Afya Imara Health Insurance Kenya | Benefits & Key Features | Old Mutual Kenya
Afya Imara Health Insurance – Benefits and Key Features
Afya Imara (meaning “Strong Health” in Swahili) is a comprehensive medical insurance product offered by Old Mutual Kenya. It is designed for individuals and families seeking flexible, affordable healthcare coverage with extensive benefits including inpatient and outpatient options, maternity cover, chronic condition management, and a unique critical illness cash payout .
Overview
| Feature | Details |
|---|---|
| Provider | Old Mutual Kenya (UAP Old Mutual Group) |
| Target Audience | Individuals and families (0 – 65 years, renewable for life) |
| Coverage Type | Comprehensive Inpatient (core) + Optional Outpatient |
| Inpatient Annual Limit | KSh 100,000 to KSh 10,000,000 (multiple plan options) |
| Outpatient Annual Limit | KSh 25,000 to KSh 200,000 (optional add-on) |
| Critical Illness Cover | KSh 750,000 cash payout on first diagnosis |
| Geographical Coverage | Kenya, Uganda, Tanzania, Rwanda, South Sudan |
Key Benefits
Inpatient Coverage (Core)
-
Hospitalization expenses – Bed charges (General Ward to Private Suite), surgeon fees, physician fees, theatre charges, ICU & HDU fees
-
Chronic & Pre-existing conditions – Covers diabetes, hypertension, cancer, HIV/AIDS, and congenital conditions after 12-month waiting period
-
Organ transplant – Coverage available for kidney, heart, liver, lung, and bone marrow transplants
-
Maternity cover – Normal delivery, C-section, complications, antenatal/postnatal care
-
Home nursing – Up to 90 days from discharge on doctor’s recommendation
-
Post-hospitalization – Coverage for 21 days after discharge
-
Parent/guardian accommodation – For children aged 12 years and below during hospitalization
-
COVID-19 coverage – Inpatient coverage for moderate and critical cases
-
Emergency evacuation – Road evacuation for all plans; air evacuation for limits above KSh 1,000,000
-
Overseas referral – Treatment in India for conditions not available locally (economy class airfare included)
Outpatient Coverage (Optional Add-on)
Outpatient cover can be added with limits ranging from KSh 25,000 to KSh 200,000 depending on the plan selected :
| Benefit | What’s Covered |
|---|---|
| Routine services | GP consultations, diagnostics, drugs, dressings |
| Specialist care | Specialist fees (on referral) |
| Dental & Optical | Routine dental treatment, frames, lenses (limits apply) |
| Well-baby clinics | Pediatric care and routine immunizations |
| Physiotherapy | Covered on referral |
| Annual medical check-up | Preventive health screening |
Critical Illness Cover (Unique Feature)
Afya Imara includes a market-first critical illness benefit – a cash payout of KSh 750,000 upon first diagnosis of specific critical illnesses :
-
Cancer
-
Stroke
-
Heart attack
-
Kidney/Renal failure
-
Paralysis
Important: This is a lump sum cash payment paid directly to the policyholder, separate from and in addition to regular medical coverage. It provides financial flexibility for treatment costs, caregiving, or any other needs during a critical illness .
