Member for

1 year 7 months
product term

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
product type