Health Insurance

Health

Health Insurance is one of the basic insurance any family must have to be able to plan its finances. Medical bills can disrupt your finances and even get you into serious debts. Therefore it is necessary to have a medical cover to protect your family and as a great tool for financial planning

Medical Cover protects policy holders and their dependents against the risk of incurring medical expenses as a result of accidents or sickness.

The policy is divided into two main categories:

  • In-patient cover - This is termed as treatment to a patient who is admitted to a hospital for treatment and requires at least one overnight stay.
  • Outpatient cover - Treatment to a patient who attends a hospital or clinic for treatment without staying there overnight.

What is covered under inpatient?

When getting health insurance in Kenya, it’s not only about going for the cheapest medical plan in the market, it is important to clearly understand what benefits can be provided on the medical plan: Here is the most common sections of a standard cover.

Bed

Hospital accommodation charges are covered net of the NHIF rebate per day. This also depends on what your cover bed entitlement is i.e. Ensuite, standard private or general ward bed.

Congenital

Congenital is a state prevailing at or before birth regardless of cause. It is capped up to a particular limit depending on the inpatient limit you have taken. However it has a waiting period of one year or more depending on the Kenyan medical insurance company that offers your policy.

Post Hospitalization

This is the period when one has been declared fit to go home but a he or she needs to undergo tests to monitor recuperation. Medical Insurance covers up to 60 days from discharge. Coverage limits depends on the package one has.

Medical Tests

In medication process practitioners recommend various tests. Insurance cover extends coverage to these services but the laboratory must be in the approved panel of providers.

Professional fees e.g. specialists

These are the various consultation fee paid to specialists e.g Cardiologists, Gynecologists etc. They are covered fully depending on the coverage limit.

What is covered under outpatient?

These are various medical procedures or tests that can be done in a medical Centre without an overnight stay;.

  • Outpatient consultations
  • X-rays, laboratory, scans and MRI
  • Laboratory
  • Antenatal & Postnatal care
  • Diagnostic examinations
  • Well baby check-ups inclusive of KEPI Immunization Programme at our selected well baby clinics only.
  • Injections and procedures performed at a primary care level in a doctor’s consultation room
  • Prescribed medicines
  • Minor trauma treatment
  • HIV services
  • Adherence and nutritional counselling
  • Follow-up every 3months
  • Prevention of mother to child Transmission (PMTCT)
  • ARV’s and Monitoring
  • Opportunistic infections

What about optical & dental cover?

The Optical Plan extends to covers the following services;

  • Routine optical consultations
  • Prescribed lenses and replacement of lenses
  • Optical Prescriptions
  • Prescription of frames

    • The Dental Plan extends to cover the following services;

  • Consultation
  • Crowning
  • Bridging
  • Braces
  • Extractions
  • Fillings (except precious metals)
  • Scaling
  • Dental X-Rays
  • Dental Prescriptions

    • Maternity cover – in built or an extra add-on to the policy?

    This covers is one of the extended health benefits in medical cover. It normally has a waiting period of 9 months. It covers

  • Inpatient cost incurred for normal and caesarean deliveries
  • Labor and recovery wards
  • Professional fees
  • Pregnancy & Maternity related hospitalization
  • Other related ailments and complications including ectopic pregnancies and miscarriages.
  • Home deliveries


    • What you need to know About Health insurance

  • The choice of health insurance is a vital decision because it influences the quality of care received while hospitalized. In Ryma before picking a preferred medical cover, we first help you understand what benefits a cover gives and we compare several before we settle on one.
  • There are waiting periods on most medical policies and they vary with different health insurance companies. This is an initial period of membership during which no benefit is payable for a certain procedure or service.
  • The majority of medical insurance companies in Kenya have opted to partner with hospitals, clinics and specialist providers in and outside the country for their clients.
  • Health insurance is now available to senior citizens up to 80 years of age.
  • Many insurance healthcare providers now include pre-existing conditions and terminal illnesses up to a certain Limit varying from different insurances.
  • We have some health cover options offering oversees treatment and transfers.
  • Maternity cover is offered but has a waiting period of 9 months. It is one of the extended health benefits along with dental, optical and funeral expenses coverage.

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