HeriAfya Medical Cover

HeriAfya Medical Cover

4 reasons to choose HeriAfya Medical Cover.

  • Extensive coverage: We offer one of the highest covers for outpatient services
  • Customisable packages: Pick and choose what coverage you want and the limits for each family member
  • Child dependant coverage: Cover your kids from ages 38 weeks to up to 23 years
  • Policy refund: If you choose to cancel the cover, you will receive a refund



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More about the product

  • Broad Coverage: This plan provides you with extensive & highest coverage including inpatient services, outpatient, maternity, dental & optical from Kes 10,000 to Kes 5,000,000
  • Flexibility: Tailor-make your insurance package with a choice of different limits for every family member
  • Access: Gain access to our comprehensive healthcare network featuring specialists, friendly hospital and specialist rates, telehealth and drug delivery services

  • Extensive Coverage: HeriAfya health insurance extends coverage to medical costs for all family members, encompassing hospitalization, surgical procedures, pharmaceuticals, and diagnostic examinations.
  • Financial Security: HeriAfya ensures protection against unforeseen medical expenses, averting potential financial strain on families during emergencies.
  • Preventative Healthcare: Inclusive services encompass preventive measures such as routine check-ups, immunizations, and screenings, promoting early identification and management of health conditions.
  • Peace of Mind: Offering assurance that loved ones are covered, HeriAfya grants tranquility, freeing individuals from concerns about potential healthcare-related financial burdens.
  • Access to Superior Medical Services: Through HeriAfya's network, families gain access to esteemed healthcare providers and specialized practitioners, guaranteeing prompt and high-quality care without prolonged waiting periods.
  • Coverage for Severe Ailments: HeriAfya's policies encompass critical illnesses such as cancer and cardiovascular diseases, ensuring access to specialized treatments and interventions.
  • Flexibility and Personalization: HeriAfya offers adaptable plans that can be tailored to meet specific needs and financial constraints, accommodating varying preferences regarding coverage levels and deductible amounts.

One can pick the inpatient benefit alone. However, they will not have an option of taking up the outpatient benefit alone. Also, to enjoy maternity benefits one must take up inpatient benefits for at least 1 year. Dental or optical benefits may be taken up with the outpatient benefit.

•   30-day general waiting period unless in case of hospitalization from an accident which will be treated from inception.

•   Treatment of pre-existing and chronic conditions will not be covered for twelve (12) months starting from the policy commencement date.

•   Treatment of major diseases (cancer, kidney dialysis, and organ transplants) will not be covered for twenty-four (24) months starting from the policy commencement date.

•    A ten (10) month waiting period for maternity and gynecological surgery.

•   A six (6) months waiting period for non-accidental dental surgery and optical surgery.

•   A thirty-six (36) month waiting period for Illness related reconstructive/plastic surgery

•   Cosmetic treatments and plastic surgery.

•   Prescribed alternative medicines including but not limited to homeopathy, acupuncture, Chinese medicine, reflexology, aromatherapy, patent medicines, and household remedies.

•   Services or treatment in any home, spa, hydro-clinic, sanatorium, step-down facility, hospice, private nursing/home care (unless pre-authorized by us), frail care or long-term care facility that is not a Hospital as defined.

•   Tests or treatment related to infertility, contraception, impotence, or sexual dysfunction.

•   Termination of pregnancy unless authorized by a registered medical practitioner when the life of a mother is at risk.

•    Treatment by the Insured Person himself or family member or spouse.

•    All costs relating to cornea, muscular, skeletal or human organ or tissuetransplant from a donor to a recipient and all expenses directly or indirectly related to organ transplantation (except as defined under the Organ Transplant Benefit).

•   Treatment of self-inflicted injury, suicide or attempted suicide, abuse of alcohol and drug addiction or abuse unless where related to mental illness.

•    Experimental or pioneering medical and surgical techniques not commonly available

•   Injury or illness while serving as a full-time member of a police or military unit

•   Travel costs or non-medical costs (except where stated in the benefit table).

•    Vaccinations such as travel vaccinations, flu vaccinations, epidemics and pandemics

•    Dentures, inlays, crowns, bridges, periodontal treatment and orthodontic treatment.

•    Replacement of eye glasses due to damage, breakage or loss

•   Repair of eye glasses; Anabolic steroids and testosterone; Autopsies; Humidifiers; Medicated shampoos and conditioners, Unregistered medicines; Massages; Multivitamins and tonics; Treatment for Obesity; Sleep studies;

•   Slimming preparations; Soaps, scrubs and other cleansers; Sunglasses, readers, contact lenses and contact lens preparations; Sun screening and sun tanning preparations; Toiletries; Treatment for hair removal; Search and rescue;

•   Dental implants; Refractive eye surgery or laser eye treatment; Photophobia and photo chromatic lenses

•    Food and nutritional supplements, including baby food and special milk preparations

•    Anti-smoking preparations; Hearing aids, glucometers and blood pressure machines

•   Expenses incurred directly or indirectly as a result of an Insured Person being involved in professional and dangerous sports including but not limited to motorcycling, rugby, football, skydiving, mountaineering, water sports etc

•    Treatment for learning difficulties, development, and behavioral problems in children.

Relevant Documents and Forms

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