Co-op Medicare

Having a pre-existing condition should not prevent you from getting a medical cover!


Co-op MediCare is plan is designed to suit your health needs. It takes care of the expensive medical treatments incurred for both inpatient and outpatient.

Your health is precious to you- it enable you live a happier life. With MediCare, you do not have to worry about not having enough money for treatment in case you fall sick.


Co-op MediCare is suitable for individuals, families, groups and oranizations.

Waiting periods
  1. 120 days for non-accidental surgery, Gynecological and ENT surgery
  2. 6 months for disclosed pre-existing, chronic, congenital and HIV/AIDS & related conditions
  3. 12 months waiting period for cancer
  4. Newly diagnosed chronic ailments are not subject to the waiting period but the amount payable is limited to the sublimit for pre-existing & chronic ailments.
  5. 12 months for maternity and 1st Ever Emergency claims
  6. All illnesses (inpatient and outpatient) are subject to 30 days waiting period
In and Out patient bundles
COVER TYPE IN PATIENT OUT PATIENT
LILAC 200,000/= 20,000/=
BLOSSOM 400,000/= 25,000/=
JASMINE 600,000/= 30,000/=
ORCHID 800,000/= 40,000/=
DAISY 1,000,000/= 50,000/=
LILY 2,000,000/= 70,000/=
TULIP 3,000,000/= 80,000/=
JACARANDA 5,000,000/= 120,000/=
Exclusions
  1. Self referred or self prescribed treatment
  2. Family planning, infertility & impotence
  3. Intentional self- injury, chronic drunkenness, suicide or attempted suicide, drug and substance abuse, hazardous pursuits(sports and hobbies)
  4. Cosmetic and beauty treatment (unless necessitated by accidental injury)
  5. Outpatient ambulance services
  6. Experimental treatment or treatment subject to medical research
  7. Weight management treatment and drugs
  8. Diagnostic equipment(glucometers, BP Machines etc and hearing aids
  9. General medical checkups not incidental to diagnosis of an illness or Injury
  10. External surgical appliances(crutches and wheelchairs and prosthesis
  11. Dental prosthesis, crowns, dentures, bridges and braces
  12. Alternative medicine ( acupuncture, chiropractor, herbal medicine).
  13. Treatment outside the appointed panel of service providers
  14. Nutritional supplements unless prescribed as part of medical treatment of specified conditions
  15. Adult vaccinations and private vaccines for children.
  16. Costs of donor and related cost transplant for organ transplant
  17. Optical services including eg eye glasses/lenses/frames, eye testing, transplants/grafts and laser surgery
Conditions
  1. Waiting period is not applicable for accidental cases or persons transferring from another Medical Insurance Policy
  2. Outpatient treatment can only be purchased at the inception/renewal of the policy and not during the term of the policy
  3. Members not subjected to medicals tests on joining.
  4. No cash deposit required and no contribution to the bill by the customer.
  5. Extensive service provider/Hospital network
Outpatient procedures
  1. Present your membership smart card at the service provider’s (doctor, clinic or hospital) facility’s desk for identification.
  2. Your membership will be checked and confirmed using your smartcard and fingerprints.
  3. Complete and sign the claim form which will be made available at the service provider’s facility. The attending physician/specialist must also complete and sign the claim form. A claim form must be completed for each episode of treatment and for each person.
  4. All bills will be sent by the service provider directly.
Benefits
  1. Pays for hospitalization medical expenses
  2. Provides supplementary benefits within the main covers which includes Pre-existing conditions, Chronic conditions, HIV/AIDS, Maternity, Inpatient Dental & Ophthalmology(eye disease)
  3. Funeral expenses cover.
  4. Enables valid members to obtain quality Healthcare from private providers
  5. Available to customers/employees and their immediate dependents
  6. Access to 24 hour medical treatment
  7. No cash deposit
  8. No contribution to the bill by the customers
  9. Various options available
  10. Wide scope of cover
  11. Dependent children can be covered on their own, provided the parent proves that they are covered elsewhere e.g. by an employer and the children are not included.
  12. Mixing of both inpatient and outpatient options.
Afya

Rest your medical worries on our shoulders

Afya plan ensures that your health is of primary importance.

