OUT PATIENT BENEFITS
1. Consultation with a general practitioner and specialist
2. Diagnostic examinations
3. Prescription medicines
4. Outpatient procedures e.g
5. Immunizations and vaccinations for children (KEPI
6. Minor trauma treatment
7. Gynecological treatment
8. Declared pre-existing, chronic, non-chronic and HIV/AIDS
conditions (covered after one year)
9. Newly diagnosed chronic conditions (covered after six
10. Congenital conditions are treated after 12 months of cover
for insureds children.
11. Psychiatric illness treatment after one year.
OUT PATIENT MANAGEMENT
1. Co-payment of KES. 500 shall be applicable for
outpatients visits to: The Aga Khan University Hospital, Nairobi Hospital,
Karen Hospital and Gertrudes Garden Childrens Hospital.
2. Co-pay of KES. 200 shall be applicable in outpatients
visits to all other service providers.
3. The out-patient cover excludes all dental and optical
treatment and private vaccines.
4. Members should sign all outpatient bills before leaving
1. 21 days for outpatient illness
2. 90 days for surgical cases
3. One year (12 months) for maternity
4. One year for pre-existing, chronic and psychiatric
5. One year (12 months) for congenital conditions
6. One year (12 months) for maternity, first emergency C/S
and maternity related conditions.
7. None for accidents
8. Two years (24 months) for cancer treatment.
9. One year (12 months) for removal of fibroids, uterus,
adenoids, tonsils, lipomas and repair of hernias.
10. One year (12 months) for optical laser treatment.
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
4. Eligible dependents include the spouse, own children and
legally adopted children.
5. Medical reports for new applicants over 57 years will be
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
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
15. Benefits not specified in the brochure or policy
16. Out-patient ambulance services.