What is the SME Health Cover?
The SME Health Cover is designed to meet the Health Insurance needs of SMEs by catering for medical expenses incurred by the insured members and their dependents for either inpatient or outpatient cases. It also caters for maternity, dental and optical expenses.
- Flexibility of Cover - Various Plans are available to choose from and combine under this cover
- Personal Accident Cover - This covers loss of life and permanent disablement of the insured due to an accident
- No waiting periods - Get treated sooner by going to a private hospital
- Hospital Cash- Get cash payments for stays in the hospital for 5 or more days
- Volume Discounts- Bigger groups will enjoy discounts on their premiums
- Flexibility on No. of employees - The cover can cater for as little as three employees to a maximum of 100
- Critical illness cover options - Members can now opt to purchase a critical illness cover with a cash pay-out of KES 750,000 for specific newly diagnosed critical illnesses. These illnesses are cancer, stroke, heart attack, renal/kidney failure, and paralysis.
To apply for this cover you will have to sit down with a Business Development Officer who will run a quotation in relation to the sum assured by the client. The proposer will then complete the application form and provide all required documents. After this, the BD Officer will kickstart the process.
Here you'll find useful tools and documents to help you get started and apply for our family cover.
- Duly filled scheme application form by the scheme contact person or sponsor, signed and stamped
- Duly filled and signed application form by each employee
- Certificate of incorporation and KRA PIN Certificate for the group
- Letter of appointment of the insurance agent or broker if any
- List of members covered and dependents (where applicable) and relevant details. All employees or members of the organization must enroll
- Proof of premium payment and the quotation. The cover will only commence after premiums payment
- Pre-existing chronic conditions, psychiatry, congenital, cancer, and HIV/AIDS including related conditions
- Overseas inpatient referrals, including catering for airfare to listed hospitals abroad (India) on credit
- Post hospitalization benefit
- Home nursing
- External aids
- Funeral expense for each person covered
- Expenses where material information is withheld or misstated
- Infertility treatment
- Cosmetic surgery unless caused by accident
- Weight management treatments and drugs
- Participation in professional & hazardous sports e.g. bungee jumping, paragliding
- Treatment other than by registered medical practitioner
- Self-referred or self-prescribed treatment
- Drugs dispensed by the treating doctor
- Nutritional supplements unless prescribed as part of medical treatment
- Alternative treatment - Chiropractors, Acupuncturist, Herbalist
- Drunkenness, drug addiction, intentional self-injury
- >Expenses incurred in connection with participation in Riot, Strike, and Civil commotion
- Naval, Military, or Air force operations
- Expenses recoverable under any other insurance e.g. NHIF, GPA, WIBA
- Beauty treatment in nature cure clinics or health hydro’s
- Diagnostic equipment (e.g. Glucometers, BP machines)
- Experimental treatment
- Contamination by radioactivity from nuclear fuel, waste, or fission
- Benefits not purchased or not indicated in the brochure
- Cover ceases at the age of 65 years
- Waiting period: 28 days waiting period for newly diagnosed chronic illnesses
- For the family cover, only one claim is paid in a single cover year
- Babies are covered from birth from 38 weeks, excluding congenital conditions
General exclusions are as follows:
*Refer to the policy document for detailed exclusions