Inpatient Plan Options
| Plan | Annual Limit | Bed Options | Chronic/Pre-existing Sub-limit |
|---|---|---|---|
| Option 1 | KSh 100,000 | General Ward (up to KSh 8,000) | KSh 50,000 |
| Option 2 | KSh 250,000 | General Ward (up to KSh 8,000) | KSh 50,000 |
| Option 3 | KSh 500,000 | Private Room (up to KSh 8,000) | KSh 300,000 |
| Option 4 | KSh 1,000,000 | Private Room (up to KSh 14,000) | KSh 400,000 |
| Higher Plans | Up to KSh 10,000,000 | Enhanced benefits | Enhanced limits |
Sources:
Premium Rates (Sample)
Inpatient Premiums for ages 30-40 (per year) :
| Plan Limit | Principal Member | Spouse | Child (0-18 yrs) |
|---|---|---|---|
| KSh 100,000 | KSh 11,752 | KSh 9,846 | KSh 5,438 |
| KSh 500,000 | KSh 24,203 | KSh 18,638 | KSh 10,552 |
| KSh 1,000,000 | KSh 28,068 | KSh 21,428 | KSh 13,856 |
Source:
Waiting Periods
| Condition/Benefit | Waiting Period |
|---|---|
| General illness | 28 days |
| Non-accident surgery | 60 days |
| Pre-existing / Chronic conditions | 12 months |
| Maternity | 12 months |
| HIV/AIDS cover | 12 months |
Sources:
Exclusions (What’s NOT Covered)
Based on the policy document, the following are excluded :
| Category | Specific Exclusions |
|---|---|
| Cosmetic | Plastic surgery (unless accident-related) |
| Fertility | Infertility treatment, assisted reproduction |
| Weight management | Bariatric surgery, weight loss programs |
| Alternative medicine | Chiropractors, acupuncturists, herbalists |
| Self-inflicted | Intentional self-injury, suicide attempts |
| Substance-related | Conditions from alcohol or drug abuse |
| Experimental | Unproven or investigational treatments |
| Pandemics | Declared pandemics/epidemics (unless specifically covered) |
| Hazardous sports | Professional sports, bungee jumping, paragliding |
| War/terrorism | Naval, military, or air force operations |
| NHIF-recoverable | Expenses recoverable under NHIF or other insurance |
Silent Features (Value-Added Benefits)
-
Lifetime Renewal – Once you join, you can renew your cover for life, even beyond age 65
-
Critical Illness Cash Payout – KSh 750,000 lump sum on first diagnosis of cancer, stroke, heart attack, kidney failure, or paralysis
-
No Excess for Inpatient – No out-of-pocket deductibles for inpatient claims
-
Installment Premium Payments – Premium financing available for those who cannot pay annually upfront
-
No Claim Discount (NCD) – Discount on renewal for claim-free periods
-
East Africa Coverage – Access to hospitals across Kenya, Uganda, Tanzania, Rwanda, and South Sudan
-
Overseas Treatment in India – Referrals to accredited hospitals in India with economy airfare included for patient and one accompanying person
-
Newborn Cover from Birth – Babies covered from birth (38 weeks term) upon notification and premium payment
-
Children up to 21 Years – Student children covered up to age 21 with proof of schooling
-
Well-Baby Clinics – Routine pediatric care and immunizations included in outpatient cover
-
Parent/Guardian Accommodation – Hospital accommodation costs covered for a parent staying with a hospitalized child under 12
-
Home Nursing up to 90 Days – Post-discharge home-based care on doctor’s recommendation
Eligibility
| Category | Requirements |
|---|---|
| Principal member | Age 0 – 65 years (renewable for life after joining) |
| Spouse | Age 18 – 65 years at joining |
| Children | Age 0 – 18 years (up to 21 years for students with proof) |
| Seniors (Afya Imara Seniors) | Age 65 – 80 years (separate product) |
| Medical report | Required for persons over 60 years |
Sources:
Why Choose Afya Imara?
| Feature | Benefit |
|---|---|
| Unique critical illness payout | KSh 750,000 cash on first diagnosis of major illnesses |
| Lifetime renewal | Cover for life once enrolled |
| Flexible plans | Multiple inpatient and outpatient options to fit your budget |
| Chronic condition cover | HIV/AIDS, cancer, diabetes, hypertension covered after 12 months |
| Regional & overseas access | East Africa network + treatment in India |
| Family-focused | Covers children from birth, parent accommodation, well-baby clinics |
| Established provider | Old Mutual Kenya (trusted insurer with strong market presence) |
Conclusion
Afya Imara by Old Mutual Kenya offers a compelling blend of comprehensive inpatient cover, flexible outpatient options, and a unique KSh 750,000 critical illness cash payout – a feature rarely found in standard medical policies. Whether you’re an individual, a young family, or planning for long-term health security, Afya Imara provides options tailored to your needs and budget.
Navigating health insurance options can be complex, but you don’t have to do it alone.
Let Annex Insurance Agency help you navigate the Afya Imara plans, compare options, and choose the coverage that best fits your health needs and financial goals.
📞 Call us today: +254 724 547669
📧 Email us: info@annexinsurance.co.ke
