| Contribution |
K1,300.00 per person per month / Exec (O) K2,000.00 per person per month |
| Annual Limit |
K1,000,000.00 |
| Institutions |
Government, Mission and Private Hospitals and Clinics registered with the Society |
| |
Services |
Type |
Coverage |
Ambulance Services ( between areas in the same locality)
(excluding air transport) |
Municipal, Government, Mission Hospital Service |
100% - subject to tariff |
| Private Ambulance Service |
80% - subject to tariff |
| Anesthetic Charges |
Government, Mission |
100% - subject to tariff, three months wait period |
| Private Hospital/Clinic |
80% - subject to tariff, three months wait period |
| Blood Transfusions |
Government, Mission &
Private Hospital/Clinic |
100% - subject to tariff
|
Consultation
(limited to 1 consultation/day) |
General Practitioner
Paramedics
Local Specialists
Visiting Foreign Specialists |
100% - subject to tariff and 1 consultation / day
100% - subject to tariff
100% - subject to tariff & referral
NIL |
Private Hospital/Clinic
- In Patient |
80% - subject to tariff |
Private Hospital/Clinic
- Out Patient |
Normal Hours, with referral: 50% - subject to tariff
Normal Hours, No referral: NIL
After Hours 50% - subject to tariff |
Dentistry
(excluding inlays, crowns, & bridges) |
Government, Mission,
Private Hospitals & Clinics |
100% - subject to stipulated annual limit
80% - subject to stipulated annual limit |
Drugs
(generic only
or equivalent listed prices) |
Local (prescription)
Essential
Supplied to In-Patient
Bought Abroad |
50% - subject to annual cover and tariff
100% - subject to annual cover and tariff
80% - subject to annual cover and tariff
25% - subject to approval |
| Specific named drugs (e.g.Sporanox, Amphotericin, Fluconazole) |
50% - subject to approval |
Over the Counter Drugs (OTC'S)
Drugs for treatment of HIV/AIDS (AZT, Triple therapy etc) |
NIL |
| Foreign Treatment |
25% subject to referal and approval by masm
|
| Lab / X-ray |
Government, Mission
|
100% - subject to tariff |
| Private Hospital |
80% - subject to tariff (normal hours)
60% - subject to tariff (after hours) |
| Lab tests abroad |
NIL |
| Major Medical & Surgical Procedures |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff, 3 months wait.
80% - subject to tariff. 3 months wait. |
| Visiting Specialist |
NIL |
Maternity
(limited to every three years) |
Delivery |
100% subject to tariff, stipulated limit, 12 months wait. |
| Ante-natal |
50% - limited to 5 visits, 12 months wait. |
| Post-natal |
50% - limited to 3 visits,12 months wait. |
| Minor Procedure |
Government, Mission |
100% - subject to tariff
|
Private Hospital/clinic
Local Specialist
Visiting Specialist |
80% - subject to tariff
100% - subject to tariff
NIL |
Optical Care
(excluding spectacles, lenses, contact lens solutions) |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff
80% - subject to tariff |
| Physiotherapy |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff and referral
80% - subject to tariff and referral |
| Surgical Sundries |
Government, Mission
Private Hospital/Clinic |
100% subject to tariff
80 % subject to tariff |
| Theatre Fees |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff, 3 months wait
80% - subject to tariff, 3 months wait |
Ward Fees
|
Government, Mission |
100% - subject to tariff, 3 months wait |
| |
|
| Private Referral Hospital |
80% - subject to tariff, 3 months wait |
| Private General Hospital |
80% - subject to tariff, 3 months wait |
| Clinics owned by Paramedics |
K300/day - subject to 24 hours observation time |
| Intensive Care Unit |
80% - subject to tariff, 3 months wait |
| also see general exclusions |
|
|
|