This cover provides protection from significant medical expensed through its extensive network of healthcare professionals and service providers.

This cover is suitable for individuals, families, groups and organizations.

Waiting periods
  1. The cover has 30 days waiting period for all claims (including outpatient), except accidents and medical emergencies.
  2. 12 months for maternity and related conditions.
  3. 90 days for Chronic and pre-existing conditions
  4. 90 days for HIV/AIDS related complications claims.
  5. Minimum joining age is 30 days for children.
In and Out patient bundles
COVER TYPE IN PATIENT OUT PATIENT
Tier 1 100,000/= 15,000/=
Tier 2 200,000/= 25,000/=
Tier 3 300,000/= 30,000/=
Exclusions
  1. Self referred or self prescribed treatment
  2. Family planning, infertility & impotence
  3. Intentional self- injury, chronic drunkenness, suicide or attempted suicide, drug and substance abuse, hazardous pursuits(sports and hobbies)
  4. Cosmetic and beauty treatment (unless necessitated by accidental injury)
  5. Outpatient ambulance services
  6. Experimental treatment or treatment subject to medical research
  7. Weight management treatment and drugs
  8. Diagnostic equipment(glucometers, BP Machines etc and hearing aids
  9. General medical checkups not incidental to diagnosis of an illness or Injury
  10. External surgical appliances(crutches and wheelchairs and prosthesis
  11. Dental prosthesis, crowns, dentures, bridges and braces
  12. Alternative medicine ( acupuncture, chiropractor, herbal medicine).
  13. Treatment outside the appointed panel of service providers
  14. Nutritional supplements unless prescribed as part of medical treatment of specified conditions
  15. Adult vaccinations and private vaccines for children.
  16. Costs of donor and related cost transplant for organ transplant
  17. Optical services including eg eye glasses/lenses/frames, eye testing, transplants/grafts and laser surgery
Conditions
  1. Waiting period is not applicable for accidental cases or persons transferring from another Medical Insurance Policy
  2. Outpatient treatment can only be purchased at the inception/renewal of the policy and not during the term of the policy
  3. Members not subjected to medicals tests on joining.
  4. No cash deposit required and no contribution to the bill by the customer.
  5. Extensive service provider/Hospital network
Enrollment requirements
  • ID of principle member
  • ID of spouse
  • ID of children above 18 years with school ID/admission letter for those above 21 years
  • Birth certificate/notification for any other dependent
  • Minimum joining age for children is at birth and maximum limit is 70 years. An applicant who has attained 70 years will exit at age 80 years
  • Children over 21 years are covered up to 25 years with proof of schooling.
  • Premiums are based on the age of the applicant
  • For any additional child over the family size of 8 an additional premium of Kshs 2,500 Kshs.2,000 and 1,500 respectively
  • Children over 21 years are covered up to 25 years with proof of schooling.
  • Premiums are based on the age of the applicant
  • For any additional child over the family size of 8 an additional premium of Kshs 2,500 Kshs.2,000 and 1,500 respectively
Benefits
  1. Pre-existing, chronic conditions and cancers, on full disclosure at the time of joining and subject to 90 days waiting period will be covered but limited to 50% of the impatient limit.
  2. Newly diagnosed chronic conditions will be covered in full within the impatient benefit.
  3. HIV/AIDS conditions will be covered 50% of the inpatient limit subject to a waiting period of 90 days.
  4. Maternity and pregnancy related conditions, normal delivery – KSh 10,000. Subject to a 12 months waiting period.
  5. Caesarean section between Kshs 30,000 and 20,000 subject to a 12 months waiting period
  6. Day care surgery(subject to specific pre-authorization)
  7. Inpatient non accidental dental and optical cover of between Kshs. 50,000 to Kshs.15,000 per family depending on the option chosen.
  8. Annual pap smear & prostrate test for the couple
  9. Accidental death of the principle member & spouse with a limit of between Kshs 300,000 & kshs.100,000
  10. Accidental permanent disability of the principal member & spouse with a limit of between Kshs. 300,000 & kshs.100,000
  11. Last expense cover per family with a limit of kshs 50,000, 30,000 or 15,000 (the last expense cover is payable on the first death of any of the declared nuclear family members).
  12. 24 hour emergency/help line.