Worried about the spread of Corona Virus in Kenya? Buy Medical Scheme Cover for yourself and family now View Plans
 
Boma Afya
Cover yourself and your family
  • Family cover of principal and 5 dependents(M + 5)
  • Covers One(1) legal spouse and up to four(4) dependent children
  • No waiting period for all outpatient claims
  • No waiting period for optical and dental services
 
Wote Afya
Cover your family and friends
  • Cover upto 10 dependents(M + 10)
  • All dependents whether biological or not are eligible for the scheme
  • No waiting period for all outpatient claims
  • No waiting period for optical and dental services

*These medical covers are capitated by Medicross Limited

500+
Cashless Network Hospitals
2000+
Lives covered
Realtime claims processing
and approval
Telemedicine, Chronic Disease Management and Care at home
services
Free Annual
Health Check-ups
24x7 Claims
customer Support

WE PAY CLAIMS: The medical scheme cover capitator(Medicross Limited) has been catering to diversified customer needs by offering healthcare services to Kenyans for the last 5 years.

Buying a medical scheme cover online helps in keeping your health records confidential as you don’t have to disclose the same to someone in person. Also, you can fill all the details and medical history information, which leaves no room for errors.

  • Get your policy with minimum documentation in 24 hours
  • Pay your premium through multiple secured payment modes
  • In-house claim assistance and customer support, always eager to help you
  • Utmost transparency when it comes to handling claim queries and settling claims

Inpatient Benefits

  • Hospital Accommodation Charges Bed entitlement, Standard ward bed net of NHIF rebates per day
  • Doctor’s (Physician, Surgeon & Anesthetist) Fee.
  • ICU/HDU and theatre Charges
  • Drugs/Medicines, dressings and internal Surgical appliance
  • Pathology, X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans
  • Radiotherapy and Chemotherapy
  • Day care Surgery for minor surgical treatment/procedure that may not require admission
  • In-Patient Physiotherapy, Hydrotherapy, Occupational therapy
  • Hospital accommodation for accompanying parent and /or guardian for hospitalized children below seven (7) years
  • Emergency Road within Kenya leading to admission
  • Congenital defects/genetic disorders
  • Post- Hospitalization benefit of up to two (2) weeks for other sicknesses and six (6) weeks for accident cases after discharge.
  • Renal dialysis

Outpatient Benefits

  • Routine outpatient consultations
  • Diagnostic Laboratory and Radiology services (X- ray, ultrasound, MRI and CT Scans)
  • Prescribed physiotherapy
  • Prescribed drugs and dressing
  • Prescribed laboratory tests
  • Referral OPD
  • HIV/AIDS related conditions and prescribed ARV’s within the outpatient cover limit per annum.
  • Newly diagnosed chronic conditions & Pre-existing chronic conditions (including cancer)
  • Pap smear for ladies and PSA for men- over the age of 40 years
  • Ambulance Services
  • Rehabilitation service as per limits

Exclusions

NB: Chronic Diseases to be covered include but not limited to:- Cancers, Hypertension, Asthma, Diabetes, Peptic Ulcer Diseases, Arthritis, Cardiac failure, Epilepsy, Chronic renal disease, Schizophrenia, Bronchiectasis , Chronic obstructive pulmonary disorder, Thyroid disease, Systemic lupus erythematous and Hyperlipidemia.

  • Active participation in war, invasion, riots or terrorism
  • Cosmetic treatment unless relating to an accident
  • Massage (except where certified as medically necessary)
  • Nutritional supplements unless prescribed by a doctor as part of treatment of a deficiency
  • Maternity cover for dependent children
  • Self-prescribed drugs
  • Treatment other than by a registered medical practitioner
  • No reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases and on pre authorization
  • Private vaccines and travel vaccines
  • Alcohol related rehabilitation

Maternity

  • Routine Antenatal check-up
  • Delivery/ Doctors Fees
  • Postnatal care up to six (6) weeks post-delivery
  • Routine Immunizations (KEPI) and Baby Friendly Vaccines
  • 1st emergency caesarean section in the lifetime of the mother
  • Pre-maturity
  • Congenital conditions

Q. How do I sign up for Healthier Kenya and what are the requirements?

A. Visit our website or simply Click Here to sign up for any of our medical covers. Whenever you are signing up, you will be asked to provide the following documents;

    Requirements

  • Duly filled form from our website
  • Copy of ID for adults
  • Birth certificates, birth notification or legal adoption papers for minors
  • Copy of KRA Certificate
  • Copy of passport photos for each applicant
  • Medical reports for Principal and Dependents

Q. When does my cover start?

A.Your cover will start once Healthier Kenya provides you with a formal email and the premium is fully paid and receipted. You will get a confirmation email within 3 working days if the application is done correctly.

