefits Limit Covered within overral Limit Covered within overral Limit
MRI and CT scans (Strategis Pre-authorization required). Scans done Covered Covered
during inpatient admission are fully deducted from the inpatient
benefits.
Day surgical operations (Strategis Pre-authorization required) Covered Covered
Inpatient physiotherapy and rehabilitation following trauma (within the 800,000 1,000,000
overall InPatient Limit)
Congenital conditions, Neonatal care (Incubator, phototheraphy, pre 15,000,000 20,000,000
maturity) as a sublimit of Overall In patient benefit
External Medical Appliances (Limited to 1 appliance per year) as a sub 300,000 500,000
limit of overall Inpatient benefit
COVID 19 Treatment (As a sublimit within overall Inpatient Limit for 7,500,000 10,000,000
inpatient cases only) Subject to approval and preauthorisation. For
outpatient cases, coverage will be up to full Outpatient benefit limit.
Accomodation/ bed/Room charges payable up to the maximum limit of
the scheme per day. This cover exclude test for non-symptomatic
members, any cost related to isolation/quarantine and COVID 19 test
requested for normal (non- medical) travel.
PRE – EXISTING and CHRONIC Diseases including HIV/AIDS (for HIV/AIDS this includes opportunistic diseases & ARV’S) As a sublimit of overall Inpatient Benefit
and subject to pre authorization.
As a sublimit of overall Inpatient Benefit 15,000,000 20,000,000
Covers hospitalization, medication, treatment and consultation by a Covered Covered
general doctor (or a specialist doctor) while admitted for a registered
chronic or pre-existing condition including but not limited to Cancer,
Organ Transplant (excludes donor cost) and Kidney Dialysis.
MATERNITY BENEFIT - Subject to approval and preauthorisation (within overall Inpatient limits)
As a sublimit of the Overall Inpatient Benefit Limit 3,000,000 4,000,000
Maternity services including Antenatal & Postnatal Clinic visits, Child Covered Covered
Birth (normal and C/S) and complications arising out of delivery (subject
to preauthorisation within overall Inpatient Limit).
INTERNATIONAL REFERRAL BENEFITS Subject to approval and preauthorisation (within In patient limits and subject preauthorisation)
International referral (Subject to Overall IP Limit) for treatment India Only Included within overall limit East Africa and India Included within overall
unavailable in Tanzania limit
Care for accompanying a referred person India. Return economy class ticket and full East Africa and India. Return economy class
board support of TZS100,000 per day up to a ticket and full board support of TZS100,000
maximum of 15 days per day up to a maximum of 15 days
International Elective treatment - Foreign Inpatient Treatment at the Covered within Inpatient Limit in India Only Covered within Inpatient Limit in East Africa
option of the member even when such treatment is available in Tanzania and India Only
. This will be on reimbursement basis covering necessary, reasonable
and customary charges only. Travel and other out of hospital stay costs
not covered.
Repatriation of Remains following an international referral 2,000,000 3,000,000
OUTPATIENT BENEFITS
Overall Limit 2,000,000 2,000,000
Primary consultations and treatment to include medical practitioners Covered Covered
fee, prescribed medicines, drugs and dressings.
MRI and CT scans . Covered - 50% of the cost will be covered under Covered Covered
Outpatient benefits and the remaining 50% covered under Inpatient
Benefit Limit (Strategis Pre-authorization required)
Radiology, Pathology, Diagnostic tests & procedures Covered Covered
Specialists & Consultation fees for consultations prescribed medicines, Covered Covered
drugs and dressings
Physiotherapy (within the overall Out Patient Limit) 250,000 300,000
Medication for Outpatient Chronic conditions (Refer Chronic 500,000 500,000
Conditions List)
Optical benefit (Strategis Pre-authorization required) 400,000 500,000
Consultation plus One Eye test per annum
Frames and lenses every two (2)years
Basic Dentistry( Strategis Pre-authorization required) Basic dental 400,000 500,000
procedures including , consultation, removal of teeth, fillings, x-rays,
scaling and polishing AND Specialized dentistry. (Root canal treatment,
crowns,) Preauthorised and in approved Network. No cash
reimbursement allowed
EMERGENCY RESCUE AND EVACUATION SERVICES Subject to approval and preauthorisation (within In patient limits and subject to limit per benefit)
Road Ambulance to the nearest hospital where required services are Covered within overall In Patient Limit Covered within overall In Patient Limit
available within Tanzania
Air Ambulance to the nearest hospital where required services are Covered within overall In Patient Limit in Covered within overall In Patient Limit in East
available within Tanzania Tanzania Africa
INTERNATIONAL EMERGENCY MEDICAL COVER
Up to 90 days of absence from Tanzania in any membership year Not Covered East Africa
(Preauthorisation required)
FUNERAL BENEFIT
Assistance 750,000 1,000,000

VALUE ADDED BENEFIT (To be offered at no additional Premium)

LIFESTYLE BENEFITS - Covers treatment, medication and investigations 250,000 300,000
for various lifestyle choices (treatment of menopausal symptoms,
contraception, child circumcision and Hepatitis B Vaccination) -
Additional limit per member
Annual Medical Check Up - Once per year for staff only at doctor's 250,000 300,000
room. Covering Urinalysis, Haemogram, Stool test, BMI, Blood
Pressure/Sugar, Chest X-ray and PSA & Pap Smear. Covered within
Outpatient Limit
Free access to a selected Gym facilty for staff - within Provider Network Covered Covered
provided