AON Kenya is the insurance responsible for providing medical cover for police officers in Kenya. The medical cover caters for inpatient and outpatient services. The rates for each job group are as follows:
National Police Service & Kenya Prisons Service Medical Insurance Cover
Scheme Scope of Cover
| Civil Service Job Group | Police Officer Grades | In-Patient | Out-Patient | Dental Cover | Optical Cover | Maternity |
| A-G | PG 1,2 | 1,500,000 | 150,000 | 50,000 | 50,000 | 125,000 |
| H | PG 3 | 1.500,000 | 150,000 | 50,000 | 50,000 | 125,000 |
| J | PG 4,5 | 1,500,000 | 150,000 | 50,000 | 50,000 | 125,000 |
| K | PG 6 | 1,500,000 | 150,000 | 50,000 | 50,000 | 125,000 |
| L | PG 7 | 1,500,000 | 150,000 | 50,000 | 50,000 | 125,000 |
| M | PG 8 | 2,000,000 | 200,000 | 50,000 | 50,000 | 125,000 |
| N | PG 9 | 2,000,000 | 250,000 | 50,000 | 50,000 | 125,000 |
| P | PG 10 | 2,300,000 | 250,000 | 50,000 | 50,000 | 125,000 |
| Q | PG 11 | 2,300,000 | 300,000 | 50,000 | 50,000 | 125,000 |
| R,S,T | PG 12-15 | 2,500,000 | 400,000 | 50,000 | 50,000 | 125,000 |
Inpatient Benefits (as per the limits)
The health care cover will cover the officer and eligible dependants for the following benefits but not limited to:-
- Hospital Accommodation Charges :
– Bed entitlement- standard ward bed net of NHIF rebate per day for Job Group A – M;
– Bed entitlement – standard private bed net of NHIF per day for Job Group N to T.
– Bed entitlement is subject of availability at the hospital.
- Naval, military, air force and other security related operations.
- War (declared or undeclared), invasion and civil war risk, riots, strikes and civil commotions and Acts of terrorism
- Hazardous pursuit which include diving and riding in any kind of race.
- Extreme and professional sports
- Prosthetic device needed as part of your treatment, which includes external artificial body part, such as a prosthetic limb or prosthetic ear.
- Transplant services – transplant of cornea, small bowel, kidney, kidney/pancreas, liver, heart, lung or heart/lung transplant (subject to fulfillment of Legal requirement for donor and recipients and specified limits with Donor costs covered upto KES. 200,000 within the inpatient limit).
- Full portability
- Doctor’s (Physician, Surgeon & Anesthetist) Fee.
- ICU/HDU Intensive Care, Intensive Therapy, Coronary care and High Dependency unit
- Theatre charges, drugs/ medicines, dressings and Internal Surgical Appliance
- Pathology, X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans
- In-Patient Physiotherapy and Hydrotherapy
- Chemotherapy, renal dialysis, physiotherapy and occupational therapy
- In-Patient Prescribed drugs/ medicines and dressings.
- Emergency Road and Air Evacuation within East Africa leading to admission using rotary and fixed wing air rescue.
- Overseas and local evacuations where treatment is not locally available.
- Where the member’s dependant is a child who is aged seven years and below, the cost of travel (airfare only, economy class) for one parent/guardian accompanying the child will be covered subject to annual limit. In addition where the medical physician deems it medically necessary to have the patient accompanied by a doctor/nurse, the insurer shall review and provide approval, within the annual inpatient limit.
- Day care Surgery for minor surgical treatment that may not require admission.
- Hospital accommodation for accompanying parent and / or guardian for hospitalized children below seven (7) years
- Post Hospitalization benefit
- Congenital defects/ genetic disorders.
- Pre-existing and chronic conditions (including cancer) to be covered in full annual limit
- Rehabilitation services
- Medical education and wellness program for members with pre-existing and chronic conditions
- Cataract operation covered upto KES. 100,000 within the inpatient limit
- Last expenses and repatriation of the mortal remains subject to a limit of 50,000 within the inpatient annual limit resulting from death from an illness
- Inpatient Fertility treatment including complications shall be covered up to KES. 125,000 within the inpatient limit.
