WORLDWIDE INDIVIDUAL HEALTH PLAN

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Contact
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Preview Quotation
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Membership Form

Health Cover Plan

Do you have Dependants?

Yes

*Your Age Bracket

*Over all Annual Limit

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Over All Annual Limit

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Over all Annual Limit	Covered to Ugx100,000,000
Illness Hospitalisation cover	Covered to Ugx50,000,000
Accident Hospitalisation cover	Covered to Ugx50,000,000
*Admissions to Intensive Care & high care units for Non Chronic Ilness*	*Covered to Ugx15,000,000 within Illness Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Accident*	*Covered to Ugx15,000,000 within Accident Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Chronic (subject to chronic waiting period)*	*Covered Upto CDL Limit*
Hospital Room Limit Per Night within hospitalization limit	UGX150,000
Pre-existing Conditions	Not covered
*Chronic conditions developed on cover (CDL)* *(Subject to a waiting period)*	*Covered Upto Ugx 10,000,000 within Illness Hospitalisation limit*
*Oncology tests, drugs & consultation, Chemotherapy and radiotherapy*	*Covered Upto CDL Limit*
*Nursing fees, medical expenses and ancillary charges*	*Covered*
*General Surgery, Surgeons’, consultants’, anaesthetists’, medical practitioners’ fees*	*Covered*
*Reconstructive surgery*	*Covered Upto Ugx 10,000,000 within Accident Hospitalisation Limit*
*Inpatient Opthamology*	*Covered Upto Ugx 10,000,000 within Accident Hospitalisation Limit*
*Inpatient Dental Treatment*	*Covered Upto Ugx 10,000,000 within Accident Hospitalisation Limit*
*Psychiatric treatment*	*Covered Upto Ugx 10,000,000 within Illness Hospitalisation limit*
*Congenital and genetic conditions defects*	*Covered Upto Ugx 10,000,000 within Illness Hospitalisation limit*
*Inpatient treatment of HIV/AIDS and all opportunistic infections*	*Covered up to CDL Limit, as per WHO guidelines and procedures*
*Rescue Cover (East Africa)*
*Ambulance Cover (East Africa)*
*International Emergency medical Cover area-up to the first 30 days of absence from the territory in any membership year. This is only for hospitalisation (Pre-authorisation required)*
*International Emergency Rescue and Evacuation (Pre-authorization Required)*
Maternity for Principal Member or Spouse
Outpatient Cover
Pre-existing Conditions
*Chronic conditions developed on cover (CDL)* *(Subject to a waiting period)*
*Oncology tests, drugs & consultation, Chemotherapy and radiotherapy*
*Antenatal and Postnatal Treatment (Postnatal is subject to maternity waiting period)*
*Psychiatric Treatment*
*Congenital and genetic conditions defects*
*Dental Cover (East Africa only)*
*Optical Cover (East Africa only)*
*Outpatient treatment of HIV/AIDS and all opportunistic infections*
*Annual Health Checks(Basic Medex): Complete blood count test, Random blood sugar test, Breast Exam and VIA for Females above 30 years, PSA for males above 45 years*
Permanent Total disability benefit for Main Member
Last Expenses
Minimum age when joining
Enrollment Medex Required
Maximum age when joining
Chronic conditions developed on cover
Illness Hospitalisation
Maternity cover
New Applicant subject to underwriting
Exclusions

Enrollment Notes:

This cover doesn’t include bills incurred while in Rwanda & South Sudan.
All Medical bills incurred outside the contractual Network on this cover will not be covered by AAR Insurance
Preexisting conditions will not be covered under this Cover
Illness Hospitalization, maternity and Chronic conditions developed on cover are subject to waiting periods
All claim incurred in providers where AAR has no affiliate will be covered if pre-authorized and if reported with genuine receipts within 48 hrs.
All Hospitalizations must be Pre-authorized through the Case Management Arm of AAR Insurance
The quoted standard premium can be increased at point of underwriting by AAR based on the risk profile presented at that point
Immunizations & vaccinations are not covered

