Overview

Our flexible health insurance solutions help reduce the risk and unpredictability inherent in your organization’s cost of healthcare.
The core plan is a fully insured inpatient scheme with optional riders of outpatient, dental, optical, maternity, group excess of loss and last expense.

Eligibility; Registered Organization or entity/Chama’s/Sacco’s/Schools employees and their spouse aged between 18 years and 70 years.
Their children 0-19 years and dependent children till 25 years.

our corporate outpatient insurance package enables your employees to access the following out-patient services;

  • Outpatient consultations
  • Diagnostic examinations
  • Injections and procedures performed at a primary care level in a doctor’s consultation room
  • Prescribed medicines
  • X-rays, laboratory, scans and MRI
  • Antenatal & Postnatal care
  • Minor trauma treatment
  • Well baby check-ups inclusive of KEPI Immunization Programme at our selected well baby clinics only
    • Baby friendly vaccines as a benefit to the member's child
  • HIV services:
    1. Adherence and nutritional counselling
    2. Follow-up every 3 months
    3. Prevention of mother to child Transmission (PMTCT)
    4. ARV’s and Monitoring
    5. Opportunistic infections

Inpatient

Inpatient covers the following:

  • Hospitalization including surgeon, physician, ICU and HDU expenses
  • Day surgery
  • Accommodation costs for parent/guardian accompanying a child of 10 years and below
  • Pre-existing, chronic and HIV/AIDS
  • Congenital and prematurity conditions
  • Cancer treatment
  • Critical illness
  • Organ transplant
  • Gynaecological illness and surgery
  • Emergency Road and Air evacuation

Outpatient

Outpatient covers the following:

  • Routine outpatient care and treatment
  • Prescribed drugs including for pre-existing, chronic and HIV/AIDS
  • Wellness check-up
  • Baby vaccinations
  • X-rays,CT Scans and MRI’s Maternity This will cover
  • Routine antenatal and post natal screening (covered under outpatient)
  • Ultrasounds
  • Delivery and maternity related complications including prematurity

Dental

Dental covers the following:

  • Consultation
  • Extractions
  • Fillings and Root canals
  • Dental x-rays
  • Scaling and Polishing

Optical

Optical covers the following:

  • Lenses and frames
  • Contact Lenses

MEDICAL INSURANCE FAQs

1.What is health/medical insurance?

Health insurance is a type of coverage that can protect you from the full expense of regular health care, as well as the costs of medical and surgical procedures.
In exchange for paying a premium, your insurance company will cover the costs of your healthcare and certain types of medical procedures.

2.What does medical insurance cover?

Health insurance can cover a variety of things, from your regular check-ups and family care to your major medical expenses.
The types of services that are covered will vary with different healthcare providers and plan types, so it is important to determine your needs before buying a specific health insurance plan.

3.How does medical insurance work?

Health insurance can help you pay for your regular healthcare costs as well as your major medical expenses, depending on the type of plan you choose.
You will pay a premium of some kind, based on your plan and coverage, whether you get your health insurance through your employer or privately. Depending on your type of plan, you may have co-pays, deductibles and coinsurance.

4.Why Is Health Insurance So Important?

Health insurance helps you to manage the costs of your family's care, including regular doctor's visits and unexpected illnesses and injuries.
Just one serious illness, or an emergency procedure can have dire consequences for your financial portfolio if you aren’t insured properly.

Health insurance coverage may seem expensive, but if you compare your premiums to the cost of surgery and other medical procedures out of pocket, there’s no question that healthcare insurance premiums are far lower in cost. Also, having adequate health insurance can help you live a healthier, longer life. These policies cover preventive care, which helps you manage your health proactively, and covered routine testing can help with early detection of common conditions and diseases, such as diabetes, heart conditions, and thyroid problems, which can require much more extensive and costly care if they go untreated.

5.What does health insurance cost?

The cost of health insurance depends on several factors. Costs vary based on your plan type, your age, number of dependants.

6.How can you get medical insurance?

Contact CEMES insurance agency. We will assess your needs E.g. Are you prone to illness?
Do you play high impact sports? Or do you have a risky profession?
If you have children, the plan that is most beneficial to you may be different from the ideal plan for someone who is single with no kids.

Then, by comparing plans we can find an affordable healthcare plan that meets your needs.