WHAT IS KPSA Medical Cover

Scope of Cover Inpatient Cover (Primary 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.

BENEFITS

Scope of Cover Outpatient 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

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