Diaspora ABC Medical Insurance

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ABC Medical insuranceYou can still take care of your
family while away with the abcD’ Bouquet.

The abcD’ Bouquet is an all inclusive Insurance package designed to
provide Medical Insurance cover for Kenyans living in the Diaspora.
Talk to us today for more information.
+254 (20) 4441162/0722200476/0734200476
talk2us@abcthebank.com
You can still take care of your
family while away with the abcD’ Bouquet.
abcD’ Bouquet Health insurance cover
INPATIENT COVER DETAILS
a) Admission in an NHIF accredited hospital
b) Doctors fees
c) Laboratory investigations
d) Prescribed medicines
e) Theatre including surgeon’s and anesthetist’s fees
f) Intensive care unit (ICU)/High Dependency unit (HDU)
g) Inpatient expenses of eye, ear and dental testing and treatment arising out of sickness or accidents.
OUTPATIENT COVER DETAILS
a) Consultation with a general practitioner
b) Consultation with a specialist upon referral by a general practitioner up to the specialist’s charges
c) Laboratory investigations and X-rays
d) Prescription medicines
e) Outpatient procedures e.g. dressings
f) Expenses of the eye, ear and dental testing and treatment arising out of sickness or accidents
g) Physiotherapist’s fees
Additional benefits
1. Pre-existing, HIV/AIDS and chronic conditions covered up to the sub limits shown below within the
Inpatient limit per family after 12 months of cover and full disclosure at the time of joining.
2. Maternity related complications covered up to Kshs. 30,000/= per family after being on cover for 10
months.
3. Dental sub limit of Ksh.20, 000/= within Inpatient per family for non-accidental dental Inpatient
hospitalization.
4. Last expense of Ksh.20,000/= per family. Benefit payable from Inpatient limits
5. Optical sub-limit of Ksh.20,000/= within Inpatient per family; to cater for non accidental inpatient
ophthalmology treatment.
6. Rescue & evacuation subject to limit and APA authorization.
7. Post hospitalization cover of Ksh.10, 000/= to a maximum of 30 days after discharge.
8. Graduated premiums and sharing of limits
9. Our limits are not capped to illness or accident hospitalization. Members can utilize to full for either,
subject to Policy Terms & Conditions.
10. Bed entitlement – Ward bed
Salient features
I. Age limit 1 Month to 75 years old. For members above 55 Years admission will be subject to receipt of a
medical examination report.
II. Lodger fees for children admitted for up to 5 years of age.
III. Administration Procedures –Members are required to fill application forms and enclose two (2)
coloured passport photos of each beneficiary. Each member gets a medical card for identification
purposes.
– Option A : Kshs. 125,000/=
– Option B : Kshs. 100,000/=
– Option C : Kshs. 50,000/=
Inpatient Limit Family size Annual Premium
Kshs 500,000 Spouse Only Ksh 11,643.00
Spouse + 1 Child Ksh 16,300.00
Spouse + 2 Children Ksh 21,190.00
Spouse + 3 Children Ksh 27,547.00
Spouse + 4 Children Ksh 32,812.00
Inpatient Limit Annual Premium
Kshs 300,000 Spouse Only Ksh 10,584.00
Spouse + 1 Child Ksh 13,759.00
Spouse + 2 Children Ksh 17,887.00
Spouse + 3 Children Ksh 23,253.00
Spouse + 4 Children Ksh 32,554.00
Inpatient Limit Annual Premium
Kshs 100,000 Spouse Only Ksh 8,900.00
Spouse + 1 Child Ksh 11,570.00
Spouse + 2 Children Ksh 15,041.00
Spouse + 3 Children Ksh 19,553.00
Spouse + 4 Children Ksh 27,357.00
BENEFITS & PREMIUMS
INPATIENT COVER
SCHEME ADMINISTRATION
1. A dedicated 24hrs Emergency Line 0722 200 100
2. Dedicated relationship officers
3. Country wide network of service providers – as per the attached provider panel accidents.
Special Clauses
a. All premiums must be paid in full before commencement of cover
b.All In patient bills will be paid net of National Hospital Insurance Fund( NHIF)
c.Doctor’s Fee is paid at 100% if APA panel is used, if you use your own doctor we settle 85% of total Bill
or subject to APA Panel rates
d.All scheduled admissions must be reported to APA Insurance with at least 48 hours notice. Member
must await APA preauthorization before proceeding
e. For emergency admissions the hospitals will contact APA within 48 hours of admission
f. All waiting periods are subject to continuous renewal with no break in cover. Where there is a break in
cover the waiting periods will apply afresh
g. Treatment for Fibroids, Hernias, Adenoidectomy, Prostrates and Haemorrhoids shall be subject to a
waiting period of 12 months
h. 30 day waiting period for illness
i. Surgical cases subject to a waiting period of 90 days
j. Organ transplantation covered in the 3rd year of cover
k.Cancer cover will be applicable for newly diagnosed conditions only in the first year of cover and
OUT PATIENT COVER
Cover Limit Premium
Kshs 100,000 Ksh 18,250.00 per person
Kshs 75,000 Ksh 14,025.00 per person
Kshs 50,000 Ksh 10,800.00 per person
Family size
Family size
Terms and conditions apply.
+254 (20) 4441162/0722200476/0734200476
talk2us@abcthebank

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