HEALTH COVER FOR SENIOR CITIZENS

Our Mission

Everything we do is driven
by our mission to provide
solutions to protect the future
of our customers.
Why Choose
J Senior Health cover?
Our Experience Introduction

We are a wholly owned subsidiary of Jubilee Holdings Ltd. Benefits

We’re the No.1 Medical Insurer in East Africa and we have provided
Medical Insurance for over 85 years to individuals, SME’s and Plan Summary
companies. Today we have over 30,000 customer relationships
countrywide. Looking after them is a workforce of 70 people, a network
General Conditions
of over 500+ hospitals and pharmacies.

Why we’re different Exclusions

• Access to our unparalleled network of trusted hospitals and Next Steps

pharmacies.
• The convenience and confidence of Jubilee Health’s customer care.
• The reassurance of our experience in delivering healthcare.
• The access to our unique wellness propositions.

Turning 65 is a major milestone! You have successfully negotiated the turns of life and
created a legacy. Many people look up to you with respect and seek your guidance.
You have always depended on yourself and would want to continue to do so even
in retirement. However, old age comes with its own challenges, health being one of
them with unforeseen emergencies. With the J Senior plan, you can continue to live a
stress-free healthy lifestyle and enjoy your golden years with your loved ones.
J Senior Benefits
J Senior is a comprehensive medical insurance product designed for the senior citizens from 61 years and above. The cover is offered through 5
simplified plans giving you flexibility to choose the most appropriate coverage for you, your spouse and family.

J Senior offers the following benefits:

Introduction

Plan Summary
Flexibility Geographical Coverage
General Conditions
• Diagnostics and physiotherapists • 5 levels of comprehensive coverage • Country wide Provider Network,
fees, prescribed drugs, dressings & • Optional plans such as outpatient, including home nursing service. Exclusions
surgical. dental, and optical. • Overseas inpatient referrals a n d
• Air and Road evacuation services • Drug delivery - for members with e m e r g e n c y c a s e s covered on
Next Steps
through Flying Doctors, Society of chronic ailments. credit basis under listed hospitals
Africa membership at an additional upon preauthorization with Jubilee
fee 50 Dollars per annum for an adult health team.
and 30 Dollars per annum for a child. • Direct access to treatment while
travelling within East Africa.
Eligibility

• Eligibility is for members eligible for

the cover are of 61 to 80 years.
Plan Summary
All inpatient treatment is subject to pre-authorization.
All benefits are subject to overall annual benefit unless specified otherwise. Amounts shown in Tanzanian Shillings.
INPATIENT PREMIER ADVANCED EXECUTIVE ROYAL CLASSY
Limit Per Family 20,000,000 50,000,000 80,000,000 100,000,000 150,000,000
Introduction
Bed Limits 150,000 150,000 250,000 300,000 350,000
OUTPATIENT PREMIER ADVANCED EXECUTIVE ROYAL CLASSY Benefits
Limit Per Person 1,200,000 1,500,000 2,000,000 2,500,000 3,000,000
OPTICAL PREMIER ADVANCED EXECUTIVE ROYAL CLASSY
Limit Per Person 200,000 400,000 600,000 600,000 800,000
General Conditions
DENTAL PREMIER ADVANCED EXECUTIVE ROYAL CLASSY
Limit Per Person 200,000 400,000 600,000 600,000 800,000 Exclusions
LAST EXPENSE PREMIER ADVANCED EXECUTIVE ROYAL CLASSY
Next Steps
Last expense benefit 1,000,000 1,000,000 1,500,000 1,500,000 2,000,000
SUB-BENEFITS UNDER INPATIENT BENEFIT
Pre-existing & Chronic 4,000,000 5,000,000 6,000,000 8,000,000 10,000,000
External Appliances Cover Per Family N/A N/A 800,000 1,000,000 1,500,000
SUB-BENEFITS UNDER OUTPATIENT BENEFIT
Medical Check-ups N/A N/A 100,000 200,000 300,000
SALIENT FEATURES PREMIER ADVANCED EXECUTIVE ROYAL CLASSY
Area of cover East Africa
Entry age 61–80 years
Entry requirement Medical examination report from Jubilee Health Insurance panel on
request basis
Plan Summary
*All inpatient treatment is subject to pre-authorization
*All benefits are subject to overall annual benefit unless specified otherwise
*This is only a summary of the benefits for more details refer to the policy document