- Psychiatric treatment including complications shall be covered up to KES. 300,000 within the inpatient limit
- Child welfare
- Mental illness including intentional self-injury and suicide
- All sexually transmitted infections (STD)
- Illnesses resulting from alcohol intoxication
Out-patient Services Benefits (as per the limits)
The Out-patient cover will cater for all routine out-patients services which include but not limited to :-
- Routine Out-patient Services
- Diagnostic Laboratory and Radiology Services (X-ray, Ultrasound, MRI and CT Scans)
- Prescribed Physiotherapy subject to pre authorisation
- Radiotherapy
- Prescribed Drugs and dressings
- Prescribed routine Laboratory tests
- Spirometry (Lung Function test)
- HIV/AIDS related conditions and prescribed ARV’s to the full cover limit family per annum
- Routine Immunization under The KEPI regime of vaccination up to one and a half (1.5) years
- Routine Ante-natal checkups and post natal care
- Newly diagnosed chronic conditions pre-existing and chronic conditions (including cancer)
- Ambulance and evacuation services using road, rotary and fixed wing air rescue
- Preventive care: to include free Medical camps, Mobile clinics for events, counseling on life style and wellness
- Annual Medical Check Ups including papsmear and PSA for Employees and Spouses shall be covered within the outpatient limit up to KES. 15,000 per annum within the specified panel
Exclusions
- The cost of non-medical goods or services including such items as telephone, newspaper or accommodation for the Member’s family is excluded.
- Massage and hydrotherapy (except where certified as medically necessary)
- Cosmetic treatment unless relating to an accident
- Treatment other than by a registered medical practitioner e.g. chiropractors, acupuncturists, herbalists and other alternative treatments
- Nutritional supplements unless prescribed by a doctor as part of treatment of a deficiency
- Maternity cover for dependent children, illegal abortions, foetal surgery and any treatment related to surrogacy.
- Self-prescribed drugs and elective pain management
- Cosmetic dental care – Cosmetic Crowns, Caps, Bridges, Orthodontics & Dentures, self – prescribed teeth cleaning and whitening, unless necessitated by accidental injury
- Replacement or repair of old dentures bridges and plates unless damage to dentures, bridges and plates becomes necessary as a result of accident
- Replacement of spectacle frames within the same year of cover, unless necessitated by a medical condition (new frames will be covered)
- Photo chromatic and/or antiglare lenses unless prescribed by a doctor
- Last expense cover for death as a result of still births or death in womb before term, accidental or suicidal death
- Reimbursement of bills incurred without authorization or for treatment as a result of an accident or life threatening emergency
Maternity (as per limits)
- Maternity benefit available to principal member and their spouse only
- Routine antenatal check-up with 2 prescribed ultra sound scans and prenatal medication
- Delivery fees for both normal deliveries and all Caesarean sections
- Post natal care up to six weeks
- Routine immunization (KEPI) for a child upto 1.5 years
- New born congenital conditions
- Pre-maturity expenses resulting from treatment of premature babies or babies born with deformities
- Complications of pregnancy
Dental cover (as per the limits):
- Dental consultation and anesthetist fees
- Dental X-ray, Root Canal and tooth extractions
- Normal compound filing
- Scaling necessitated by prevailing medical conditions prescribed by a dentist
- Accident related Dental treatment
Exclusion
- The cost of replacement or repairs of old dentures, bridges and plates unless damage to the said dentures, bridges and plates arises as the result of bodily injury sustained by the Member caused solely and
directly by accidental external and visible means. - The cost of orthodontic treatment of a cosmetic nature unless such treatment becomes necessary as the result of bodily injury sustained by the Member caused solely and directly by accidental external visible means or as a result of disease other than normal decay.
