Member for

3 years 8 months

This medical insurance is an indemnity for medical expenses incurred following illness, disease or accidents. It covers inpatient (when hospitalized) and outpatient (without hospitalization) for SMEs and individuals.

  • SME- An employer of 5-100 employees (flexibility can be granted)
    • Age 18-65 years (extended to 70 years)
    • One legal spouse.
    • Biologically, legally adopted children below 18 years of age (extended to 25 years in full time schooling for SME).
    • Lodger fee for children below 12 years accommodated
    • KEPI & Vaccines up to Kshs. 5,000 for children up to 1.5 years
    • Annual medical check-up up to Kshs. 10,000
  • Individual- One person or family (of 1-5)
    • Age 18-65 years (extended to 70 years)
    • One legal spouse.
    • Members between 50 – 65 years to get medical examination at their cost – cover not automatic
    • Waiting period for illness - 30 days for individuals and 14 days for SME and No waiting period for accident (option to waive if transferred from existing scheme)
    • Biologically, legally adopted children below 18 years of age (extended to 25 years in full time schooling under SME)
    • Lodger fee for children below 12 years accommodated
    • KEPI & Vaccines up to Kshs. 5,000 for children up to 1.5 years
    • Annual medical check-up up to Kshs. 10,000 for Employee and Spouse under SME.
    • Pre-existing, Chronic Cases i.e. Maternity– waiting period of 12 months under Individuals.
  • Medical Expenses when hospitalized
  • Treatment without hospitalization
  • Last expense – free benefit of Kshs. 50,000, Kshs. 75,000 and Kshs. 100,000 payable to next of Kin (with-in 48hrs)
  • Personal accident cover of Kshs. 500,000 for principal member.
  • Offer options to purchase separately (Maternity, Dental and Optical)
Not included in the main cover, but insured has an option to purchase separately;
  • Maternity
    • Waiting period of 12 months (for individuals), 10 months for SME
    • Full term baby (36 weeks), normal and C-section, labor, recovery ward, other ailments and complications
    • Pre-natal & Ante-natal outpatient treatment
    • Dependent children not eligible for this benefit
  • Dental
    • Includes consultation, X-Rays, Fillings, Extractions, Prescriptions, Surgical, Anesthetic fees but excludes cosmetic treatment, replacement of old dentures, bridges and plates (unless due to accident)
  • Optical
    • Includes consultation, Testing, prescribed glasses, frames (1 pair every two years – maximum Kshs. 10,000), but excludes sunglasses, lenses, replacement of frames below 2 years (unless of an accident)
  • Expenses recoverable under other insurances i.e. NHIF
  • Hazardous sports
  • Cosmetic surgery
  • Drugs/Alcohol related
  • Family planning
  • Food supplements
  • Old age homes, places of rest
  • Participating in riots or strikes
  • STDs (Except HIV)
  • Genetic Disorders
  • Military / Airforce operations
  • Ambulance cost (unless under inpatient cover)
  • Pain Management
  • Suicide attempts or intentional injury
  • Epidemics / Unknown Diseases
product_id
1