SUMMARY
Introduction
1. There is 1 year waiting period for chronic & pre-existing diseases.
2. Treatment of Hemorrhoids, Fibroids, Hernia (except congenital, Adenoidectomy within the first 12 months).
3. Cancer is treated in the third year of continuous coverage. Benefits
4. All referral overseas cases must be pre-authorized in writing by Jubilee team.
5. For emergency treatment abroad, clients should notify Jubilee within 48 hours.
6. Any direct or indirect consequences, loss or bodily injury or sickness relating to a disease declared by the World Health Org anization (WHO) asa pandemic outbreak will
not be covered.
7. All the MRI, CT scan, and PET Scan tests will be conducted on the second year of covered as seen in the benefit summary table except for accidental cases within the
policy. X-rays and Ultrasound guaranteed after 30days
8. Overseas treatment is covered only when it is referred to by any attending specialist for treatment that is not available in Tanzania. Self-referral will not be covered. We
cover for treatment and in-hospital accommodation only up to the specific sublimit that is Pre-existing & Chronic Conditions, Congenital Conditions and all sub limits as seen in
the benefit summary table.
9. Maternity package stands as an exclusion for Jcare senior.
10.Birth defects, Congenital illness, conditions and illness, conditions and illnesses related to genetic disorders subjected to twelve months waitingperiod.
11.Psychiatric illness, mental disorders and/or insanity expenses will be covered up to the applicable sub limit subject to twelve months waiting period with the benefit of 3,000,000 in all levels under Inpatient and Full benefit
under outpatient limit.
12.All expenses associated with HIV/AIDS and related conditions (subject to twelve months waiting period and full declaration on the application at policy inception)
General Conditions
Inception of Insurance
No insurance shall be in force or effective until the Proposal form has been accepted by Jubilee in writing and the Insured has paid the full premium.

Policy and Schedule

This Policy and the Schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any
part of this Policy or of the Schedule shall bear such specific meaning wherever it may appear.

Recovery of Uninsured Expenses

If Jubilee pays expenses incurred by a Member, which are not covered under the terms and conditions of this Policy, then the Member/Insured shall
repay such amounts to Jubilee upon demand. Such expenses shall include amounts in excess of Schedule limits and other expenses not covered under
this Policy.

Notification of claims
In the event of any illness or accident giving rise to a claim under this Policy the Member shall notify Jubilee within 48 ho urs prior to scheduled
admission and within 48 hours after emergency admission. The liability of Jubilee in respect of any contingency in any period of insurance giving rise
to a claim hereunder shall be limited in respect of such claim to the period of two calendar months immediately following the next annual renewal date
and to the maximum benefits as stated in the Schedule. Failure to observe this notification of claim condition will invalidate a claim.
General Conditions
Eligibility
Members eligible for the cover are of 61 to 80 years.

Termination
The insurance shall cease in respect of: Introduction
a. Members (adults) who attain the age of 85 years coincident with the annual renewal date of this policy or otherwise at the ne xt renewal date
immediately following attainment of age 85; and Benefits
b. Death of the main member unless requested otherwise by the Insured in writing and Jubilee has accepted. In such circumstance, the next adult shall
assume the contracting role until policy end. The continuance of the insurance in respect of such persons shall be subject to the terms, conditions
limitations contained herein.

Premium General Conditions

All premiums for medical insurance are payable annually in advance at the beginning of the coverage period. Full annual premium is payable
immediately for anyone who becomes a member at any time during the coverage period. Exclusions

Company’s right to decline renewal Next Steps

Jubilee shall not be bound to renew this, Policy. Jubilee shall have the right to decline or qualify the terms of the insurance in respect of all or
anyMember on giving the Insured Fourteen (14) days’ notice in writing prior to any annual renewal date.

