The cover provides insurance in excess of NHIF for medical and surgical expenses reasonably incurred by the insured members within the period of insurance.

FEP Medicaid

fep

The cover provides insurance in excess of NHIF for medical and surgical expenses reasonably incurred by the insured members within the period of insurance.

We have pleasure in setting out below, a description of our proposal for the FEP Medicaid cover:

1. Eligible age

> Children – From birth (born full term at 38 weeks) to 18 years; up to 25 years subject to proof of full time learning

 > Principle member and spouse – up to 80 years

2. Geographical limit – Kenya but extended worldwide (excluding USA and Canada) up to eight weeks from the date of travel.

 3. Mode of identification – GA cards

4. Management by GA approved BUDGET panel of credit providers

5. Waiting period

 > 1 Month for illness related cases; none for accident- Not applicable for members being transferred from another insurer (at inception) 

> 6 Months for Pre- Existing Cancer conditions

 > 9 Months for Maternity- Normal Delivery, elective C/S and related complications

6. Lodging facilities for parent accompanying a child below 10 years being admitted Evacuation

 

Overall, the cover provides insurance in excess of NHIF for medical and surgical expenses reasonably incurred by the insured members within the period of insurance.

INPATIENT IN EXCESS OF NHIF BRONZE BRASS
Cover Limit (Per Family) 500,000 200,000
Panel of providers Budget panel Budget panel
Bed Limits Ward Bed Ward Bed
Pre-existing, chronic, HIV/AIDS and related conditions KES 250,000 KES 100,000
Congenital & pre-maturity conditions KES 100,000 KES 100,000
Psychiatric treatment KES 200,000 KES 200,000
Inpatient ophthalmology KES 50,000 KES 50,000
Inpatient Dental KES 50,000 KES 50,000
Cataract operation KES 60,000 KES 60,000
Hospital bed charges
Nursing Care
Diagnostic
Laboratory or other medically necessary facilities and services
Physician's, surgeons, anesthetists', or physiotherapist's feesn
Operating theatre charges
Specialist consultations or visits
Overseas treament
All drugs, dressings or medications prescribed by the physician for in-hospital use
Maternity and related complications- Normal Delivery and caesarean section KES 30,000 KES 10,000
First emergency operation for caesarean sectionn KES 50,000 KES 30,000
Post hospitalization for accident cases only Ksh. 25,000/= or 3 weeks whichever comes first Ksh. 25,000/= or 3 weeks whichever comes first
Evacuation Cover
Last Expense cover KES 250,000 KES 150,000
OUTPATIENT IN EXCESS OF NHIF BRONCE BRASS
Cover Limit (Per Family) 50,000 -
Consultation Limit KES 2,000 N/A
Laboratory investigations N/A
Drug administration and dispensing N/A
Kidney Dialysis N/A
Cancer Chemotherapy N/A
Radiology N/A
MRIs N/A
CT scans N/A
Nursing and midwifery servicesn N/A
Maternity Antenatal services N/A
Monthly clinic reviews at Ksh. 5,000 N/A
Minor surgical services N/A
Physiotherapy services N/A
Occupational therapy services N/A
Referral for specialized services N/A
Any other benefit as approved by the NHIF Board of management N/A
DENTAL IN EXCESS OF NHIF BRONZE BRASS
Consultation
Extractions
Gingivitis
Filling
Dental X- ray
Root Canal
OPTICAL IN EXCESS OF NHIF BRONZE BRASS
Choice of any frame being retailed up to Kshs. 2500/-
Plastic White Lenses
Plastic White Bifocals
LAST EXPENSE COVER IN EXCESS OF NHIFF
BENEFITS WITHIN EXECUTIVE UMASH PLAN (250,000 LIMIT) BENEFITS WITHIN EXECUTIVE UMASH PLAN (150,000 LIMIT)
Mortuary payments (14 days max) retailed up to Kshs. 2500/- Mortuary payments (14 days max)
Trailer Land Cruiser with chase car (nationwide) price inclusive one night stay Trailer Land Cruiser with chase car (nationwide) price inclusive one night stay
Executive coffin Executive coffin
Advertisement on Nation/ Standard Wreaths (Heart, round, Cross & Bunch of 80 roses)
Wreaths (Heart, round, Cross & Bunch of 80 roses) Full High Resolution portrait
Full High Resolution portrait -
Main exclusions
  • Non Declared Preexisting and Chronic conditions
  • War and Kindred risks (whether war be declared or not))
  • Cosmetic surgery unless necessitated by an accidentt
  • Family planning/infertility
  • Treatment other than by registered medical practitioner
  • Intentional self-injury, drunkenness, drug addiction
  • Naval, military or air force operation
  • Expenses recoverable under any other insurance e.g. NHIF
  • Beauty treatment in nature cure clinics or health hydros
  • Contamination by radio activity from nuclear fuel, waste or fission
  • Any expenses or claims arising while abroad in United States of America and Canada.
  • Consultants fees unless referred by a general practitioner
  • Age related hearing aids and senility
  • Terrorism and related conditions
  • Supplements
  • Expenses related to pain management services and treatment, weight management services and treatment, services and supplies including treatment of obesity.
  • Participation in professional and hazardous sports e.g. bungee jumping
  • Self-referred or self-prescribed treatment
  • Participation in riots, strikes and civil commotion
  • Civil war, rebellion, revolution, insurrection or military or usurped power.
  • Laser correction eye sight
  • Illness/ injury resulting from experimental treatment
  • General Health Check ups
  • Any expenses incurred as a result of natural calamities such as volcanic eruptions, earthquakes and typhoons.
  • All expenses related to donor screening, treatment, including surgery to remove organs from the donor, in case of transplant surgery
  • Outpatient benefit for the Brass Plan
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