Click here to download RUGARAMA HEALTH INSURANCE SCHEME Summary.

Hospital Vision To move forward and offer more comprehensive services which heal physically, mentally and spiritually so that they may have a better life.   Mission statement. Work as a team to offer quality services, meet the community’s physical, mental and spiritual needs whilst showing the love of Jesus. The goal of the scheme. To have a healthy and productive community, by reducing the burden of out of pocket payment on house hold. Specific objectives.

  • To help the community members have timely medical attention.
  • To help the community members increase their utilization of health services so as to mitigate the negative effects of illnesses/diseases.
  • To help the community and households have adequate preparations for emergency health interventions.
  • To have timely and appropriate care for the increasing population that is ageing.

Functioning of the scheme. The scheme is envisioned to operate on the following pillars ;(PPPP)

  • Plan for your health; Pay when well
  • Protect the house hold from unplanned expenditure; No large debt incurred by the house holds.
  • Partnership in health care; an equal responsibility between the hospital and the community.
  • Active Participation; the consumers will be actively involved in service uptake; that is a powerful consumer body will be created.

Legible members.

  • A group of people.
    • A community association (“Kwezika”) is said to be eligible to join the scheme if it has been in existence for more than a year. Evidence of this must be confirmed with the relevant authorities at LC1, LC11 and LC111 or any other relevant documentation that confirms the existence of the group.
    •  Employees in an organization
    •   Students in a school or institution of higher learning.

Procedure of applying and registering

  • Filling a form designed for this purpose.
  • Members can apply to join the scheme after fulfilling certain laid down and agreed upon criteria as a group. The group applies through their representative who is given the full authority to deal with the hospital.
  • The individual or organization will be given a receipt upon payment after fulfilling all requirements.
  • The beneficiaries will register with members of the family taking a group photo in accordance with the age ranges.
  • For a person who changes residence or for other justifiable reasons, is transferred to another locality shall inform the respective group/ organization leader of his intention to continue as a group member or not.

 

  • Once a group has been registered, each family in this particular group will have a kind of ledger opened for it. At registration, each family will be given a receipt indicating the amount paid and this receipt will be presented at every visit of any member of the family along with the family group photo. The ledger will in part be used to record the person who has come for treatment and the amount to be paid by the individual as well as the amount to be paid by the scheme. This is for the purposes of identification, verification, validation and accessing health care benefits under the scheme.

 

  • All family members who are still under the care of one head will be automatically taken on in the scheme. There will be no exclusions of any member(s) in any family if the member family decides to enroll in the scheme.

 

  • The decision to determine which category of the scheme to enroll into will be determined by the groups themselves and not the individual member(s).

  Payment schedule and payment modalities.

  • Individuals within a group will make their payments to the group leader.
  • On behalf of the group/Institution the leader will make payments to the scheme at the hospital.
  • Payment modalities will be agreed upon between the group and the hospital.
  • Members will always pay a consultation fee for every visit except where the visit is a follow up of the previous visit for conditions not classified as chronic.

  Premium contribution. The scheme has  four categories:

The classic category.

Members under the classic category are as follows

    • 1-6 family members each family will pay 60,000/= annually.
    • 7-8 family members each family will pay 96000/= annually.
    • 9 and above members each additional members adds 25000/= to 96000/=

Under this category, the health package will have the following components;

  • OPD, Laboratory investigations, x-ray, ultrasound scan and drugs.
  • Antenatal care.
  • Normal delivery services for mothers who attend antennal care for at least 4 times whether at Rugarama hospital or not.
  • Eye care, examination and treatment of infections and allergies.
  • Dental care, examination and extractions.
  • Admission charges of up to ¼ of the total charge.(this excludes surgical procedures).
  • Emergency surgical procedures not exceeding 10000/=

Silver category.

Members under silver are categorized as follows

    • 1-6 family members each family will pay 150,000/= annually.
    • 7-8 family members each family will pay200,000/=annually
    • 9 and above members each additional members adds 40000/= to 200,000/=

Under this category, the health package will have the following components.

  • OPD, this includes; consultation, laboratory investigations, x-ray, ultra sound scan, drugs.
  • Antenatal care
  • Normal delivery services for mothers who attended antenatal care for at least 4 times whether at Rugarama or elsewhere.
  • Eye care this includes examination, treatment of infections and allergies.
  • Dental; this will include examination and extractions.
  • Admission charges of up to ¼ of the total charge.(this excludes surgical procedures)
  • Emergency surgical procedures not exceeding 20,000/=
  • Well check person once per year (on appointment), tests to be covered are general physical examination, LFT, RFT, RBS and HIV.