Co-ordination of Benefits
The Policy will not provide compensation other than on a proportionate basis if the Member has any other insurance in force or is entitled to indemnity
from any other source in respect of the same accident, illness, or expense. Jubilee has full rights of subrogation and may take proceedings in the
Member’s name, but at Jubilee’s expense, to recover for its benefit the amount of any payment made under this Policy.

Cancellation
Jubilee may cancel this Policy by sending Fourteen (14) days’ notice by registered mail to the Insured’s last known address and in such event, Jubilee
shall refund to the Insured a pro-rata portion of the premium for the unexpired term of the current period of insurance. The Insured may cancel this
Policy by giving Fourteen (14) days’ notice by registered mail to the insurer last known address.
General Conditions
Cancellation within 30 days from commencement date shall attract a prorated premium refund for the remaining days to policy expiry subject to no
claims incurred and/ or reported less administration expenses at 15%. This shall be after claims submission time bar period of 90 days from date of
deletion. There will be no refund on cancellation by the member after 30 days from commencement date of the policy.

Case Management Introduction

The medical treatment of the Member as inpatient shall be managed according to the following regulations:
• The service must be medically necessary and delivered in a hospital. Benefits
• The service must be authorized in terms of our pre-authorization procedure.
• The service, medication or supplies that the Member is charged for must relate to the reason for the admission. Should the Member undergo any
further treatment not covered under that is deemed by us to be medically unnecessary we shall avoid all liability for such costs.
General Conditions
Arbitration
Should any dispute arise between Jubilee and the Insured touching on the meaning of this Policy or as to the rights, obligations, or liability of either
party under this Policy, the same shall in the first instance be referred to arbitration in accordance with the statutory provisions for the time being in Exclusions
force applicable thereto.
Next Steps
Time Bar
In the event of Jubilee disclaiming liability in respect of any claim hereunder Jubilee shall not be liable to such claim or possible claim after expiry of
Ninety (90) days from the date of such disclaimer unless the disclaimer shall be the subject of legal proceedings or arbitration actually commenced
against Jubilee.

Fraudulent/Unfounded Claims
If any claim under this policy is in any respect fraudulent, false, intentionally exaggerated, or unfounded or if any false declaration or statement shall
be made in support thereof then, all benefits paid and/or payable in relation to that claim shall be forfeited and recoverable. In addition, all cover in
respect of the Insured person shall be terminated from Date of Entry without refund of premiums, and the member shall no longer be eligible for cover for
any future periods.

Jurisdiction
Any legal proceedings instituted in connection with this Policy shall be brought before a court of competent jurisdiction in the Republic of Tanzania. This
insurance is made and accepted subject to all the provisions, conditions and warranties set forth herein and, in any forms, or endorsements
attached
 General Conditions
hereto all of which are to be considered as incorporated herein, and any provisions or conditions appearing in any forms or endorsements attached hereto which alter the insurance provisions in so far
as they are inconsistent therewith.

In any action, suit, or other proceedings where the insurer alleges that any medical expense is not covered by this Policy, the burden of proving that such expense is covered shall be upon the Insured.
Introduction
Renewal of the Policy
This plan is a one-year contract, renewable each year on the anniversary of the start date. The Policy will remain in force for a period of 12 months from the effective date, provided that all premiums
due have been paid and that the Policy has not been terminated. Benefits

As the anniversary of the Policy approaches, Jubilee shall notify the insured with the terms of the next period of coverage and the premiums due. If it is necessary to make changes to the Policy, they
General
will only apply from the renewal date. All renewal confirmation should be received prior to the expiry of the preceding policy period. All renewal instructions received after expiry Conditions
of the policy period
shall be deemed as new members and all terms applicable to new members shall apply. Renewal shall be upon receipt of the full premium. Lapse period, The Member should renew the Insurance policy
within 30days from the expiry date of the existing policy to avoid termination.
Exclusions
Duty of Disclosure
The duty of disclosure continues throughout the life of the policy: Next Steps
In addition to providing all basic information necessary to enable us to place the risk, you must ensure that you are complying with your legal duty of disclosure of
all material matters relating to the risk. In particular, you must satisfy yourself as to the accuracy and completeness of the information you provide to Jubilee both
at inception of the policy and throughout the policy term.

