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Medical FAQ's

Which hospitals do you work with?

Do you explain the benefits to scheme members and how to access them in a brochure or pamphlet?

Can I use my personal doctors?

What advice do you give to those with medical challenges?

Do you refund inpatient premiums if I do not get admitted in hospital?

What happens to my limit if I do not claim; can it be carried forward to next medical year?

What happens when I lose my smart-card / photo-card?

Do you access the patient’s medical data and how confidentially are they handled?

Do you visit patients in hospital, and is the visit’s aim to control treatment?

Which hospital rooms are available for our members?

Do you cover chronic diseases and related conditions? What if a member joined the scheme already suffering from the chronic condition?

What is a pre-existing medical condition?

Do you cover HIV/AIDS and related conditions?

Do you cover maternity benefits?

Does the cover cater for use of ambulances?

Do you cover dental and optical benefits?

Do you cover funeral expenses and mortuary fees?

Do you cover overseas treatment?

Do you have any arrangements for treatment outside the country if a member desires to seek treatment out of Kenya?

Do you cover children over 18 years? Does that include adopted children?

Can I cover my brother, sister and parents who are my “dependents”?

Is there a waiting period before a member can get treatment?

If I spend my money on treatment, do you refund my expenses and what is the procedure?

How are the reimbursement claims paid, especially for small amounts, and how soon?

Do you cover herbal treatment?