Gold category.

Members under the Gold category are as follows;

    • 1-6 family members each family will pay 180,000/= annually.
    • 7-8 family members each family will pay 230,000/=annually.
    • 9 and above members each additional member adds 40,000/= to 230,000/=

Under this category, the health package will have the following components.

  •       OPD, this includes; consultation, laboratory investigations, x-ray, ultra sound scan, drugs.
  •       Antenatal care
  •       Normal delivery services for mothers who attended antenatal care for at least 4 times whether at Rugarama or elsewhere.
  •       Eye care this includes examination, treatment of infections and allergies.
  •       Dental; this will include examination and extractions.
  •        Admission charges will be catered for up to ½ of the total charges.(this excludes surgical procedures)
  •       Emergency surgical procedures whose cost does not exceed 30,000/=
  •       Well check person once per year (on appointment), the tests to be covered are general physical examination, LFT, RFT, RBS, HIV, LIPID PROFILE, FBC, U/S SCAN.

Platinum category.

Members under this category will be as follows;

    • 1-6 family members each family will pay 250,000/= annually
    • 7-8 family members each family will pay 300,000/= annually
    • 9 and above members each additional member adds 40,000/= to 300,000/=

Under this category, the health package will have the following components.

  • OPD, this includes; consultation, laboratory investigations, x-ray, ultra sound scan, drugs.
  • Antenatal care
  • Normal delivery services for mothers who attended antenatal care for at least 4 times whether at Rugarama or elsewhere.
  • Eye care this includes examination, treatment of infections and allergies.
  • Dental; this will include examination and extractions.

Admission charges will be catered for up to ¾ of the total charges.(this excludes surgical procedures) Dental care, covering examination, extraction, fillings, polishing and scaling. Eye care, as for classic plus glasses not exceeding 30000/=. Emergency surgical procedures whose cost does  not exceed 50,000/= Well check person once in a year (on appointment), the tests covered are general physical examination, LFT, RFT, RBS, HIV, LIPID PROFILE, FBC, U/S SCAN, PSA, HepB, THYROID HORMONES.   Secondary/ Primary category Members under this category are as follows;

    • 1 member. pay 10,000/= annually.

Under this category, the health package will have the following components;

  • OPD, Laboratory investigations, x-ray, ultrasound scan and drugs.
  • Eye care, examination and treatment of infections and allergies.
  • Dental care, examination and extractions.
  • Admission charges of up to ¼ of the total charge.(this excludes surgical procedures).
  • Emergency surgical procedures not exceeding 10000/=

  University(higher Institution) Student category Members under this category are as follows;

    • 1 member. pay 30,000/= annually.

Under this category, the health package will have the following components;

  • OPD, Laboratory investigations, x-ray, ultrasound scan and drugs.
  • Eye care, examination and treatment of infections and allergies.
  • Dental care, examination and extractions.
  • Admission charges of up to ½ of the total charge.(this excludes surgical procedures).
  • Emergency surgical procedures not exceeding 20000/=
  • Well check person once per year (on appointment), tests to be covered are general physical examination, LFT, RFT, RBS and HIV.

Exclusions The health insurance scheme is for people who are otherwise health and productive. “It is not for the sick”, and must be protected from misuse. There are exclusion to this scheme.

  • Referrals outside Rugarama hospital.
  • Elective surgery.
  • Lenses and frames.
  • Hearing aids.
  • Ambulance services.
  • Dentures and braces.
  • Accidents secondary to Dangerous sports like motor and bicycle racing.
  • Self-inflicted injury while insane or sane.
  • Illnesses complicated by alternative medicine including use of local herbs.
  • Chronic conditions.
  • Admissions in the single patient rooms.
  • Alcoholism and addiction.
  • Cosmetic surgery and or related medicines and products.
  • Preventive treatment and vaccinations.
  • All expenses and treatment not reasonable, customary and necessary for the treatment of an injury or illness.
  • Medical treatment not related to the diagnosis of an illness or accidental injury.
  • Injuries or illness arising from occupational hazards.
  • Food supplements.
  • Age above 70 years at the time of first enrollment.

CHRONIC CARE; Patients diagnosed as having a chronic condition, will be enrolled in the special care clinic for routine care and appointments. In this case the cost will be born by the person himself or her self. Admission will only be covered by the scheme only if the above conditions related to chronic care have been consistently fulfilled.

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