Waiting Period
This is the time that the client will wait before accessing some services or benefits from his/her policy as below:

1. 30 Days waiting period for a new member unless he/she has a copy of medical card from a previous insurer (recent card that is within 3 month).
2. 1 Year waiting period for pre-existing diseases and chronic diseases. Any disease with a frequent recurrence within 3 months and the treatmentis for a long
duration. e.g., Hypertension, Diabetes.
3. 1 year waiting period for maternity including clinics and delivery.
4. 2 years waiting period for cancer treatment.
5. Lapse period during renewal is 1 month from the expiry date. Any policy that shall not be renewed after 1 month shall be treated as a new policywhere all waiting
periods shall be applied with the exception of the 30 days waiting period for normal illness from commencement of coverage.
6. All expenses associated with HIV/AIDS and related conditions (subject to twelve months waiting period and full declaration on the application at policy inception)
7. Organ transplant (subject to twelve months waiting period).
8. Treatment of Hemorrhoids, Fibroids, Hernia, congenital, Adenoidectomy subjected to 12 months.
9. 1 year waiting period for any non-accidental related surgery and treatment etc.
10. Birth defects, Congenital illness, conditions and illness, conditions and illnesses related to genetic disorders subjected to twelve months waiting period.
11. Psychiatric illness, mental disorders and/or insanity expenses will be covered up to the applicable sub limit subject to twelve months waiting period with the benefit of
3,000,000 in all levels.
Exclusions
(These are some of the exclusions. For more details, please refer to the policy document)

1. Expenses incurred as a result of a member’s participation in:

a. Naval, military or air force or operations.
b. Hazardous sports including but not limited to Winter sports, water sports, mountaineering, hunting, polo, racing on horseback, rugby, league Introduction
football, motorcycling or motor racing on machines of greater than 125cc.
c. Riding or driving in any kind of race. Benefits
d. Air travel except as a fare-paying passenger in any aircraft licensed for passenger carrying. Cover shall not in any event apply to a Member
whilst operating, learning to operate, or serving as a member of a crew of any aircraft or to travel in any aircraft being used for skydiving,
Plan Summary
racing, testing or exploration.

