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SME Medical product

Definition

This is a medical insurance product designed to cover a registered organization or entity with the following membership;

  • Minimum number – 7 Employees.
  • Maximum number – 19 Employees.

Main Products:

Inpatient cover

Optional Benefits

  • Outpatient cover
  • Maternity cover
  • Last expense cover
  • Dental Cover
  • Optical Cover

Eligibility:

  • Employees between the ages of 18 years and 60 years. A member already in the scheme can have cover extended up to 65 years of age provided that he/she remains in active service.
  • Dependent children from 30 days of age up till the age of 18 years or to the age of 23 years if residing with their parents and enrolled full-time in a recognized post-secondary institution.

Scope of cover:

Coverage For Hospitalisation (Inpatient Cover)

Inpatient cover provides for medically necessary hospital bed charges (Private Standard Room up to Kshs.12,000/= net of NHIF for inpatient limits of 3,000,000 and above and standard ward for inpatient limits below 3,000,000), doctor’s bills, anesthetist’s bills, operating theatre fees, pharmacy, laboratory and investigations reasonably incurred by an insured member. This cover will be on credit facility with our providers.

Outpatient Services

Outpatient cover provides for medically necessary consultation fees, investigatory procedures (laboratory & radiology), referral to specialists, pharmacy and dressings. Cover will be on credit facility basis with our providers and on 80% re-imbursement.

Enhanced benefits

  • Cover for Pre-existing and chronic conditions
  • Cover for HIV/AIDS including Opportunistic infections of HIV conditions
  • Free personal accident cover of Kshs. 500,000 for employees only
  • Free last expense for Kshs. 50,000 for employees only.

Dental and Optical Cover

The Dental cover provides for cost of fillings, x-rays, extractions including surgical extraction together with anaesthetics fees

  • The Optical cover provides for the cost of eyeglasses and eye testing.

Maternity Cover

Maternity cover will cater for delivery expenses, pre-natal care, post-natal care and ultrasounds all within the maternity limit. Please note that all families must be covered for maternity benefits for the maternity package to apply.

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SME Application Form
SME Claim Form

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