Everything You Should Know About the BIMA YA MWANANCHI Medical Cover

The BIMA YA MWANANCHI is an affordable medical insurance plan offered by Britam Insurance. Designed for individuals and families, it provides financial protection in case of unexpected medical emergencies.

Bima Ya Mwananchi Benefits

The bima ya mwananchi offers three main benefits:

  • Inpatient Cover: This covers hospital bills arising from hospitalization, chronic or pre-existing illnesses, maternity care, and emergency ambulance services.
  • Outpatient Cover (Optional): This covers reasonable costs incurred at designated hospitals and clinics for consultations, medication, and other outpatient treatments. You can choose to include additional benefits like dental, optical, and chronic illness coverage within the outpatient limit.
  • Last Expense: This benefit provides a lump sum payout to your beneficiaries in case of your passing. There’s also a fire cash benefit included in the product.

Who Can Get Covered By the Bima ya Mwananchi?

To be eligible for the bima ya mwananchi cover:

  • The main policyholder and their spouse must be between 18 and 65 years old at the time of application.
  • Children between 38 weeks and 18 years can be automatically included.
  • Dependent children above 18 but below 24 years can be covered only if they are enrolled in school or college and proof of enrollment is provided.
  • The policy is renewable annually, but coverage ceases at the age of 70. Britam reserves the right to renew or not renew the cover upon expiry.

Bima Ya Mwananchi Waiting Periods

The bima ya mwananchi waiting periods before you can claim for certain benefits are:

  • 1 month: For all illnesses except accidental injuries.
  • 1 month: For death due to natural causes. Death by accident is covered immediately.
  • 10 months: For maternity and pregnancy-related treatments.
  • 1 year: For surgical procedures unless caused by an accident.
  • 10 months: For chronic and pre-existing conditions.

How to Get Covered by the BIMA YA MWANANCHI

  • You can apply for the BIMA YA MWANANCHI policy through a Britam office or an appointed agent/broker.
  • Documents required during application include passport-sized photos for yourself and each dependent, copies of your ID and spouse’s ID (and birth certificates for dependents).

Using Your Bima Ya Mwananchi Cover at the Hospital

  • Visit a hospital within Britam’s approved network.
  • Upon admission, present your photo ID card for verification.
  • The hospital will confirm your coverage validity, and treatment will proceed.

NOTE: In case of an emergency and admission to a non-listed hospital, notify Britam within 24 hours via the helpline on your insurance card.

What’s not Covered by the Bima ya Mwananchi?

The bima ya mwananchi policy excludes coverage for certain procedures and expenses, including:

  • Routine check-ups and examinations not related to diagnosing an illness or injury.
  • Tests like colonoscopies, fiber-optic investigations, and HSG.
  • Costs arising from illegal acts.
  • Cosmetic surgeries or obesity treatments.
  • Expenses covered by other insurance or sources like NHIF or WIBA.
  • Nutritional supplements and hormonal therapy.

NOTE: A complete list of exclusions is available in the policy documents.

Britam has a wide network of approved hospitals where you can access medical care using your BIMA YA MWANANCHI cover. Here is a list of Britam insurance medical cover hospitals:

  • P Shah Hospital Parklands
  • Mater Hospital
  • Gertrude’s Garden Children’s Hospital & Satellite Clinics
  • The Karen Hospital
  • Aga Khan University Hospital and Clinics
  • Nairobi Hospital and Clinics
  • A.R. Health Services and Satellite Clinics
  • Avenue Healthcare Clinics and the Main Hospital
  • Meridian Medical Centre and Clinics
  • Metropolitan Hospital
  • Nairobi Women’s Hospital
  • Nairobi West Hospital Ltd
  • Guru Nanak Hospital
  • Chiromo Lane Medical Centre
  • Westlands Medical Centre
  • Menelik Medical Centre
  • Langata Hospital
  • Melchizedek Hospital
  • Nairobi South Medical Centre
  • Sinai Hospital, Rongai Branch
  • Thika Road Health Services
  • Savannah Health Services Ltd
  • Langata Hospital – Langata Road
  • Sinai Hospital
  • Seventh-Day Adventist Clinic
  • Coptic Hospital
  • Jamaa Hospital
  • Lions Sightfirst Eye Hospital
  • Francis Community Hospital Kasarani
  • Kahawa Wendani Hospital
  • Anka Hospital Eastleigh
  • Mariakani Cottage Hospital
  • Equity Afia Rongai
  • Mary’s Hospital Langata
  • Uhai Neema Hospital Kasarani
  • Eldoret Hospital

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