Honestly, insurance can be a confusing topic and we understand. While many of us possess insurance cover, a good number do not quite grasp the benefits that come with it.
To begin with, health care is expensive, and not all of us can pay for it out of pocket hence the need for a cover. Often, you can purchase an inpatient cover and an outpatient one. However, you can also purchase an inpatient cover only. These are different plans and can be offered by your company as one of the benefits or, you can purchase them as an individual.
In either situation, it’s important to know what an inpatient policy covers. Do not assume, please find below 16 cases that your inpatient cover can cater for provided that the services you are seeking were received at the Preferred Provider approved by the Company and that Pre-authorization has been obtained in writing:
1. Hospital Accommodation Charges that cater for your bed. To be specific, this is the Standard ward bed that is net of your NHIF rebates per day.
2. Theatre fees, drugs, injections, dressings and materials used in theatre.
3. Costs of services provided by general practitioners, specialists, technicians and physiotherapists in hospital only.
4. Drugs/Medicines, dressings and internal Surgical appliances.
5. Radiology including but not limited to X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans hospital (scans and MRI’s are subject to Pre-authorization by the Company)
6. Pathology, and blood transfusions.
7. Radiotherapy and Chemotherapy.
8. Inpatient Physiotherapy, Hydrotherapy, Occupational therapy.
9. Renal Dialysis.
10. Hospital accommodation for accompanying parent and /or guardian for hospitalized children below seven (12) years.
11. Congenital defects/genetic disorders
12. Intensive care and High Dependency Unit fees. This is subject to written reconfirmation with your insurer every forty-eight (48) hours.
13. Medication on discharge, “To Take Out”, which is subject to the maximum dosage for a fourteen (14) day period.
14. Post-Hospitalization benefit of up to two (2) weeks for other sicknesses and six (6) weeks for accident cases after the discharge.
15. Day Care Surgery for minor surgical treatment/ a procedure that may not require admission.
16. Attendance of a qualified Nurse at the residence of the Member, when confined to
bed by a doctor’s directive.
The following terms and conditions shall apply;
I. The Company must be fully informed of and approve scheduled hospital admission at least forty-eight (48) hours before such admission, and in the event of an Emergency, not later than twenty-four (24) hours after hospital admission.
II. Hospitalization excludes consultations and all treatment before and after the period of hospitalization.
III. Member’s maintenance in any Hospital, Nursing Home or Sanatorium is subject to a second opinion by the Company’s appointed medical advisor.
Important to note, your insurer reserves the right to a second medical opinion from a Peer Review or a team of specialist medical practitioners. Besides, its liability shall be determined after the deduction of any National Hospital Insurance Fund rebate, which could and should have been claimed against the Hospital.
For those seeking specialized treatment outside Kenya, you are required to provide approval from the Director, of Medical Services in the Ministry of Health- However, these requests vary from one insurer to the other. Overseas treatment is on referral basis