How often should I make my premium contributions?

You can conveniently make your Healthier Kenya payments annually or on instalments. Premium financing is available to eligible members subject to our terms and conditions..

Q. How can I pay my premiums?

Make your payments directly to Healthier Kenya by using MPESA .

How will you make an M-PESA payment?

On the last step of our buy medical cover tab, you shall be automatically prompted to pay your premiums in the following steps:

    Steps

  1. A confirmation window will appear indicating the amount of the Medical Cover and MPESA payment option. You will proceed by clicking “Send Request”
  2. You will get a push notification to your phone requesting for input of the M-PESA PIN to complete the transaction
  3. Upon confirmation, funds will be deducted from your M-PESA account and transaction will be completed
  4. An E-receipt shall be sent to your email with confirmation details of your purchase

Q. What am I covered for?

A. You will be covered based on the benefit options purchased and as outlined in the acceptance letter and policy document..

Q. What are the vaccines covered under Healthier Kenya Medical cover?

We only cover KEPI (Kenya Expanded Programme on Immunization) regime vaccines under Healthier Kenya (private and travel vaccines are not covered.)

Q. Which hospitals can I go to?

A. A list of providers and specialists will be provided in your membership pack. The same can be accessed on the Healthier Kenya website. You can also call our offices directly on 0719091000 for further assistance. Always carry your Healthier Kenya e-medical card and your national ID/passport for identification and verification..

Can I add a member mid cover?

No. To cover a new member, you will need to purchase a new policy. You can get more information from our website:- Click here for more information

Q. What is the procedure of enrolling a new born child?

A. Simply enroll all your dependents through our Healthier Kenya portal. To cover a new member, you will need to purchase a new policy. You can get more information from our website Follow this link

Q. Are there Healthier Kenya products that don’t require a waiting period?

A.Yes. You do not require a waiting period for the following services:

  • Outpatient
  • Optical Services
  • Dental Services

What is the waiting period for Healthier Kenya Products?

    1 month

  • Surgical cases except accidental injuries incurred within the period of cover
  • 3 months

  • Pre-existing conditions, chronic, congenital, HIV/AIDs related conditions, Gynecological surgeries and internal /external implants.
  • Cancer Inpatient treatment
  • Dialysis Inpatient treatment
  • Organ transplant
  • 6 months

  • maternity and related conditions

Q. Who can I speak to in the event I need any assistance, information, clarification or guidance?

A. You can get in touch with our 24/7 call center for any assistance - at this number shown below: +254 719091000.

Q. Will I pay full premium when I add a member mid cover?

A. Yes, you will need to pay the full amount to the following account MPESA payment to Medicross through Paybill Number 7325737 - MEDICROSS LIMITED – HK.

Q. Does your cover have exclusions?

A. Yes. Healthier Kenya shall not be liable for payments in respect of:

  • Active participation in war, invasion, riots or terrorism
  • Cosmetic treatment unless relating to an accident
  • Active participation in war, invasion, riots or terrorism
  • Cosmetic treatment unless relating to an accident
  • Massage (except where certified as medically necessary)
  • Nutritional supplements unless prescribed by a doctor as part of treatment of a deficiency
  • Maternity cover for dependent children
  • Self-prescribed drugs
  • Treatment other than by a registered medical practitioner
  • Reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases and on pre authorization
  • Private vaccines and travel vaccines
  • Alcohol related rehabilitation

Q. How do I submit a life cover claim?

A. A claim occurs when a maturity, part maturity, cashback or death benefit is due. To submit a claim, the policy owner or beneficiary is required to visit any of our offices with the Original Contract Document, ID/Passport and Proof of Banking details (An ATM Card, A Certified Bank Statement or a Cancelled Cheque)

Q. How long does a life cover claim take?

A claim takes at most five working days once the beneficiary provides all necessary documents..

How can I change or update the contact details of my beneficiaries?

You can simply manage and update all your dependents and beneficiary details through our Healthier Kenya portal.

Who can I speak to in the event I need any assistance, information, clarification or guidance?

You can get in touch with our 24/7 call center for assistance through.

  • Phone: +254 719 091 000
  • Chat: Through our website chatbot Tumaini
  • Social Media:(healthierke on Facebook, Twitter, Instagram and LinkedIn)
  • Email: support@healthierkenya.co.ke