- Filing using semi-precious and precious metals
Optical (as per the limits)
- This benefit caters for expenses related to eye treatment. Optical cover includes the cost of lens and frames. Members who have obtained frames will not be entitled to a replacement within the contract year
unless necessitated by a medical condition or accidental injury - Prescription for ophthalmic treatment and eye lenses to be issued by an Ophthalmologist
- There would be a sublimit within the ophthalmic cover for frames and lenses Ophthalmic ultrasound if prescribed by the Ophthalmologist
- The frames shall be limited to one pair for every two years (2) and up to a maximum of Kshs. 10,000 or the maximum optical limit whichever is lower.
Exclusion
- The replacement of frames unless directly caused as a result of an accidental injury.
- The replacement of lenses unless necessitated in the course of further treatment in connection with the contingency insured hereby.
- Sunglasses and Plano lenses / contact lenses prescribed or otherwise
International & Domestic Referrals
- Referral to medical institutions that offer specialized services not available in the country
Medical Evacuation- Emergency Road and Air Rescue/ Evacuation, Including Treatment Abroad
Scheme members will be covered for the following Road and Air ambulance and evacuation services:
- Emergency Air Ambulance Evacuation Services within East Africa
- Emergency Road Ambulance Evacuation services within East Africa
- Overseas Evacuation/Treatment abroad (e.g. India, South Africa, Europe) where treatment is not available locally and within policy limits.
Who is Eligible?
- Eligible Employee – An employee is eligible for membership under this Policy upon entering Full Time Active Service of the Insured i.e. 18 years to mandatory retirement age
- Eligible Dependent – Means one (1) legal spouse of the Member and/or five (5) unmarried children or legally adopted children who are dependent upon the Member for support, provided always that such children are aged not less than 38 weeks (full term birth) and not more than 18 years at the date of enrolment into the Scheme (extended to 25 years if in full time formal education) and are residing with the Insured employee.
- Eligibility for new members: An eligible person shall be any person who is:
a. An employee who is yet to attain the age of 65 years.
b. A spouse who is yet to attain the age of 70 years
Registration
- A) Mobile Phone USSD Registration:
- Type *252# from either a SAFARICOM or AIRTEL line
- Enter your Employment Number and National ID Number. The above will be verified against the database
- If successful, you will be asked to enter your work county and your gender
- If not successful, you will be asked to contact a number at Administrator for further assistance (0730604000)
- All erroneous attempts will be logged onto the system and will be queried so as to reach the officer in’Registration Distress’ or control fraudsters
- Once done, you will be given a PIN number that you can use to register your dependants and a message confirming that you are now a fully registered member with the NPS/Prisons Medical Scheme will pop up
- While registering your spouse, please provide the ID number
- For dependent children over eighteen (18) of age, kindly provide their ID Numbers
- While registering children, please state whether they are disabled (if applicable)
Completion of member registration forms which will be circulated to all officers through your HR office. Duly completed National Police Service and Kenya Prisons Service member registration forms to be submitted to the HR. Application forms can also be downloaded and printed from the administrators website;
Below are the required documents to attach to the application form:
- For spouses – copy of Marriage certificate, Kadhi certificate, Civil marriage certificate, Signed affidavit
- For dependant children – Birth certificates, legal adoption papers
- Documentary evidence that dependants over 18 years are enrolled full-time in a recognized post- secondary institution
- Proof of disability for children above maximum age and are disabled
The National Police Service / Kenya Police Service Panel List of Healthcare Facilities
Officers and their families will have access to:
- Healthcare facilities countrywide
- Healthcare facilities in East Africa
- Panel of Providers worldwide on referral including India, Turkey, Jordan, Israel, United Kingdom, South Africa, Australia, Switzerland and Pakistan for critical medical evacuation
Administrator will be seeking feedback on any adjustments to the list that they propose to be made and updated lists will be communicated accordingly. Procedures for Access to Medical Care under the Scheme
- Confirm the nearest healthcare facility to you from the Administrator Panel List of Healthcare Facilities
- Avail yourself at the healthcare facility
- Present your Medical Identification Card at the healthcare facility
- You and your eligible dependants seeking treatment will be asked to register your finger prints in the biometric system for identification
- On successful identification, you will receive treatment and be asked to sign a claim form