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Terms and Conditions
Endelea Insurance Plan
The following Terms & Conditions apply to Endelea Plan Group Insurance Scheme administered by Medican Services Ltd and by signing up for Endelea Insurance Plan, you are deemed to have read, understood and accepted these Terms & Conditions.
1.1 Endelea Plan is a progressive healthcare benefits management platform that simplifies access to health education and health insurance benefits with great flexibility and instalment payment plans. Endelea Plan members are covered under Group Scheme administered by Medican Services Ltd. Insurance policies are underwritten by licensed and regulated insurance companies with demonstrated claims settlement record.
2.1 To be eligible as a Principal Member in Endelea Insurance Plan, you must be:
2.3 Instructions on how to register and access Endelea Insurance Plan products will be found on Endelea App (available from Google Play Store and Apple App Store) or Endelea Plan website https://www.endeleaplan.com or by contacting Endelea Plan customer support centre on telephone number 0111 014 500 / WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com.
3.1 A member’s account in the Endelea Insurance Plan is activated upon registration and
payment of the required Initial Subscription Amount depending on the respective Plan.
3.2 Upon activating the respective Plan account, a member will be added to the
respective Endelea Plan Group Insurance Scheme administered by Medican Services
Ltd and relevant insurance policy underwritten by licensed insurance company.
3.3 A Member’s health insurance benefits will only attach when the respective cover is
effective and annual premium has been paid in full. Medican Services Ltd guarantees
annual premium finance for Endelea Plan members whose subscription payments are
up to date with no overdue balance.
3.4 A member’s account will be marked as inactive when their subscription payment is
more than 1 month overdue (1 month after due date). The inactive member’s health
insurance benefits will then be inactivated and lapse within 14 days thereafter.
3.5 A member whose Endelea Plan account has been inactivated and health insurance
cover has lapsed will no longer be eligible to claim any insurance benefits under the
Scheme. Any account payments made by the Member will be considered to have
been applied to the member’s insurance policy cover up to and until the time of
account inactivation and will, therefore, not be refundable.
3.6 A member may be re-accepted into the Scheme and insurance benefits re-applied
only after meeting the applicable requirements including payment of all outstanding
overdue balance accrued up to and until the time of application to re-join the Scheme
and receiving Scheme Re-Acceptance confirmation.
4.1 A member whose account is active will be eligible to make an application for a valid
claim in line with the underwriter (insurance company)’s claim processing requirements.
4.2 Information on claim process can be accessed on Endelea App (available from Google
Play Store and Apple App Store) or online https://www.endeleaplan.com or by
contacting Endelea Plan customer support centre on telephone number 0111 014 500 /
WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com.
4.3 Application for claims by members covered under the Endelea Plan Group Insurance
Scheme administered by Medican Services Ltd will be submitted through and facilitated
by Medican Services Ltd.
4.4 Medican Services Ltd will make reasonable effort to ensure that a qualifying claim by a
member whose account is active is facilitated and processed as quickly as possible and
help in addressing any arising requirements by the Underwriter.
4.5 An administration fee of 10% of the awarded insurance claim benefit amount will be
charged to all non-medical expenses claims processed for Endelea Plan members
under the Group Insurance Scheme administered by Medican Services Ltd.
4.6 A member will be required to complete payment of annualised subscriptions from the
date of registration (or its anniversary for subsequent periods) before the awarded
insurance claim benefit is disbursed/credited to their account. Medican Services Ltd
reserves the right to deduct the balance of remaining annual subscription amount, in
addition to the administration fee, from the awarded insurance claim benefit before
disbursing/crediting to the member’s account.
5.1 Although Medican will have taken all reasonable precautions to ensure that the
information provided is accurate and that a member suffers no loss or damage as a
result of the use of Endelea Plan Group Insurance Scheme, by using the service you
agree that your use is entirely at your own risk and you assume full responsibility for any
risk of loss or damage arising from the use of the service with the exclusion of any wilful
and gross negligence by Medican or its officers, employees, subcontractors or agents.
You are responsible for the correctness of the data in your Endelea Plan account.
5.2 By using Endelea Plan Group Insurance Scheme, you hereby acknowledge that you
have registered for Endelea Plan membership voluntarily and without any coercion and
have no legal rights, other than the express contractual obligations, against Medican for
the use of the Scheme. This includes agreement to receive communications from
Medican, Endelea Plan or our partners and service providers by way of SMS, email or
any other form of information dissemination.
