| Contribution |
K3,500.00 per person per month
/ VIP (O) K4,200.00 per person per month
|
| Annual Limit |
K2,000,000.00
|
| Institutions |
Government, Mission, 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 |
90% - subject to tariff |
| Anaesthetic Charges |
Government, Mission |
100% - subject to tariff |
| Private Hospital/Clinic |
90% - subject to tariff |
| Blood Transfusions |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff
100% - subject to tariff |
| Consultation |
General Practitioner
Paramedics
Local Specialists
Visiting Foreign Medical Specialist |
100% - subject to tariff
100% - subject to tariff
100% - subject to tariff, referral
60% - subject to tariff, referral, letter of guarantee from MASM. 12 months wait period. |
| Private Hospital/Clinic - In Patient |
100% - subject to tariff |
| Private Hospital/Clinic - Out Patient |
Normal hrs with referral 50% - subject to tariff
Normal hrs 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
90% - subject to stipulated annual limit |
Drugs
(generic only
or equivalent listed prices) |
Local (prescription)
Essential
Supplied to In-Patient
Bought abroad
Over the counter drugs (OTC's) |
90% - subject to annual cover and tariff
100% - subject to annual cover and tariff
100% - subject to annual cover and tariff
60% - subject to approval
80% (range of antiacids, pain killers & cough syrups. |
| Specific named drugs (e.g. Sporanox, Amphotericin, Fluconazole) |
70% - subject to annual cover and tariff |
| Drugs for treatment of HIV/AIDS (first line drugs) |
100% |
| Foreign Treatment |
Specialist foreign medical treatment |
60% - subject to annual cover, referral by local specialist, MASM approval. 12 months wait. |
| Travel emergency medical treatment |
60% - subject to annual cover. |
Student foreign medical treatment |
60% - subject to annual cover and letter of guarantee from MASM. |
| Lab / X-Ray |
Government, Mission |
100% - subject to tariff |
| Private Hospital |
90% - subject to tariff (normal hours)
80% - subject to tariff (after hours) |
| Foreign lab tests |
60% - subject to tariff. 12 months wait |
| Major Medical & Surgical Procedures |
Government, Mission |
100% - subject to tariff. 3 months wait. |
| Private Hospital/Clinic |
90% - subject to tariff. 3 months wait. |
| Visiting Foreign Medical Specialist |
60% - subject to tariff,referral. 12 months wait. |
Maternity
(limited to every three years) |
Delivery |
100% subject to tariff, stipulated limit, 12 months wait. |
| Ante-natal |
90% |
| Post-natal |
90% |
| Minor Procedure |
Government, Mission
Private Hospital/clinic
Visiting Foreign Medical Specialist |
100% - subject to tariff
90% - subject to tariff
60% - subject to tariff, referral, 12 months wait. |
Optical Care
|
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff
90% - subject to tariff |
| Physiotherapy |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff, referral
90% - subject to tariff, referral |
| Surgical Sundries |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff
90% - subject to tariff |
| Theatre Fees |
Government, Mission
Private Hospital/Clinic |
100% - subject to tariff.
90% - subject to tariff. |
| Ward Fees |
Government, Mission Hospital |
100% - subject to tariff, 3 months wait |
| Private Referral Hospital |
90% - subject to tariff, 3 months wait |
| Private General Hospital |
90% - subject to tariff, 3 months wait |
| Clinics owned by Paramedics |
K300/day - subject to tariff, 3 months wait, limited to 24 hours observation time |
| Intensive Care Unit |
90% - subject to tariff, 3 months wait |
| |
|
| also see general exclusions |