2. Expenses directly or indirectly incurred as a result of: General Conditions

a. War (“declared or undeclared”), riot, strike, and civil commotion.
b. Intentional self-injury, suicide, or attempted suicide (whether sane or insane), venereal disease, Member’s own criminal act, intoxication, the use
of drugs not prescribed by a physician or injury sustained whilst in a state of insanity, alcoholism or costs resulting from dependency on or abuse
of drugs or other addictive substance. Next Steps
c. Nervous breakdown, general debility, psychoneurosis, general “overhaul”.
d. Vaccination, or any treatment undertaken or carried out as a preventative measure.
e. Treatment by chiropractors, acupuncturists, and herbalists, stays and/or maintenance or treatment received in nature cure clinics or similar
establishments, or private beds registered within a nursing home, sanatoria, convalescent and/or rest homes or ‘cures’ attached to such
establishments.
f. Miscarriage, ante-or-postnatal care, caesarean operation stands as an exclusion.
g. Family planning and fertility treatment e.g., costs of treatment related to infertility and impotence, hormone imbalance, Hormone Replacement
Therapy (HRT).
h. Cosmetic or beauty treatment and/or surgery.
i. Massage.
j. Any injury, illness or disease specified as an exclusion and complications caused by a condition that is excluded.
Exclusions
k. Any claim for expenses relating to any contingency arising whilst the Member is outside the territorial limits of Tanzania, but this limitation shall
not apply to any Member temporarily abroad and requiring emergency treatment for an illness or injury that occurs during the period of travel
provided that such period does not exceed six weeks in any one visit. Travel and accommodation costs are not covered.
l. Any claim for expenses relating to an accident or illness which may have occurred prior to the effective date or illness occurring within Thirty
(30) days of the effective date to any illness where it was within the knowledge of a member that he was suffering from it at the effective date. Introduction
m. Any claim for expenses occasioned by or through or in consequence, directly or indirectly caused by acts of God (natural causes)
n. Treatment of obesity and slimming preparations. Benefits
o. Epidemics or unknown diseases.
p. Expenses incurred in connection with Examinations for check-up purposes not incidental to diagnosis of a sickness or accidental bodily injury
Plan Summary
such as general health examinations, scans of any nature or any other form of disease/illness prevention (except annual general check-up
where covered).
q. Experimental treatment and drugs not scientifically recognized or not proven to be effective based on established medical practice. General Conditions
r. Costs of treatment for, or related to, Menopause, andropause, ageing, puberty, and pre-menstrual tension syndrome.
s. Bone marrow transplants.
aa. Any treatment arising from an accident or event because the member or dependent was under influence of alcohol and drugs, unless
prescribed and taken according to instructions of a medical practitioner.
ab. Medical expense directly or indirectly resulting from and in connection with any act of terrorism (“declared or undeclared”), regardless of any
other cause contributing concurrently or in any other sequence to the medical expense. All expenses in respect of illnesses/conditions that were
subject to waiting periods when the member and dependent joined the scheme.
ac. Widal test
ad. Any direct or indirect consequences, loss or bodily injury or sickness relating to a disease declared by the World Health Organization (WHO)
as a pandemic outbreak e.g., COVID-19.
ae. Circumcision is not included.
32. Charges recoverable under any Workmen’s Injury of compensation including Governmental insurance fund or any other medical plan.
33. Treatment outside East Africa is an exclusion unless approved in writing by Jubilee health upon referral.
What you get once you
purchase your J Senior cover
A comprehensive Welcome Pack
Once the policy commences, you will receive a membership pack within 5 days which will include: Introduction
Membership Card Policy Document Benefits
Proof of identity and cover when you need Terms and conditions of your policy.
treatment.
Plan Summary
Provider Panel
Acceptance Letter List of Hospitals, Physicians, Clinics, and
Confirming the plan and benefits purchased. General Conditions
other Healthcare Providers.
Exclusions
When you receive your pack, ensure that you check the details of your policy on your welcome letter and keep your membership card in a safe place.
You will need it when you require treatment, so the provider knows who you are (it’s not used for payment). It also has all the emergency contact
numbers you will need.
Senior Wellness Club Introduction

• Lifestyle Management: Members receive support through lifestyle Benefits

management and programs.
• Self -monitoring: Facilitation of self-monitoring devices.
Plan Summary
Lifestyle Management Program
General Conditions
• Delivery of prescribed medications to your office/home.
Exclusions

Next Steps
How to apply for J Senior cover
Get a quote today
1. Review and choose an Inpatient cover limit
2. Add Optional Benefits
3. Fill in and sign the member application form and attach supporting documents. Introduction
4. Jubilee Health will revert within 3 working days of receipt of your application.
5. Pay for the cover. Benefits
6. Receive your welcome pack.

*The policy will be effective when the premium is paid in full, and a
Plan Summary
confirmationis issued.
*Waiting periods where applicable will start from the date the policy is effective General Conditions
or the date the benefit is purchased, whichever is later.
Exclusions
Supporting documents required in addition to a fully completed
and signed application form are: Next Steps
• National ID, Citizen registration card, birth certificate, and Passport of all
adult applicants, dependents, and beneficiaries.

To find out more about our other products you can:

Give us a call on our Speak to your Jubilee Email Us at

24hr Call Center Health Sales MedicalRetailUnderwriting@
0746 811 313 Representatives jubileetanzania.co.tz
today. or visit our website
www.jubileeinsurance.co.tz
 JUBILEE HEALTH INSURANCE COMPANY OF TANZANIA LIMITED

Head Office:
5th Floor, Amani place, Ohio Street
P.O. Box 20524, Dar es salaam, Tanzania
Call Centre: 0746 811 313
www.jubileeinsurance.co.tz

Jubilee Health Insurance Company of Tanzania Limited is regulated by Tanzania Insurance Regulatory Authority (TIRA).