Over all Annual Limit	Covered to Ugx200,000,000
Illness Hospitalisation cover	Covered to Ugx100,000,000
Accident Hospitalisation cover	Covered to Ugx100,000,000
*Admissions to Intensive Care & high care units for Non Chronic Ilness*	*Covered to Ugx25,000,0000 within Illness Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Accident*	*Covered to Ugx25,000,0000 within Accident Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Chronic (subject to chronic waiting period)*	*Covered Upto CDL Limit*
Hospital Room Limit Per Night within hospitalization limit	UGX150,000
Pre-existing Conditions	Not covered
*Chronic conditions developed on cover (CDL)* *(Subject to a waiting period)*	*Covered UptoUgx 20,000,000 within Illness Hospitalisation limit*
*Oncology tests, drugs & consultation, Chemotherapy and radiotherapy*	*Covered Upto CDL Limit*
*Nursing fees, medical expenses and ancillary charges*	*Covered*
*General Surgery, Surgeons’, consultants’, anaesthetists’, medical practitioners’ fees*	*Covered*
*Reconstructive surgery*	*Covered UptoUgx 20,000,000 within Accident Hospitalisation Limit*
*Inpatient Opthamology*	*Covered UptoUgx 20,000,000 within Accident Hospitalisation Limit*
*Inpatient Dental Treatment*	*Covered UptoUgx 20,000,000 within Accident Hospitalisation Limit*
*Psychiatric treatment*	*Covered UptoUgx 20,000,000 within Illness Hospitalisation limit*
*Congenital and genetic conditions defects*	*Covered UptoUgx 20,000,000 within Illness Hospitalisation limit*
*Inpatient treatment of HIV/AIDS and all opportunistic infections*	*Covered up to CDL Limit, as per WHO guidelines and procedures*
*Covered*
*Covered*
*Covered (North America covered upto 50% of each benefit Group)*
*Covered (North America covered upto 50% of each benefit Group)*
Normal Delivery-Ugx1,200,000, Caesarian Section-Ugx1,500,000

Enrollment Notes:

This cover doesn’t include bills incurred while in Rwanda & South Sudan.
All Medical bills incurred outside the contractual Network on this cover will not be covered by AAR Insurance
Preexisting conditions will not be covered under this Cover
Illness Hospitalization, maternity and Chronic conditions developed on cover are subject to waiting periods
All claim incurred in providers where AAR has no affiliate will be covered if pre-authorized and if reported with genuine receipts within 48 hrs.
All Hospitalizations must be Pre-authorized through the Case Management Arm of AAR Insurance
The quoted standard premium can be increased at point of underwriting by AAR based on the risk profile presented at that point
Immunizations & vaccinations are not covered

Over all Annual Limit	Covered to Ugx300,000,000
Illness Hospitalisation cover	Covered to Ugx150,000,000
Accident Hospitalisation cover	Covered to Ugx150,000,000
*Admissions to Intensive Care & high care units for Non Chronic Ilness*	*Covered to Ugx35,000,000 within Illness Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Accident*	*Covered to Ugx35,000,000 within Accident Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Chronic (subject to chronic waiting period)*	*Covered Upto CDL Limit*
Hospital Room Limit Per Night within hospitalization limit	UGX200,000
Pre-existing Conditions	Not covered
*Chronic conditions developed on cover (CDL)* *(Subject to a waiting period)*	*Covered UptoUgx 30,000,000 within Illness Hospitalisation limit*
*Oncology tests, drugs & consultation, Chemotherapy and radiotherapy*	*Covered Upto CDL Limit*
*Nursing fees, medical expenses and ancillary charges*	*Covered*
*General Surgery, Surgeons’, consultants’, anaesthetists’, medical practitioners’ fees*	*Covered*
*Reconstructive surgery*	*Covered UptoUgx 30,000,000 within Accident Hospitalisation Limit*
*Inpatient Opthamology*	*Covered UptoUgx 30,000,000 within Accident Hospitalisation Limit*
*Inpatient Dental Treatment*	*Covered UptoUgx 30,000,000 within Accident Hospitalisation Limit*
*Psychiatric treatment*	*Covered UptoUgx 30,000,000 within Illness Hospitalisation limit*
*Congenital and genetic conditions defects*	*Covered UptoUgx 30,000,000 within Illness Hospitalisation limit*
*Inpatient treatment of HIV/AIDS and all opportunistic infections*	*Covered up to CDL Limit, as per WHO guidelines and procedures*
*Covered*
*Covered*
*Covered (North America covered upto 50% of each benefit Group)*
*Covered (North America covered upto 50% of each benefit Group)*

