KENYA PRIVATE HEALTH INSURANCE - OUTPATIENT OPTIONS

Outpatient cover in Kenya refers to treatment given at a hospital, consulting room, doctors’ office or out-patient clinic where you do not go in for in-patient treatment or day-case treatment.

This includes cover for treatment received in a casualty ward or emergency room, following an accident or sudden illness. To be considered an emergency, the treatment must be received within 24 hours of the emergency event. If you are covered for this benefit, it will be indicated in your Table of Benefits along with the benefit limit.

This is treatment which does not normally require a patient to occupy a hospital bed. The list below details the benefits payable for out-patient treatment only. If you are having treatment and you are not sure which benefit applies, please call us and we will be happy to help.

Our Medical Provider directory is available on the website.

This online directory allows you to search for hospitals, clinics, doctors and specialists on a county to county basis, with the ability to narrow down the search to specific regions.

OUTPATIENT LIMITS
KES 200,000.00 KES 100,000.00 KES 75,000.00 KES 50,000.00 KES 30,000.00
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Co - Payment No co-payment at high cost providers No co-payment at high cost providers

No co-payment at high cost providers

No co-payment at high cost providers

No co-payment at high cost providers

Consultation fee limit No Consultation limit No Consultation limit No Consultation limit No Consultation limit

No Consultation limit

Outpatient consultations Covered Covered Covered Covered Covered
Diagnostic examinations Covered Covered Covered Covered Covered
Injections and procedures performed at a primary care level in a doctor’s consultation room Covered Covered Covered Covered Covered
Prescribed medicines Covered Covered Covered Covered Covered
X-rays ,pathology, scans and MRI Covered Covered Covered Covered Covered
ECG exams Covered Covered Covered Covered Covered
Pre, post and antenatal care Covered under Maternity Cover Covered under Maternity Cover Covered under Maternity Cover Covered under Maternity Cover Covered under Maternity Cover
Minor trauma treatment Covered Covered Covered Covered Covered
KEPI Vacination Covered Covered Covered Covered Covered
Routine medical check-up for Employee & Spouse Covered Covered Covered Covered Covered