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MADISON INSURANCE CO. LTD: ALPHA HEALTH MEDICAL IN-PATIENT COVER


Choose from this options

Choose Father insurance


Minimum: 19 Maximum: 29





Minimum: 30 Maximum: 39





Minimum: 40 Maximum: 49





Minimum: 50 Maximum: 59





Minimum: 60 Maximum: 64





Minimum: 65 Maximum: 70




Choose Mother insurance


Minimum: 19 Maximum: 29





Minimum: 30 Maximum: 39





Minimum: 40 Maximum: 49





Minimum: 50 Maximum: 59





Minimum: 60 Maximum: 64





Minimum: 65 Maximum: 70




Choose Children insurance


Minimum: 1 Maximum: 18
Number of children:




TOTAL PREMIUM

see what is covered

INPATIENT MAIN BENEFITS

1.      Admission in a NHIF accredited hospital.

2.      Accommodation for parent/ guardian accompanying a child below 8 years.

3.      Doctors; surgeons; and specialists fees.

4.      Laboratory investigations, x-rays, ultra sounds, and nursing procedures.

5.      Prescribed drugs, dressing, surgical appliances, and nursing procedures.

6.      Theatre charges including surgeons and anesthetists fees.

7.      Intensive care (ICU)/ High dependency unit (HDU).

8.      Radiotherapy, chemotherapy, physiotherapy.

9.      Gynecological treatment.

10.  Day care surgery.

11.  Prematurity covered within the congenital conditions limit (available if client has maternity cover)

 

Bed capacity:

For a limit of KES. 2,000,000: Standard private room is covered up to a limit of KES. 10,000 per day.

For a limit of KES. 1,000,000: Ward bed is covered

For a limit of KES. 500,000: Ward bed is covered

For a limit of KES. 300,000: Ward bed is covered

 

Declared pre-existing, chronic and HIV/AIDS conditions within the inpatient benefits after one year:

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 300,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 250,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 200,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 100,000

 

Newly diagnosed chronic conditions covered after six months within the inpatient benefits.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 350,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 300,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 250,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 150,000

 

Congenital conditions treated after one year of cover for insureds children within the pre-existing and chronic.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 175,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 150,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 100,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 75,000

 

Prematurity conditions treated after one year of cover for members with the maternity benefit.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 175,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 150,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 100,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 75,000

 

Psychiatric illness is covered within the inpatient limit after one year of cover.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 175,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 150,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 100,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 75,000

 

First ever emergency caesarean section within the inpatient benefit after one year.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 100,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 80,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 75,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 50,000

 

Inpatient non accidental dental treatment within the inpatient benefit.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 60,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 50,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 40,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 30,000

 

Inpatient non accidental optical treatment within the inpatient benefit.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 80,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 70,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 60,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 50,000

 

Post hospitalization visits/follow-ups within the inpatient benefit.

For a limit of KES. 2,000,000: It is covered to a sublimit of KES. 30,000

For a limit of KES. 1,000,000: It is covered to a sublimit of KES. 25,000

For a limit of KES. 500,000: It is covered to a sublimit of KES. 20,000

For a limit of KES. 300,000: It is covered to a sublimit of KES. 15,000

 

Free last expense benefit:

Covered up a limit of KES. 50,000

 

INPATIENT MANAGEMENT

Emergency Admissions

1.      Each member is issued with a membership card for identification with the service provider.

2.      Services are offered on presentation of the Madison insurance card and authentication of the members identity.

3.      All members are required to produce their NHIF cards prior to discharge for purposes of NHIF rebate computation.

4.      In the absence of the NHIF card, members will be required to pay the NHIF rebate in cash.

 

Scheduled Admissions (non-emergency admissions)

1.      The patient will agree with the doctor on the dates of admission.

2.      The doctor will then complete an inpatient preauthorization form.

3.      The form should be presented to Madison in advance, but at list 48 hours prior to the admission.

4.      Madison will evacuate the condition under the treatment and if covered, a letter of undertaking will be issued to the hospital with a copy to the patient.

5.      On the admission the patient will be required to present a letter of undertaking to the hospital.

6.      At discharge the patient is required to produce his/her NHIF card as above.

7.      Ensure to sign a claim form and the final invoice.

 

WAITING PERIODS

1.      21 days for outpatient illness

2.      45 days for inpatient illness

3.      90 days for surgical cases

4.      One year (12 months) for maternity

5.      One year for pre-existing, chronic and psychiatric condition

6.      One year (12 months) for congenital conditions

7.      One year (12 months) for maternity, first emergency C/S and maternity related conditions.

8.      None for accidents.

9.      Two years (24 months) for cancer treatment.

10.  One year (12 months) for removal of fibroids, uterus, adenoids, tonsils, lipomas and repair of hernias.

11.  One year (12 months) for optical laser treatment.

 

ELIGIBILITY

1.      Adults- 19 years and above.

2.      Children (38 weeks) full term and discharge from hospital to 18 years.

3.      Maximum joining age 60 years, existing members are covered for life.

4.      Eligible dependents include the spouse, own children and legally adopted children.

5.      Medical reports for new applicants over 57 years will be required.

 

EXCLUSIONS (WHAT IS NOT COVERED)

1.      Illness occurring within the waiting periods.

2.      Expenses incurred in connection with the venereal disease.

3.      Expenses incurred in relation to and or in connection with the ritual circumcision.

4.      Expenses incurred in relation to intentional self-injury, attempted suicide, domestic violence, deliberate exposure to exceptional danger and hazardous sports.

5.      Medical expenses incurred as a result of infertility, impotence or in the course of treatment to correct the cause of infertility, family planning and hormonal replacement therapy.

6.      Cosmetic treatment.

7.      Medical expenses incurred outside Madison insurance panel of service providers.

8.      Expenses as a result of act of terrorism and war.

9.      Expenses incurred where material information is withheld or misstated.

10.  Expenses incurred in connection with drunkenness, treatment of chronic alcoholism, intoxication, use of drugs not prescribed by a physician or drug addiction.

11.  Nutritional food supplements and weight management.

12.  Chiropractors, acupuncturists, and herbalists fee.

13.  Medical checkups.

14.  Private vaccines except KEPI recommended vaccine for children.

15.  Benefits not specified in the brochure or policy document.

16.  Out-patient ambulance services.

 



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