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KPSA

KPSA Medical Cover

This is a tailor made medical package that provides heath solutions to the Kenya Private Schools Staff. It offers the option of:

  • In-patient Benefit
  • Out-patient Benefit
  • Dental Cover

Inpatient Cover (Primary Cover)


Scope of Cover

  • Hospitalization costs net of NHIF rebate
  • Bed charges - inclusive of ICU & HDU charges, operating theatre cost
  • Doctor’s fee and Surgeon/Anaesthetist fee
  • Diagnostic Procedures, Dressings, Pathology, X-ray, MRI Scans
  • Inpatient day case procedures
  • Inpatient Physiotherapy, Radiotherapy and Chemotherapy
  • Cover for treatment abroad if treatment unavailable locally
  • Emergency Road and Air Evacuation covered up to overall limit
  • Declared and Newly diagnosed Pre-existing, Chronic and HIV/AIDS conditions covered up to Kshs 300,000/= within the inpatient limit on full disclosure at the time of joining subject to one year waiting period.
  • Congenital conditions covered up to Kshs 100,000within sub limit of pre-existing, chronic and HIV/AIDS
  • Post hospitalization treatment of Kshs 50,000/= within the inpatient limit up to a maximum of 3 weeks after discharge.
  • First Emergency caesarian section covered up to Kshs 150,000/= within the inpatient limit.
  • Inpatient non-accidental dental cover of Kshs 50,000/= per family per annum within the inpatient limit
  • Inpatient non-accidental optical cover of Kshs 75,000/= per family per annum within the inpatient limit
  • Lodger fee for a parent guardian accompanying below 8 years to hospital will be covered
  • Bed limit Entitlement is a general ward bed for limits below 2 Million an Standard Private room for limits of 2 Million and above.

Outpatient Cover


Scope of Cover

  • Doctors Consultations Fee and specialist’s fees
  • Covers Surgeons, Physicians and anaesthetists fees, operating theatre charges
  • Covers Dispenses drugs & dressings
  • Covers Diagnostic Procedures; -x-rays, ECG, encephalogram, audiogram, radiotherapy & chemotherapy
  • Day care Procedures under local anaesthesia
  • Consultation fees for general practitioner Pre-existing, Chronic conditions and HIV/Aids covered up to full Outpatient benefit
  • Free Outpatient dental cover of Ksh 20,000/= per family per annum
  • KEPI recommended vaccines Only

Inpatient Premium - below 65 years

OPTION LIMIT

A

5,000,000

B

2,000,000

C

1,000,000

BED ENTITLEMENT

SPR up to a maximum of Kshs. 10,000/= per day

SPR up to a maximum of Kshs. 10,000/= per day

General Ward

Bed

M

29,030

26,469

21,346

M+1

39,916

36,395

29,351

M+2

52,889

48,222

38,888

M+3

65,726

61,484

49,583

M+4

82,606

75,318

60,739

M+5

101,192

92,264

74,406


OPTION LIMIT

       D

       750,000

     E

     500,000

   F

    300,000

BED ENTITLEMENT

General Ward

Bed

General Ward

Bed

General Ward

Bed

M

17,077

15,198

13,490

M+1

23,480

20,898

18,550

M+2

31,112

27,690

24,578

M+3

39,667

35,304

31,337

M+4

48,591

43,246

38,388

M+5

59,525

52,978

47,025

Inpatient Premium - 65-75 years

OPTION LIMIT

A

5,000,000

B

2,000,000

C

1,000,000

BED ENTITLEMENT

SPR up to a maximum of Kshs. 10,000/= per day

SPR up to a maximum of Kshs. 10,000/= per day

General Ward

Bed

M

34,153

31,140

25,113

M+1

46,960

42,818

34,531

M+2

62,223

56,732

45,751

M+3

77,324

72,334

58,333

M+4

97,183

88,609

71,458

M+5

119,049

108,546

87,536

 

OPTION LIMIT

D

750,000

E

500,000

F

300,000

BED ENTITLEMENT

General Ward

Bed

General Ward

Bed

General Ward

Bed

M

20,090

17,880

15,871

M+1

27,624

24,586

21,824

M+2

36,602

32,576

28,916

M+3

46,667

41,534

36,867

M+4

57,166

50,878

45,162

M+5

70,030

62,327

55,324

Outpatient Premium - below 65 years

OPTION LIMIT

A

150,000

B

100,000

C

80,000

D

50,000

M

39,276

31,592

28,176

23,053

M+1

52,041

41,859

37,333

30,546

M+2

66,352

53,370

47,600

38,946

M+3

81,281

65,378

58,310

47,708

M+4

96,318

77,473

69,098


Inpatient Premium - 65-75 years

OPTION LIMIT

A

150,000

B

100,000

C

80,000

D

50,000

M

46,207

37,167

33,149

27,122

  M+1

61,224

49,246

43,922

35,936

 M+2

78,061

62,788

56,000

45,818

 M+3       95,625      76,915      68,600 
M+4      113,315       91,145  

Exclusions
  • Illness occurring within the waiting period
  • Ritual circumcision
  • Intentional self injury, attempted suicide, domestic violence Deliberate exposure to exceptional danger and hazardous sports
  • Treatment for Infertility , impotence or in the course of treatment to correct the cause of infertility, family planning and hormonal replacement therapy
  • Cosmetic treatment
  • Expenses as a result of acts of terrorism and war
  • Expenses incurred where material information is withheld or misstated
  • Private vaccines except KEPI recommended vaccines for
  • Children
  • Outpatient ambulance services
  • Drunkenness, treatment of chronic alcoholism, intoxication, use of drugs not prescribed by a physician or drug addiction
  • Nutritional food supplements and weight management Chiropractors, Acupuncturists and Herbalists’ fees
  • Medical checkups
Policy terms and conditions
  • Waiting periods: one year for all chronic conditions, ninety days for all surgical cases, and twenty one days for all outpatient and inpatient claims apart from cases arising out of accidents
  • The maximum joining age is 70 years, while the last renewal age will be 75 years.
  • A co-pay of Ksh 500/= in all outpatient consultations in category A hospitals i.e Agakhan Hospital, Nairobi Hospital, Gertrude's and Mater Hospitals respectively) and a copay of Kshs 200/= in all other hospitals will be applicable
  • A new members and existing one on renewal, will be required to provide proof that they are KPSA members.
  • Medical examination for members 60 years and above.

 

Emergence Lines:

  • 0723 972 489 
  • 0702 094 003
  • 0702 094 029