OCTAGON AFYA PLUS POST-RETIREMENT MEDICAL SCHEME (PRMS) COVER Health cover is a comprehensive medical cover designed for Octagon Insurance Brokers retail customers and underwritten by Jubilee Health Insurance limited.

It has five (5) distinct categories to create flexibility for members. The Octagon Afya Plus PRMS Health cover comprises inpatient, outpatient, dental and optical benefits.

Benefits

Inpatient

This will cover:

• Hospital treatment & Services
• Specialist Fees including doctor’s fee, surgeon fee, anesthetist.
• Nursing care, ICU and HDU charges, Theatre charges
• Diagnostic & surgical procedures including pathology, X-ray, MRI, CT scan, Lab tests.
• Inpatient prescribed physiotherapy, chemotherapy, and radiotherapy
• Day care surgery or treatment
• Local Emergency Road & Air Ambulance Service
• Overseas referral for treatment not available locally. (Economy Air ticket included for inpatient limits above Kes.2M)
• Pre-existing, chronic cover, and HIV/ Aids and related treatment, , Organ transplant subject to full disclosure (cost of donor or securing the organ is excluded), Gynecological treatment, Kidney Dialysis (12 months waiting period); Cancer treatment including radiotherapy and chemotherapy (1 year waiting period).
• Inpatient Dental and Optical hospitalization resulting from an illness (12 Months waiting period)
• Post hospitalization visits after discharge (up to 3 weeks after discharge)
• Lodging facilities for a parent accompanying a child aged 12 years and below
• Psychiatric and Psychological conditions (12 Months waiting period)
• Inpatient Medical expenses incurred outside Kenya (for a maximum of 6 weeks from the date of travel on reimbursement basis)
• Home Nursing

Outpatient

This will cover:

• Consultation fees with General Practitioner and Specialist (Doctors on panel)
• Outpatient Prescription drugs and medicines and dressing
• Outpatient Laboratory investigations and Radiology services (Authorization required)
• Pre-existing, chronic cover, psychiatric, congenital conditions and HIV/Aids and related treatment, Gynecological illness and treatment (12 months waiting period)
• Cancer treatment (1 year waiting period)
• Counseling services upon referral by a general practitioner
• KEPI and baby friendly immunization for children aged 1.5 years and below
• General Health check-up include: Pap Smear and PSA once per year (Employee and spouse only)

Dental

This will cover:

• Dental consultation and gum diseases
• Extractions
• Fillings (except precious metals)
• Scaling and Polishing
• Dental X-Rays and Prescriptions

Optical

This will cover:

• Optometrist consultations
• Eye examinations
• Frames
• Prescription lenses
• Optical prescriptions