5.3 You agree that Medican and its officers, employees, agents and partners will not be
liable for any loss or damage including, without limitation, any direct, indirect, special,
incidental, consequential or punitive damages, whether arising out of contract, statute,
tort or otherwise arising from:
5.4 Medican disclaims liability from the fraudulent actions of any third parties including butnot limited to any disputes with underwriters or healthcare providers for services provided by them or their representatives.
5.5 Medican disclaims liability arising from any mistreatment, malpractices or wrongful actions of any of the underwriters or contracted healthcare providers in the line of providing health services.
6.1 You may contact the Endelea Plan customer support centre on 0111 014 500 /
WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com to report any
dispute or claim relating to Endelea Insurance Plan. Claims may also be initiated on
Endelea App (available from Google Play Store and Apple App Store).
6.2 All disputes arising from the Endelea Plan Group Insurance Scheme or these Terms &
Conditions will be addressed by way of amicable discussions between the parties.
6.3 If an amicable resolution of the dispute or claim fails for a period longer that 90 days
from the date the dispute or claim first arose, the dispute may be resolved by an
arbitrator agreed on by both parties and in default of such agreement by an arbitrator
appointed by the Chairman of the Kenya Chapter of the Chartered Institute of
Arbitrators on the application of either party. Such arbitration shall be conducted in
Nairobi in accordance with the Arbitration Act 1995 or any re-enactment thereof.
6.4 To the extent permissible by law, the determination of the arbitrators shall be final,
conclusive and binding upon the parties hereto.
6.5 These Terms & Conditions and the use of the Endelea Plan Group Insurance Scheme
service shall be governed by the Laws of Kenya.
7.1 Medican reserves the right at any time to modify these Terms & Conditions and to impose new or additional terms or conditions on your use of Endelea Plan Group Insurance Scheme services. Such modifications and additional terms and conditions will be notified to you. Your continued use of the Services will be deemed acceptance thereof.
Endelea Advantage Plan
The following Terms & Conditions apply to Endelea Advantage Medical Scheme and by enrolling for the Scheme you are deemed to have read, understood and accepted these Terms & Conditions.
1.1 Endelea Advantage Plan is a self-funded out-patient medical scheme that allows members to set aside funds used to access and pay for outpatient healthcare services using biometric medical smartcards or mobile phones at designated health clinics and hospitals. The scheme is managed by Medican Services Limited.
2.1 To be eligible as Principal Member in Endelea Advantage medical scheme, you must be:
2.3 Instructions on how to register and access Endelea Advantage services will be found on Endelea App (available from Google Play Store and Apple App Store) or Endelea Plan website https://www.endeleaplan.com or by contacting Endelea Plan customer support centre on telephone number 0111 014 500 / WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com.
3.1 As a member in the Endelea Advantage medical scheme, you will have a member
account and a medical smartcard card. Don’t reveal your Account information to
anyone else. You are solely responsible for maintaining the confidentiality and security of
your account and medical card, and for all activities that occur on or through your
account and medical card. You agree to immediately notify Medican Services Ltd of
any security breach of your account or loss / damage to your medical card. Medican
Services Ltd shall not be responsible for any losses arising out of the unauthorized use of
your medical card.
3.2 Your account will be credited with contributions you make. A minimum contribution of
KSh 10,000 is required for principal member and KSh 5,000 for each dependant.
Medican reserves the right to change the minimum contribution from time to time.
3.3 Existing members will be eligible to access emergency medical loan instantly while at
the hospital depending on their account activity and prevailing loan terms that can be
accessed on Endelea App (available from Google Play Store and Apple App Store) or
by contacting Endelea Plan customer support centre on telephone number 0111 014
500 / WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com
3.4 Available balance will be the net of total member contributions less any utilisation,
charges and the minimum balance required to be maintained in the member account,
which is 20% of the total contribution from the principal member and dependants. The
minimum balance will be maintained in the principal member’s account and will be
refunded upon termination of the contract in line with the termination clause.
3.5 Each member will receive a smartcard with microchip that can store data helping track billing whenever accessing service and also making them aware of benefits utilisation.
This smartcard will charge a maintenance fee.
4.1 Funds in your Endelea Advantage Account can only be spent at designated healthcare
providers which have been contracted for Endelea Advantage medical scheme.
Members shall be liable to pay any excess amount incurred outside their available
balance and such excesses shall be paid by the member to the service providers.
