Health Management
     
The Co-op Medical Scheme offers an In-Hospital medical insurance product designed to meet the prevalent Medical Insurance needs of the valued customers who include corporate bodies, Co-operative Societies and Government organizations. The cover is differentiated to reflect the diversity of the different clients in the market.

In-Patient Hospital cover

    The scheme offers In and outpatient the latter operating on self fund basis, benefits ranging from Kshs.100,000 to Kshs.10,000,000.
    The group benefit can be purchased per member or per family.
    Per family benefit means that for a given benefit limit, all the medical expenses of the family will be paid out of that limit on a first claim basis until the limit is exhausted.
    Per member benefit means each member, whether spouse or child, has a fixed limit from which all his/her medical expenses will be paid from. No sharing.
    A 28 days waiting period is applicable for illness related admissions except where the client is joining from another underwriter or Health insurer provider.

Plan A

    Hospitalization: The cover pays for all illness or accident expenses related to a member's treatment while admitted in a Hospital up to the limit chosen. This includes Hospital charges, Doctors fees and prescribed medicine.
    Post Hospitalization: The cover includes payment for follow-up medical expenses after an admission but limited to the benefit limit chosen.
    Evacuation services: The cover pays for road and air evacuation by ambulance including transfer from one Hospital to another. We have an arrangement with an ambulance services provider. The costs of evacuation are within the overall benefit limit.


Plan B
    This is an enhancement of plan A above to include pre-existing conditions, HIV/AIDS related infections or maternity benefits. This attracts a premium loading of 15-35% above option A premiums depending on the profiles of the group seeking cover. Group profile refers to size, average age, location, claims experience history etc

    Pre-existing and chronic conditions: These conditions will be covered up to a defined limit provided disclosure is made. This is useful in order to decide on appropriate loading.
    HIV/AIDS related conditions: The policy will pay for the opportunistic infections but not the antiretroviral drugs which the members needs on a continuous basis. Full disclosure is necessary to determine the premium loadings and the benefit limit. The benefit payable is 50% of the overall limit subject to a maximum of Kshs.300,000 per policy period.
    Maternity benefit: This benefit is considered for clients with at least twenty employees and helps defray the costs of delivery, doctor's fees, bed and drugs.