HEALTH INSURANCE

OUR CUSTOMISED PRIVATE HEALTH INSURANCE BENEFITS

Medical or private health insurance is typically customized to meet specific needs of an individual, business or industry. Our cover options are – but not limited to:

INPATIENT TREATMENT
In-patient medical or private health insurance in Kenya refers to treatment received in a hospital where an overnight stay is medically necessary. In-patient benefits include things like hospital accommodation, anaesthesia and theatre charges, surgical fees, surgical appliances, prostheses and diagnostic tests.

OUTPATIENT TREATMENT
Outpatient cover in Kenya refers to treatment given at a hospital, consulting room, doctors’ office or out-patient clinic where you do not go in for in-patient treatment or day-case treatment.

This includes cover for treatment received in a casualty ward or emergency room, following an accident or sudden illness.

MATERNITY COVER
Where covered, routine maternity refers to medically necessary costs incurred during pregnancy and childbirth, including hospital charges, specialist fees, the mother's pre- and post-natal care, midwife fees (during labour only) as well as newborn care.

OPTICAL COVER
With optical cover we pay for an eye test at major Kenyan opticians and eye doctors, which includes the cost of your consultation and sight/vision testing. We pay for spectacle and contact lenses

DENTAL COVER
With dental cover we pay for access to many dentists in Kenya and extends to follow-up dental treatment, dental surgery, dental prostheses, orthodontics or periodontics.

We offer a one stop shop for all your medical needs ranging from inpatient, outpatient, and maternity, dental, optical and ONLINE medical scheme administration. Additional benefits include:

  • Pre – existing cover, chronic conditions, and congenital conditions covered.
  • Over 2500 medical service practitioners on list of panel across East Africa.
  • All NHIF hospitals in Kenya covered on 100% reimbursement.
  • Specialist fees, Diagnostic tests, Prescription drugs and day care surgery included.
  • Treatment outside Kenya – managed and fully covered; preference to India, South Africa & Pakistan.
  • We do not set apart the benefits under the various headings e.g. drugs, doctor's fees, etc as long as it is within the overall limit of cover.
  • Online utilization reports are offered allowing each employee privacy and access to balance left.
  • There is no ceiling amount for ward bed. The client can therefore go to any hospital regardless of the cost of the ward bed. The client can also choose to use a Private room*.
  • For a child aged 7 years and below, we pay the accommodation fee for the accompanying parent/Guardian (Lodger Fee).
  • We offer identification membership photo cards at no additional fee
  • Maternity cash benefit for each child born & Maternity and pregnancy related complications covered.
  • Congenital Illness (Condition that a person is born with) covered.
  • Pre Existing conditions covered
    (medical conditions or any related conditions for which one or more symptoms have been shown at some point during the five years prior to commencement of cover, irrespective of whether any medical treatment or advice was sought.)
  • Chronic conditions covered
    (defined as a sickness, illness, disease or injury which has one or more of the following characteristics: Is recurrent, without a known, generally recognized cure, Is not generally deemed to respond well to treatment, prolonged supervision or monitoring, Leads to permanent disability, Requires palliative treatment.)
  • Widest variety of Dental & optical medical service providers.
  • 24 hour emergency numbers accessible in cases of emergencies

All Kenyan ambulance offered: including E-Plus, St. John's Ambulance, AVENUE Healthcare ambulances, AMREF air evacuation.

With our offers, you can also ensure that benefits you feel are not essential for your company are excluded, for example treatment for abnormal pregnancy, the number of available hospitals, oral surgical procedures and/or emergency overseas cover.

We also include the additional flexibility of tailoring the benefits for different categories of staff. Tailor made private health insurance is available for the following conditions for all employees:

  • HIV / AIDS
  • Chronic conditions
  • Cancer
  • Dental
  • Congenital illness
  • Optical

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