4.22 Information on the contracted healthcare providers for Endelea Advantage will be
accessed on Endelea App (available from Google Play Store and Apple App Store) or
online using the link https://endeleaplan.com/advantage/partners/ or by dialling USSD
code *849*300# and selecting Claim under main menu then Check Provider List or by
contacting Endelea Plan customer support centre on telephone number 0111 014 500 /
WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com.
4.3To access healthcare services at the contracted healthcare providers you are required
to identify yourself as Endelea Advantage member through your medical smart card
and original national identification card or passport, or any other means of identification
that Medican may in its sole discretion determine fit. The healthcare provider shall have
the responsibility to check whether the identification card or other approved means of
identification presented maA co-payment of KSh 200 shall be made to the healthcare provider upon every visit for
outpatient services. This amount of Co-Pay may be reviewed from time to time and any
changes will be notified to members.
4.5 The principal member can add dependents to their Endelea Advantage Account who
can access healthcare services within the overall available balance limit.
5.1 Although Medican will have taken all reasonable precautions to ensure that the
information provided is accurate and that you suffer no loss or damage as a result of the
use of Endelea Advantage Service, by using the Service you agree that your use is
entirely at your own risk and you assume full responsibility for any risk of loss or damage
arising from the use of the Service with the exclusion of any wilful and gross negligence
by Medican or its officers, employees, subcontractors or agents. You are responsible for
the correctness of the data in your Endelea Advantage account.
5.2 By using Endelea Advantage Service, you hereby acknowledge that you have
registered for Endelea Advantage membership voluntarily and without any coercion
and have no legal rights against Medican for the use of the Service including any
related communications from Medican, Endelea Plan or our partners and service
providers by way of SMS, email or any other form of information dissemination.
5.3 You agree that Medican and its officers, employees, agents and partners will not be
liable for any loss or damage including, without limitation, any direct, indirect, special,
incidental, consequential or punitive damages, whether arising out of contract, statute,
tort or otherwise arising from:
5.4 Medican disclaims liability arising from any mistreatment, malpractices or wrongful actions of any of the contracted healthcare providers or their agents and representatives in the line of providing healthcare services.
5.5 Medican disclaims liability arising from any mistreatment, malpractices or wrongful actions of any of the contracted healthcare providers or their agents and representatives in the line of providing healthcare services.
6.1 Either party may determine to terminate membership contract at any moment in time
after the minimum membership period of 1 year.
6.2 You can terminate membership in Endelea Advantage medical scheme by sending an
email to memberservice@endeleaplan.com.
6.3 3 In case of termination, all remaining funds in your Endelea Advantage Account, minus
any outstanding payments (net of charges) to Medican, Service Providers and/or the
contracted healthcare providers, shall be refunded within 45 days to a bank account or
MPESA account number advised by the principal member at time of termination.
6.4 Termination of membership in the Endelea Advantage medical scheme shall not
terminate your registration to other Endelea Plan services. In case of any issues, you can
contact Endelea Plan customer support centre on 0111 014 500 / WhatsApp 0748 201
428 or Email memberservice@endeleaplan.com for any questions or action to be taken.
7.1 You may contact the Endelea Plan customer support centre on 0111 014 500 /
WhatsApp 0748 201 428 or Email memberservice@endeleaplan.com to report any
dispute relating to Endelea Advantage medical scheme during the contract period.
7.2 YAll disputes arising from the Endelea Advantage medical scheme or these Terms &
Conditions will be addressed by way of amicable discussions between the parties.
7.3 If an amicable resolution of the dispute or claim fails for a period longer that 90 days
from the date the dispute or claim first arose, the dispute may be resolved by an
arbitrator agreed on by both parties and in default of such agreement by an arbitrator
appointed by the Chairman of the Kenya Chapter of the Chartered Institute of
Arbitrators on the application of either party. Such arbitration shall be conducted in
Nairobi in accordance with the Arbitration Act 1995 or any re-enactment thereof.
7.4 To the extent permissible by law, the determination of the arbitrators shall be final,
conclusive and binding upon the parties hereto.
7.5 These Terms & Conditions and the use of the Endelea Advantage service shall be
governed by the Laws of Kenya.
8.1 Medican reserves the right at any time to modify these Terms & Conditions and to impose new or additional terms or conditions on your use of Endelea Advantage Services. Such modifications and additional terms and conditions will be notified to you. Your continued use of the Services will be deemed acceptance thereof.
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