Family Information
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Customer Information
Medical Declaration
Summary
Payments
Let us get to know more about you.

This product is designed for individuals below the age of 65 years.

Myself
My spouse & I
My Family & I
My Child(ren) & I

Choose the benefit (s) you desire to add to your cover

Current Selected Inpatient Limit
KES 500,000
Add Benefits to your cover
Chargeable Premium
Annual Benefit Limit
Add Out-Patient Cover
Chargeable Premium
Annual Benefit Limit
Add Dental Cover
Chargeable Premium
Annual Benefit Limit
Add Optical Cover
Chargeable Premium
Annual Benefit Limit
Add Maternity Cover
Chargeable Premium
Annual Benefit Limit
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Annual Premium Summary
Plan
Inpatient KES
Training Levy KES
PHCF KES
Stamp duty KES 40
Total KES
Instalment Payment Breakdown
Select a Payment Instalment Plan from the options below
Details you will need to buy J-Care Insurance Policy
  • KRA PIN for the customer (Principal)
  • ID number for the customer (principal) and spouse
  • Birth certificate copies for the dependant (s)

Customer Information

Personal Details
Beneficiary (Last Expense / Personal Accident) Details
Next of Kin Details Check this if Next Of Kin is same as Beneficiary

To complete your purchase, please note that we require a medical examination report

Have you done a medical examination within the last 30 days?
Please provide the following details:

Confidential Medical History

In completing these questions please ensure that each question is answered fully and accurately for all people to be covered.

Have you had a medical cover with Jubilee Health in the last 3 years?

Please insert the name of the scheme ? Please select Start and End Date of the cover?

Have you had a previous health cover with any other Insurance company?

Please insert the name of the scheme/Insurance Company? Please select Start and End Date of the cover?
Please attach a copy of renewal invite and utilization report from the previous insurer?


Have you suffered from any medical/health complaint which may necessitate a surgical operation or for which you reasonably anticipate the necessity of treatment ?

Have you suffered from a chronic/long term medical debiliating condition or is there any known disability,abnormality or recurrent illness or injury ?.

Summary

Plan
Inpatient KES
Training Levy KES
PHCF KES
Stamp duty KES 40
Total KES
Choose Payment Method
Pay using Mpesa Express
Pay using Mpesa Paybill
Total Amount to pay
KES
Premium Summary
Plan
Inpatient
KES
PHCF
KES
Training Levy
KES
Stamp Duty
KES 40
Total
KES