Medical Insurance

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Benefits offered under Medical Insurance

Main Benefit

A fully insured In-patient scheme.

Optional Riders

  • A fully insured out patient scheme
  • A fully insured Dental and optical cover
  • A fully insured Maternity Cover
  • Last/Funeral expense cover
  • Excess of Loss Cover

Enhanced benefits

  • Cover for Pre-existing and chronic conditions
  • Opportunistic infections of HIV conditions

Other benefits offered at a fee

  • Fund management / Scheme administration only
  • HIV management programme / administration only.

Structure of Cover

Cover can be either on a:

  • Per Family /shared limit. The family shares the cover on a first come first to claim basis until the limit is exhausted.
  • Per person basis. Each member has own limit.

Scheme Membership:

  • All Permanent Employees.
  • One Legal Spouse per principle member.
  • Own or legally adopted child from 0 months (a term baby) to 18 years (or 23 Years for a child who is a fulltime school or college students).

Scope of Cover

Coverage for Hospitalization (Inpatient Cover)

Inpatient cover provides for medically necessary hospital bed charges, doctor’s bills, anesthetist’s bills, operating theatre fees, ICU expenses, day surgery,physiotheraphy pharmacy, laboratory and investigations reasonably incurred by an insured member. Local road and air evacuation is also included. This cover will be on credit facility with our providers.

Outpatient

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.

Dental

This provides for:

  • Cost of fillings
  • X-rays.
  • Extractions including surgical extraction together with anaesthetics fees

Optical

This provides for:

  • The cost of eyeglasses and eye testing.

Maternity

This benefit shall cover

  • Delivery fees, consultation and treatment for both mother and child only during the period of confinement in hospital.
  • Costs for miscarriages and abortions may be covered, provided they are certified by a gynaecologist as being necessary to save the life of the mother.
  • This benefit is only available to staff/ legal spouse

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