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Aetna FAQs
Executive Healthcare Plan Overview & FAQs
The Executive Healthcare Plan (EHP) is designed with the needs of regionally mobile individuals in mind. It provides the medical cover you require, with a first-class level of service you can rely on.
EHP provides a range of cover options with benefits that can include:
- Emergency evacuation or out of country transportation costs to an appropriate medical facility within your selected geographic coverage area for in-patient/day-patient treatment; this also includes reasonable travel costs
- Flexibility to obtain medical treatment at the facility of your choice, within your selected geographic coverage area
- Accident and emergency treatment outside of your selected geographic coverage area for temporary business trips or holidays
- In-patient and out-patient psychiatric treatment
- Primary care
- Alternative medicine
- Routine pregnancy and childbirth
- Complications of pregnancy
- New born accommodation
- Accidental damage to teeth
- Transport of mortal remains/cost of local burial or cremation
- Hospice care charges
- Organ transplant
- Rehabilitation
In terms of accessing care, geographic coverage options include:
- Africa plus India, Pakistan and Bangladesh
- Worldwide excluding the U.S.
- Worldwide including elective treatment in the U.S.
Our skilled team is here to partner with you to identify your ideal solution.
Individual Executive Health Plan FAQs.
Q. Will the plan cover any illnesses or injuries that I had prior to enrolling in the plan?
A. Existing conditions may be specifically excluded and the terms of any exclusion will be noted on your schedule of cover. These will be assessed at the time of application based on the information you declare to us. Undeclared conditions will be excluded and will invalidate your cover.
Q. Is there an annual benefits limit?
A. You are able to claim up to an annual maximum of U.S. $1,000,000 under the Major Medical option and U.S. $1,500,000 under the Foundation option. Additionally, certain benefits have sub-limits. You will only be required to pay an excess if you have specifically chosen this option.
Q. Can I seek treatment anywhere in the world?
A. Three geographic coverage options are available for accessing emergency and elective treatment. These include Africa plus India, Pakistan and Bangladesh, Worldwide excluding the U.S., and Worldwide.
Q. Am I covered if I travel outside of my selected geographic coverage area?
A. You are covered for accident and emergency treatment outside of your selected geographic coverage area for temporary business trips or holidays. Specifically, this benefit is provided for up to 90 days during the period of cover and limited to a maximum of 60 days of treatment per event.
Q. Is a medical examination required to enrol in the plan?
A. No. In the rare instance that we require additional information for fair and accurate underwriting purposes, we will ask you to submit a medical report from your doctor.
Q. How quickly does my cover go into effect?
A. As soon as we receive a completed application form (fax or original), we can confirm immediate cover for 15 days, subject to underwriter's acceptance and pending receipt of the premium. If you wish to be covered immediately, dial us at +254.203.747.135 or +254.203.747.155 or e-mail info@insightgroupafrica.com.
Q. Can my family members also be covered?
A. Yes. Your spouse or adult partner, who is permanently living with you, can be included as a dependant. Also eligible for cover are unmarried children not more than 18 years old and living with you, or not more than 23 years old and in full-time education. Again, this is subject to a completed medical declaration form.
Q. What happens if I want to cancel my cover?
A. You have 15 days from the commencement date of your cover to review your benefits. If you decide to cancel and no claims have been made, we will arrange a full refund of any premium paid, provided we receive a written request to cancel your cover.
Group Executive Health Plan FAQs.
Q. Will the plan cover any illnesses or injuries that an employee had prior to enrolling in the plan?
A. Existing conditions may be specifically excluded and the terms of any exclusion will be noted on an employee's schedule of cover. These will be assessed at the time of application based on the information they declare to us. Undeclared conditions will be excluded and will invalidate their cover.
Q. Can employees have their existing conditions waived?
A. For groups of 10 or more employees, employers will have the option of having medical history disregarded cover. Employers may also be eligible for continuous transfer terms cover if they already have an existing international health plan.
Q. Is there an annual benefits limit?
A. Employees are able to claim up to an annual maximum of U.S. $1,000,000 under the Major Medical option and U.S. $1,500,000 under the Foundation option. Additionally, certain benefits have sub-limits. Employees will only be required to pay an excess if this is included within their plan.
Q. Can employees seek treatment anywhere in the world?
A. Employees can access care for emergency and elective treatment within their geographic coverage area. This area is dependent on the plan purchased by their employer. The three options include Africa plus India, Pakistan and Bangladesh, Worldwide excluding the U.S., and Worldwide.
Q. Are employees covered if they travel outside of their geographic coverage area?
A. Employees are covered for accident and emergency treatment outside of their geographic coverage area for temporary business trips or holidays. Specifically, this benefit is provided for up to 90 days during the period of cover and limited to a maximum of 60 days of treatment per event.
Q. Is a medical examination required to enrol in the plan?
A. No. In the rare instance that we require additional information for fair and accurate underwriting purposes, we will ask the employee to submit a medical report from his or her doctor. Note: For groups of 10 or more employees, the group administrator of the employer may sign a group declaration form for and on behalf of their employees.
Q. Can family members of employees also be covered?
A. Yes. An employee's spouse or adult partner, who is permanently living with them, can be included as a dependant. Also eligible for cover are unmarried children not more than 18 years old and living with them, or not more than 23 years old and in full-time education. Again, this is subject to a completed medical declaration form.
Contact us to learn more about our International Medical Cover services. To learn more about AGB, click on the link www.aetnaglobalbenefits.com