FAQs

1.) Who needs life insurance?
If someone depends on you financially, you probably need life insurance. If you are a breadwinner, life insurance can provide critical financial support to your loved ones if you die prematurely. Life insurance can also help you establish a fund you can access for planned life events like college or retirement, or for emergencies and opportunities.

Later in life, it can help you transfer your wealth to the next generation.

2.) What is Group Life Assurance cover?
Group Life Assurance Cover is an arrangement, which provides for the payment of a lump sum, usually expressed as a multiple of salary, in the event of death of a member of the scheme while in service of the employer.

The aim of this cover is to aid employers to alleviate the financial distress that might befall the dependants of an employee upon his death.

3. )What exactly is covered by this assurance?
Group Life Assurance covers death from any cause.

4.) What are the benefits?
The benefit payable is a cash lump sum usually a multiple of Annual salary. The cash Lump Sums is paid for the benefit of your dependants who may include a person or persons included in the Nomination of Beneficiary Form.

5.) Why should I go for a medical checkup?
A Medical Examination will only be required when your Death Benefit goes beyond the Free cover limit.

When your Death Benefit exceeds the limit, it will be necessary to provide evidence of your health before the Death Benefit in excess of the limit can be accepted. This will also apply to any subsequent increase in Benefit beyond the limits set by the Insurance Company from time to time. If you do not comply with the requirements for medical examination, your Benefit will be limited to the Free Cover limit of the Scheme as advised from time to time.
You will be advised when a Medical report is required and this must be carried out by one of the Medical Examiners appointed by the Insurance Company. The Medical Examiner must not be your own Private Doctor. Note that the cost of the medical examination is borne by the Insurance Company.

6.) Which exclusions are applicable?
Group Life Assurance exclusions are those causes of death which the Insurance Company is not willing to admit, since the admission of these causes of death would make Insurance extremely expensive. Some can however be accepted at optionally excessive premium.

Deaths arising directly or indirectly or traceable to any of the following events are excluded:
• Active & direct involvement in war, whether declared or not;
• Aviation except for passengers and crew of airlines and private flying purely for transport purposes;
• Atomic energy and/or nuclear fission or reaction;
• Intake of illegal drugs.

7.) What is meant by nomination of beneficiary?
You may nominate one or more of those of your relatives or dependants to whom you would wish the Organization to pay the Benefit due in the event of your death. 

The nomination will ensure that payment can be made to your dependants promptly without being included in your estate. The nomination will not be binding on the Organization. However, the Organization will, where they hold a Nomination of Beneficiary, pay particular attention to the deceased employee's wishes.

8.) How will my beneficiaries be paid?
Normally the Insurance Company will pay the Death Benefit to the Organization that employed the deceased member. The Organization then decides how the Cash Lump Sum will be delivered to their Beneficiary(ies).


9.) What are the principal types of medical expense insurance coverage?
Medical expense insurance is broadly classified into two principal types of coverage: Standard Medical plan and Enhanced Medical plan. Standard plan generally exclude cover for medical expenses that relate to the treatment of pre-existing/chronic medical conditions, Maternity, Dental and Optical. Enhanced Medical plans on the other hand can be underwritten to include the treatment of pre-existing /chronic medical conditions.

10.) What types of expenditures are commonly excluded under major medical expense plans?
Although providing very broad coverage, major medical plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from: (1) convalescent or custodial care; (2) physical examinations, unless required for the treatment of an injury or illness (it should be noted that some plans now cover this expenditure); (3) cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect; (4) occupational injuries and illnesses that are otherwise covered under a Workers' Compensation law; and (5) routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however).

11.) Even though major medical plans provide broad coverage, insured’s still incur certain "out-of-pocket" costs. What are these costs?
An insured's "out-of-pocket" costs under major medical expense plans include the deductible, cost-sharing amounts arising from the operation of the coinsurance clause, and medical expenditures that are deemed by the plan to be in excess of "reasonable and customary" charges. Only charges that are "reasonable and customary" for a specific type of service are eligible for reimbursement under medical expense plans. The definition of "reasonable and customary" may vary somewhat from one medical expense plan to another.

12.) What is the coinsurance clause in medical expense plans and how does it work?
Coinsurance, sometimes called "percentage participation," requires the insured to share in the cost of medical care. Under an 80/20 coinsurance provision, the medical expense plan pays 80 percent of eligible medical charges above any deductible. The insured is required to pay the remaining 20 percent. Other coinsurance arrangements, e.g., 70/30 or 90/10, are sometimes used. In the event of large or catastrophic medical expenses, an insured might suffer severe financial hardship due to the operation of the coinsurance clause. To compensate for this possibility, many major medical expense plans contain a coinsurance cap, or stop-loss limit. This provision places a limit on the insured's out-of-pocket costs in a given year arising from the operation of the coinsurance clause. The size of the coinsurance cap generally ranges from $2,000 to $3,000, depending on the plan, although limits as low as $1,000 are sometimes used. Once the coinsurance cap has been reached, all eligible expenses above this amount are paid in full, up to the plan's overall limit of coverage.

13.) What is the difference between coinsurance and copayment?
On occasion, these terms have been used interchangeably. However, it is preferable to define the two terms differently, despite their similarity of purpose. Under a copayment or copay provision, the insured usually is required to pay a set or fixed dollar amount (e.g., 200/- or 500/-) each time a particular medical service is used. Copay provisions are frequently found in medical plans offered by health maintenance organizations (HMOs) where a nominal copayment is applied to each office visit and to each prescription that is filled.

