INPATIENT OPTIONS

KENYA PRIVATE HEALTH INSURANCE - INPATIENT OPTIONS

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. 

For all in-patient and day-case treatment costs:

  • it must be medically essential for you to occupy a hospital bed to receive the treatment
  • your treatment must be provided, or overseen, by a consultant
  • we pay for accommodation in a room that is no more expensive than the hospital’s standard single room with a private bathroom. This means that we will not pay the extra costs of a deluxe, executive or VIP suite etc.
  • if the cost of treatment is linked to the type of room, we pay the cost of treatment at the rate which would be charged if you occupied a standard single room with a private bathroom in the hospital where you have your treatment must be recognised

Our Medical Provider directory is available on the website.

This online directory allows you to search for hospitals, clinics, doctors and specialists on a county to county basis, with the ability to narrow down the search to specific regions.

INPATIENT LIMIT KES10,000,000.00 KES5,000,000.00 KES2,500,000.00 KES1,000,000.00 KES500,000.00 KES300,000.00 KES200,000.00
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Bed limits Private room Private room Private room Private room Standard Ward Standard Ward Standard Ward
Prescription drugs and dressings Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Physicians fees Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Specialist fees Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Surgical fees including anaesthetist Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Diagnostic Tests: Pathology Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Diagnostic Tests: Radiology Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Any other diagnostic tests Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Theatre charges Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
High Dependency Unit Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Intensive Care Unit Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Diagnostic tests Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Pre-existing conditions
On full disclosure at the time of joining
KES           1,000,000.00 KES             500,000.00 KES             250,000.00 KES             100,000.00 KES           75,000.00 KES           65,000.00 KES           50,000.00

Chronic conditions
On full disclosure at the time of joining

KES           1,000,000.00 KES             500,000.00 KES             250,000.00 KES             100,000.00 KES           75,000.00 KES           65,000.00 KES           50,000.00
HIV/AIDS
On full disclosure at the time of joining
KES           1,000,000.00 KES             500,000.00 KES             250,000.00 KES             100,000.00 KES           75,000.00 KES           65,000.00 KES           50,000.00
Cancer treatment Covered Covered Covered Covered After 3rd year After 3rd year After 3rd year

Organ transplantation 


Covered Covered Covered Covered Covered Covered Covered
Organ transplantation covers operation costs for Kidney transplants ,Heart transplants , Liver transplants , Lung transplants and Bone Marrow transplants excluding cost of obtaining the donor organ
Surgical appliances and internal prostheses KES             500,000.00 KES             300,000.00 KES             200,000.00 KES             200,000.00 KES         100,000.00 KES           65,000.00 KES           50,000.00
Accommodation costs for 1 parent staying in hospital with insured child Paid In Full Child under 6 years paid In Full Child under 6 years paid In Full Child under 6 years paid In Full Child under 6 years paid In Full Child under 6 years paid In Full Child under 6 years paid In Full
Day Care Surgery under General anaesthesia 30 Days Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Local ambulance to hospital for emergency cases Paid In Full Covered Covered Covered Covered Covered Covered
Local ambulance offered by the following professional emergency medical assistance providers: Red Cross Ambulance (E Plus), St. Johns Ambulance
Air evacuation through AMREF per event KES             300,000.00 KES             300,000.00 KES             180,000.00 KES             180,000.00 KES         180,000.00 KES         180,000.00 KES         180,000.00
Treatment outside Kenya where treatment is not locally available (Preauthorisation required) Allowed on reimbursement Allowed on reimbursement Allowed on reimbursement Allowed on reimbursement Allowed on reimbursement Allowed on reimbursement Allowed on reimbursement
CT, MRI and PET scans subject to pre authorisation Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Maternity expenses (normal & caesarean) related complications KES             100,000.00 KES             100,000.00 KES             100,000.00 KES             75,000.00 KES           50,000.00 KES           50,000.00 KES           50,000.00
InPatient Ophthalmology: includes cost of cataract removal KES             100,000.00 Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
In Patient Dental KES             100,000.00 Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Emergency dental or Optical treatment following accident Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full Paid In Full
Funeral expenses – No Exclusions KES             100,000.00 KES             50,000.00 KES             50,000.00 KES             50,000.00 KES           50,000.00 KES           50,000.00 KES           50,000.00

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