Outpatient Cover Per Person
1. Consultation fees at appointed service providers.
2. Diagnostic laboratory and radiology services.
3. Prescribed Physiotherapy.
4. Prescribed drugs and dressing.
5. Outpatient cover for chronic conditions and HIV/ AIDS
subject to two years waiting period.
6. Outpatient prescription subject to a sublimit of Ksh.
50,000 per person per annum.
7. All outpatient claims are subject to Ksh. 1,000 copayments.
1. Illness claims incurred within the first 28 days of
2. Surgical claims incurred within the first 60 days of
3. Amounts recoverable from other insurances such as NHIF,
4. Expenses where material information is withheld or
5. Benefits not specified in the brochure and policy.
6. Treatment by any other than a certified medical
7. Expenses incurred in connection with active participation
in riots, civil unrest etc.
8. Self-inflicted injury and attempted suicide.
9. Medical costs due to experimental treatment.
10. Professional and hazardous sports activities.
11. Cosmetic Surgery.
12. Outpatient dental and optical claims.
14. Homeopathy, chiropractic treatment, acupuncture, herbal
medicine and treatment.
15. Experimental treatment.
16. Cosmetic surgery.
18. Medical bill incurred at a non-appointed facility.
19. Alcoholism, drug abuse and related ailments.
20. Treatment outside the approved and or recommended
21. Dialysis for management of a long term ailment.