This insurance Cover is usually arranged on an annual basis. It is available as a stand-alone policy, but is often purchased as an add-on to another policy, such as travel, motor, household and Life Policies. Sickness cover is usually only available as an add-on to personal accident insurance, as insurers view it as presenting a greater degree of risk.
Insurance Cover is provided in the event of accidental death or bodily injury for:
- capital sums: This is a one off lump sum payment in the event of death or certain specified injuries
- Weekly benefits: This is payable for a maximum of 104 weeks, if the insured is temporarily disabled due to an accident.
1. The capital benefits of a Personal accident insurance cover are:
- Death: The death must occur within 12 months of the accident for the benefit to be payable. It should have occurred during the period with which the policy was in force.
- Total loss of sight in one or both eyes
- Total loss of one or both limbs: The loss must occur within 12 months (sometimes 24 months) of the accident
- Permanent total disablement: This is not payable until at least 12 or 24 months after the accident, as it may take this length of time to determine whether the disablement is both permanent and total. The disability is normally declared by a certified medical Doctor.
- Permanent partial disablement: a lump sum is payable on a sliding scale depending upon the part of the body affected.
2. The weekly benefits are:
- Temporary total disablement: this is paid when the insured is unable to carry out his/her usual occupation
- Temporary partial disablement: this is paid when the insured is unable to carry out a substantial part of his/her usual occupation.
Limits apply to each of these benefits. Cover is often bought in ‘units’; for example, 1 unit of cover may equal a capital sum of Kshs.1, 000,000. The proposer can buy as many units as they like provided they are able to pay the premium. However, insurers try to ensure that any weekly benefits are not greater than the insured’s normal earnings, as it may encourage fraudulent claims.
Sickness cover only provides weekly benefits. The Cover is subject to a 7 day franchise and excludes sickness contracted within the first 21 days of the commencement of the policy period. This waiting period varies from company to company according to the wording provided in the policy document.
Cover usually only applies within the following geographical limits:
- Personal accident – worldwide
- Sickness – Kenya. Sickness cover may be extended beyond these normal limits, subject to an additional premium.
The typical age limits which apply when taking cover out are:
- Personal accident: 18 – 70 years
- Sickness: 18 – 60 years.
