How to know what your health cover includes

QuestionsHow to know what your health cover includes
howandwhere Staff asked 2 years ago

These are some of the services you might want to check with your cover provider whether they are included in your particular cover.

General Out-patient Services: Outpatient services provided by or on the order of a clinician/ physician who is licensed as a general practitioner.

Specialized Out-patient Services: Outpatient services provided by or on the order of a physician who is licensed as a specialist or consultant and to whom a Member has been referred to by a general practitioner/Primary Care clinician where a member was registered.

  • Routine outpatient services as per the Kenya essential package for health subject to policy terms and conditions.

Specialised referrals

  • ┬áDrug and Substance Abuse Rehabilitation Services
  • Renal services and dialysis
  • Specialized radiological diagnostic services
  • Chronic ailment services such Diabetes and Hypertension, Ultrasound, ECG,

Cancer medical care and treatment services which includes

  • radiotherapy services
  • chemotherapy services
  • surgical intervention subject to preauthorization by the fund

Dental Cover

This benefit caters for outpatient dental procedures, which include

  • Extraction,
  • Root canal,
  • Dental X-ray Services
  • Accident related inpatient Dental cases

Optical Cover An optional benefit that caters for expenses related to eye treatment,

  • Consultation
  • Eye testing
  • Prescription for ophthalmic treatment
  • prescription of eyeglasses
  • Accident related inpatient optical cases


Inpatient shall be on a referral basis from the selected outpatient Health Care Provider. This cover includes medical and surgical conditions which require admission. It includes the following:

  • Hospital accommodation charges
  • Pre-hospitalization diagnostic services
  • Doctor’s (physician, surgeon & anaesthetist) fees.
  • Nursing charges
  • Drugs/medicines, dressings and internal surgical appliances.
  • Diagnostic, laboratory or other medically necessary services
  • Rehabilitation services
  • Operating theatre services
  • Radiological diagnostic e.g. x-ray services, CT scan, MRI,ECG
  • In-patient physiotherapy.
  • Daycare surgery surgical procedures that do not require an overnight stay.
  • Emergency Road Rescue Ambulance services for transportation and transfer of a sick member for treatment from a place of incident or facilities where adequate care is not available to the next available NHIF accredited hospital or medical facility within the territorial limits of Kenya.
  • Emergency Air Rescue Emergency Air Rescue Services will be provided for transportation and transfer of an injured member to an NHIF accredited facility within the territorial limits of Kenya where adequate medical care is available.
  • Overseas Treatment Treatment costs arising from a condition that warrants treatment overseas because the treatment is not available in Kenya will be covered subject to preauthorization from NHIF. Group Life Group personal accident cover and last expenses
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