14.) What is a preexisting conditions clause and what is the effect of its inclusion in major medical expense plans?
A preexisting condition is often defined as a medical condition (i.e., an injury or illness) that required treatment during a prescribed period of time, e.g., 3 or 6 months, prior to the insured's effective date of coverage under the major medical expense plan. Sometimes, a preexisting condition is defined to include medical conditions that were known to the insured, even though no treatment was provided during the prescribed period. A preexisting conditions clause excludes coverage for preexisting conditions for possibly as long as 12 months after the effective date of coverage. Because the definition of a preexisting condition, and the provisions of the clause itself, may differ considerably from one plan to another, it is recommended that newly insured individuals (and prospective insured’s) completely familiarize themselves with this policy provision.

15.) How does the medical expense coverage offered by Health Maintenance Organizations (HMOs) differ from the coverage provided under basic and major medical expense plans?
Basic and major medical expense plans are generally classified as indemnity contracts. These plans indemnify, or reimburse, the insured for medical expenses incurred and typically require the completion and filing of claim forms. In addition, these plans usually contain deductible and coinsurance cost sharing provisions and may restrict coverage for certain types of medical care expenditures. Indemnity plans, however, provide the insured with substantial freedom relative to the choice of physician, including whether a primary care physician or a specialist will be seen. In contrast, HMO coverage emphasizes comprehensive (including preventive) care and typically contains very few exclusions, no (or small) deductibles, and nominal copayments. However, there is much less freedom of choice of physician under traditional HMO coverage since the patient is typically required to be under the care of a primary care physician who serves as a "gatekeeper." In this role the primary care physician determines whether the services of a specialist are needed, in addition to determining what other medical services are required for treatment. Some HMOs today offer a point-of-service option, whereby patients may opt for indemnity type coverage (with a deductible and coinsurance) when they desire medical treatment outside the HMO network.

16.) What is a chronic condition?
This is a condition that not be cured but can only be managed through medical attention, diet and exercises. Examples include diabetes, cancer, hypertension, arthritis and gout.

17.) Do you cover pre-existing conditions for individuals?
Yes we do however this is subject to the waiting period and sub limits

18.) Can I see my personal doctor on Outpatient and Inpatient?
We have a panel of providers through whom our clients can enjoy credit facilities. Members who wish to go to a personal doctor will have to pay and seek reimbursement.

19) Am I covered if I get sick while out of the country?
Members are covered for a period of SIX weeks (42 days) while you are out of the country for emergency admission due to illness or accidents while travelling for business or leisure. Overseas scheduled medical treatment MUST to be pre-authorized and will only be permitted if the treatment for the specific condition is not available locally. This is done on a reimbursement basis and the refund is subject to the terms and conditions of the policy.

20.) What happens when I reached my insured limit?
Eagle Africa Insurance Brokers will inform the insured person in the event of such an incident. The member will be required to pay back any amounts incurred in excess of the insured limits. It is important that you keep track of your benefit utilization.

21.) Is my benefit transferable to my dependants?
No. AfyaMilele is strictly on a per person basis and is therefore not transferable.

22.) What are the payment plans?
Premium should be settled in full before placement of cover either by cash or personal/bankers cheque. Installment payment can be organized through IPF up to a maximum 6 installments

23.) Who needs life insurance?
If someone depends on you financially, you probably need life insurance. If you are a breadwinner, life insurance can provide critical financial support to your loved ones if you die prematurely. Life insurance can also help you establish a fund you can access for planned life events like college or retirement, or for emergencies and opportunities.

Later in life, it can help you transfer your wealth to the next generation.

24.) What is Group Life Assurance cover?
Group Life Assurance Cover is an arrangement, which provides for the payment of a lump sum, usually expressed as a multiple of salary, in the event of death of a member of the scheme while in service of the employer.

The aim of this cover is to aid employers to alleviate the financial distress that might befall the dependants of an employee upon his death.

25.) What exactly is covered by this assurance?
Group Life Assurance covers death from any cause.

26.) What are the benefits?
The benefit payable is a cash lump sum usually a multiple of Annual salary. The cash Lump Sums is paid for the benefit of your dependants who may include a person or persons included in the Nomination of Beneficiary Form.

27.) Why should I go for a medical checkup?
A Medical Examination will only be required when your Death Benefit goes beyond the Free cover limit.

When your Death Benefit exceeds the limit, it will be necessary to provide evidence of your health before the Death Benefit in excess of the limit can be accepted. This will also apply to any subsequent increase in Benefit beyond the limits set by the Insurance Company from time to time. If you do not comply with the requirements for medical examination, your Benefit will be limited to the Free Cover limit of the Scheme as advised from time to time.

You will be advised when a Medical report is required and this must be carried out by one of the Medical Examiners appointed by the Insurance Company. The Medical Examiner must not be your own Private Doctor. Note that the cost of the medical examination is borne by the Insurance Company.

28.) Which exclusions are applicable?
Group Life Assurance exclusions are those causes of death which the Insurance Company is not willing to admit, since the admission of these causes of death would make Insurance extremely expensive. Some can however be accepted at optionally excessive premium.

Deaths arising directly or indirectly or traceable to any of the following events are excluded:
Active & direct involvement in war, whether declared or not;
Aviation except for passengers and crew of airlines and private flying purely for transport purposes;
Atomic energy and/or nuclear fission or reaction;
Intake of illegal drugs.

29.) What is meant by nomination of beneficiary?
You may nominate one or more of those of your relatives or dependants to whom you would wish the Organization to pay the Benefit due in the event of your death. 

The nomination will ensure that payment can be made to your dependants promptly without being included in your estate. The nomination will not be binding on the Organization. However, the Organization will, where they hold a Nomination of Beneficiary, pay particular attention to the deceased employee's wishes.

30.) How will my beneficiaries be paid?
Normally the Insurance Company will pay the Death Benefit to the Organization that employed the deceased member. The Organization then decides how the Cash Lump Sum will be delivered to their Beneficiary(ies).

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