Terms & Conditions

Your privacy is critically important to us. Our Privacy Policy explains how we collect, use, disclose, and safeguard your information when you use our Service.

By using the Service, you consent to the collection and use of your personal data in accordance with our Privacy Policy, which is incorporated into these Terms by reference.

Health Data Collection: MindSure collects mental health-related information to provide personalized insurance coverage and wellness recommendations. This includes:

• Wellness assessment responses
• App engagement metrics
• Therapy session information (with your consent)
• Health Index calculations

Data Security: We implement industry-standard security measures to protect your data, including encryption, access controls, and regular security audits. However, no method of transmission over the Internet or electronic storage is 100% secure.

Third-Party Sharing: We may share your data with:

1. Licensed therapists and mental health professionals within our network
2. Payment processors for premium collection
3. Regulatory authorities as required by law
4. Reinsurance partners for risk management (in anonymized form)

MindSure provides digital mental health insurance coverage as detailed in your policy document. Coverage includes but is not limited to:

Included Benefits:

• Outpatient therapy sessions with licensed professionals
• Prescription medications for mental health conditions (as per formulary)
• Digital mental health assessments and screenings
• Emergency psychological support via telehealth
• Wellness rewards and preventive care programs

Wellness Engagement Discount: Active participation in MindSure wellness programs may qualify you for premium discounts of up to 20% based on your Health Index score and engagement level.

Waiting Period: A standard 6-month waiting period applies for coverage of pre-existing conditions or certain mental health benefits to prevent adverse selection.

Premiums are calculated based on actuarial models that consider your Health Index, demographic factors, and selected coverage level.

Payment Methods: We accept various payment methods including:

• Mobile money (M-Pesa, Airtel Money)
• Credit/Debit cards
• Bank transfers
• Digital wallets

Billing Cycle: Premiums are billed monthly. You authorize MindSure to automatically charge your selected payment method on the billing date unless you cancel your subscription.

Late Payments: If your payment is overdue by more than 30 days, your coverage may be suspended until payment is received. A reinstatement fee may apply.

Premium Adjustments: Your premium may be adjusted annually based on:

1. Changes in your Health Index
2. Claims history
3. Overall portfolio experience
4. Regulatory requirements

To submit a claim for mental health services:

Step 1: Access care through MindSure's provider network whenever possible. For in-network providers, claims are typically submitted directly by the provider.

Step 2: For out-of-network services or when the provider does not submit claims directly, you must submit a claim form within 90 days of service receipt.

Step 3: Include all required documentation:

• Completed claim form
• Itemized receipt from provider
• Diagnosis and treatment details
• Proof of payment

Claims Adjudication: We typically process claims within 14 business days of receiving complete documentation. You will be notified of the decision via your preferred communication method.

Appeals Process: If your claim is denied, you have the right to appeal within 60 days of the denial notice. The appeals process involves review by an independent medical professional.

MindSure does not cover the following:

General Exclusions:

• Services received outside of Kenya (unless pre-approved for emergency care)
• Experimental treatments not recognized by the Kenya Medical Practitioners and Dentists Council
• Services related to non-mental health conditions
• Cosmetic or elective procedures

Mental Health Specific Exclusions:

• Inpatient psychiatric hospitalization beyond 30 days per year
• Court-ordered evaluations or treatments
• Conditions arising from substance abuse without concurrent treatment for addiction
• Services rendered by unlicensed practitioners

By You: You may cancel your MindSure policy at any time by providing 30 days written notice. Premiums paid in advance will be prorated and refunded, minus any applicable cancellation fees.

By MindSure: We may terminate or suspend your policy immediately, without prior notice or liability, for any reason including but not limited to:

• Non-payment of premiums
• Violation of these Terms
• Fraud or misrepresentation
• Abuse of the service or providers

Effect of Termination: Upon termination, your right to use the Service will immediately cease. If you wish to terminate your account, you may simply discontinue using the Service.

Survival: All provisions of these Terms which by their nature should survive termination shall survive termination, including, without limitation, ownership provisions, warranty disclaimers, indemnity, and limitations of liability.

These Terms shall be governed and construed in accordance with the laws of the Republic of Kenya, without regard to its conflict of law provisions.

Any disputes arising from or relating to these Terms or your use of the Service shall be subject to the exclusive jurisdiction of the courts of Kenya.

Dispute Resolution: Before resorting to formal legal proceedings, we encourage you to contact us directly to attempt to resolve any dispute informally. If informal resolution fails, disputes shall be resolved through mediation in Nairobi, Kenya.

Regulatory Compliance: MindSure operates in compliance with the Insurance Act (Cap. 487) of Kenya and is regulated by the Insurance Regulatory Authority (IRA) of Kenya.

Consumer Protection: Your rights as a consumer are protected under the Consumer Protection Act of Kenya. If you believe your rights have been violated, you may file a complaint with the Kenya Insurance Regulatory Authority.

If you have any questions about these Terms, please contact us:

MindSure Digital Mental Health Insurance

Email: info@mindsure.co.ke

Phone: 0727 345 738 (Customer Service)

Address:
MindSure Headquarters
Westlands, Nairobi
Kenya

Business Hours: Monday to Friday, 8:00 AM - 5:00 PM EAT

For claims-related inquiries, please use the dedicated claims contact line: 0727 345 738 or email claims@mindsure.co.ke