Enrollment Notes:

This cover doesn’t include bills incurred while in Rwanda & South Sudan.
All Medical bills incurred outside the contractual Network on this cover will not be covered by AAR Insurance
Preexisting conditions will not be covered under this Cover
Illness Hospitalization, maternity and Chronic conditions developed on cover are subject to waiting periods
All claim incurred in providers where AAR has no affiliate will be covered if pre-authorized and if reported with genuine receipts within 48 hrs.
All Hospitalizations must be Pre-authorized through the Case Management Arm of AAR Insurance
The quoted standard premium can be increased at point of underwriting by AAR based on the risk profile presented at that point
Immunizations & vaccinations are not covered

Over all Annual Limit	Covered to Ugx400,000,000
Illness Hospitalisation cover	Covered to Ugx200,000,000
Accident Hospitalisation cover	Covered to Ugx200,000,000
*Admissions to Intensive Care & high care units for Non Chronic Ilness*	*Covered to Ugx45,000,000 within Illness Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Accident*	*Covered to Ugx45,000,000 within Accident Hospitalisation Limit*
*Admissions to Intensive Care & high care units for Chronic (subject to chronic waiting period)*	*Covered Upto CDL Limit*
Hospital Room Limit Per Night within hospitalization limit	UGX200,000
Pre-existing Conditions	Not covered
*Chronic conditions developed on cover (CDL)* *(Subject to a waiting period)*	*Covered UptoUgx 40,000,000 within Illness Hospitalisation limit*
*Oncology tests, drugs & consultation, Chemotherapy and radiotherapy*	*Covered Upto CDL Limit*
*Nursing fees, medical expenses and ancillary charges*	*Covered*
*General Surgery, Surgeons’, consultants’, anaesthetists’, medical practitioners’ fees*	*Covered*
*Reconstructive surgery*	*Covered UptoUgx 40,000,000 within Accident Hospitalisation Limit*
*Inpatient Opthamology*	*Covered UptoUgx 40,000,000 within Accident Hospitalisation Limit*
*Inpatient Dental Treatment*	*Covered UptoUgx 40,000,000 within Accident Hospitalisation Limit*
*Psychiatric treatment*	*Covered UptoUgx 40,000,000 within Illness Hospitalisation limit*
*Congenital and genetic conditions defects*	*Covered UptoUgx 40,000,000 within Illness Hospitalisation limit*
*Inpatient treatment of HIV/AIDS and all opportunistic infections*	*Covered up to CDL Limit, as per WHO guidelines and procedures*
*Covered*
*Covered*
*Covered (North America covered upto 50% of each benefit Group)*
*Covered (North America covered upto 50% of each benefit Group)*

Enrollment Notes:

This cover doesn’t include bills incurred while in Rwanda & South Sudan.
All Medical bills incurred outside the contractual Network on this cover will not be covered by AAR Insurance
Preexisting conditions will not be covered under this Cover
Illness Hospitalization, maternity and Chronic conditions developed on cover are subject to waiting periods
All claim incurred in providers where AAR has no affiliate will be covered if pre-authorized and if reported with genuine receipts within 48 hrs.
All Hospitalizations must be Pre-authorized through the Case Management Arm of AAR Insurance
The quoted standard premium can be increased at point of underwriting by AAR based on the risk profile presented at that point
Immunizations & vaccinations are not covered

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MEMBER DETAILS

ENTER BELOW DETAILS OF THE SPOUSE(01) AND DEPENDANTS WHERE APPLICABLE

MEDICAL DICLARATION

NOTE: FOR MEMBERSHIP TO BE CONSIDERED, THIS DECLARATION MUST BE COMPLETED IN FULL AND ALL QUESTIONS ANSWERED

(a). Cardiovascular

(b). Respiratory

(c). Endocrine

(d). Neurological

(e). Musculo Skeletal

(f). Blood Disorders

(g). Genito - Urinary

(h). Gastro - Intestinal