As Kenya’s population ages, securing reliable and comprehensive medical insurance for seniors has become a priority for families seeking to ensure quality healthcare without financial strain. The Old Mutual Afya Imara Seniors Cover is a tailored health insurance plan designed specifically for individuals aged 65 to 80, offering lifetime coverage and a wide range of benefits to address the unique healthcare needs of the elderly. This article provides an in-depth exploration of the Afya Imara Seniors Cover, including its rates, benefits, exclusions, and eligibility criteria.
What is Afya Imara Seniors Cover?
The Afya Imara Seniors Cover by Old Mutual Kenya is an enhanced medical insurance solution crafted to provide financial security and access to quality healthcare for senior citizens. Unlike standard health plans, this cover caters specifically to individuals aged 65 to 80 years, with the option to renew for life once enrolled. It addresses both inpatient and outpatient needs, including chronic and pre-existing conditions, ensuring seniors can live healthier lives without the burden of exorbitant medical costs.
This plan is part of Old Mutual’s broader Afya Imara suite, which includes options like Afya Imara, Afya Imara County, Afya Imara Junior, and Afya Imara Executive, but it stands out for its focus on the elderly. With a comprehensive hospital network, flexible payment options, and coverage for critical illnesses, it’s a leading choice for families looking to secure elderly healthcare in Kenya.
Key Features of Afya Imara Seniors Cover
The Afya Imara Seniors Cover is designed to offer flexibility, affordability, and comprehensive healthcare access. Below are the standout features that make it a top choice for senior medical insurance in Kenya:
- Lifetime Coverage: Once enrolled, policyholders can renew their cover for life, subject to Old Mutual’s renewal review, ensuring long-term healthcare security.
- Wide Geographical Coverage: Access to Old Mutual’s extensive network of hospitals across East Africa (Kenya, Uganda, Tanzania, Rwanda, and South Sudan), with overseas referrals for treatments unavailable locally.
- Convenient Evacuation Services: Road evacuation is available for all cover limits, while air evacuation is provided for limits above KES 1 million. Overseas emergency treatment is covered for up to 60 days on a reimbursement basis.
- Affordable Premiums: No excess charges for inpatient cover, installment payment options through Insurance Premium Financing (IPF), and a no-claim discount (NCD) to reduce costs for claim-free years.
- Comprehensive Benefits: Covers inpatient and outpatient services, chronic conditions, dental and optical care, and critical illnesses like cancer, heart attack, stroke, kidney failure, and paralysis with a cash payout of KES 750,000 upon first diagnosis.
Coverage Details and Inpatient Limits
The Afya Imara Seniors Cover offers a range of inpatient limits to suit different budgets and healthcare needs, from KES 500,000 to KES 10 million. Below is a detailed breakdown of the inpatient benefits and associated waiting periods:
| Benefit | Waiting Period | Option I (KES 500,000) | Option II (KES 1M) | Option III (KES 3M) | Option IV (KES 5M) | Option V (KES 10M) |
|---|---|---|---|---|---|---|
| Bed Type | – | General Ward (Max KES 8,000) | General Ward (Max KES 10,000) | Standard Private Room (Max KES 18,000) | Standard Private Room (Max KES 18,000) | En Suite (Max KES 26,000) |
| Emergency Evacuation | No waiting period | Road Ambulance | Road Ambulance | Road & Air Ambulance | Road & Air Ambulance | Road & Air Ambulance |
| Accidents | No waiting period | To overall limit | To overall limit | To overall limit | To overall limit | To overall limit |
| Acute Conditions | 28 days (illness) / 60 days (surgical) | To overall limit | To overall limit | To overall limit | To overall limit | To overall limit |
| Newly Diagnosed Chronic Illnesses | 28 days (illness) / 60 days (surgical) | 350,000 | 700,000 | 2,000,000 | 2,500,000 | 3,500,000 |
| Chronic, Pre-existing, Congenital, HIV/AIDS | 1 year | 250,000 | 400,000 | 700,000 | 800,000 | 1,000,000 |
| Organ Transplant (excl. donor costs) | 1 year | 100,000 | 200,000 | 200,000 | 300,000 | 500,000 |
| Psychiatric/Psychological Illnesses | 1 year | 200,000 | 300,000 | 500,000 | 500,000 | 700,000 |
| Post-Hospitalization (Reimbursement) | 21 days post-discharge | 20,000 | 20,000 | 30,000 | 30,000 | 30,000 |
| Non-Accident Dental Surgery | 1 year | 150,000 | 150,000 | 200,000 | 200,000 | 250,000 |
| Non-Accident Eye Treatments | 1 year | 150,000 | 150,000 | 200,000 | 200,000 | 200,000 |
| Accident-Related Dental/Ophthalmological | No waiting period | 500,000 | 1,000,000 | 3,000,000 | 5,000,000 | 5,000,000 |
| Illness-Related Reconstructive Surgery | 1 year | 200,000 | 200,000 | 250,000 | 300,000 | 300,000 |
| Non-Accident Maxillofacial Surgery | 1 year | 200,000 | 300,000 | 400,000 | 400,000 | 500,000 |
| Gynecological Surgery | 1 year | 200,000 | 300,000 | 400,000 | 400,000 | 500,000 |
| Surgical Implants/Prostheses | Condition-specific | 300,000 | 300,000 | 400,000 | 400,000 | 500,000 |
| Last Expense (Per Member) | As per illness/accident | 75,000 | 100,000 | 100,000 | 150,000 | 150,000 |
| Passive War/Terrorism | No waiting period | 300,000 | 500,000 | 700,000 | 1,000,000 | 1,000,000 |
| COVID-19 Treatment (Moderate) | 28 days (illness) / 60 days (surgical) | 250,000 | 250,000 | 250,000 | 250,000 | 250,000 |
| COVID-19 Treatment (Critical ICU/HDU) | 28 days (illness) / 60 days (surgical) | 500,000 | 1,000,000 | 1,000,000 | 1,000,000 | 1,000,000 |
Outpatient Benefits
The outpatient cover is optional and requires the purchase of inpatient cover. It ranges from KES 100,000 to KES 200,000, covering:
- Routine Outpatient Services: Consultations, diagnostics, drugs, and dressings.
- Medical Check-Ups: Included within the outpatient limit.
- Pre-existing and Chronic Conditions: Covered after a 1-year waiting period.
- Dental Benefits: Up to KES 20,000 for fillings, extractions, root canals, and scaling (excludes crowns, caps, bridges, orthodontics, dentures).
- Optical Benefits: Up to KES 20,000, with frames replaceable every two years (max KES 8,000; excludes plano, photochromatic, antiglare lenses).
- Annual Wellness Check-Ups: KES 5,000–10,000, depending on the limit.
Co-Pays:
- Nairobi Hospital, Aga Khan, Pandya, Karen, AAR, MP Shah: KES 2,000.
- Other providers: KES 1,000.
Premium Rates for Afya Imara Seniors Cover
The premium rates for Afya Imara Seniors Cover are structured to accommodate various budgets, with inpatient and outpatient options clearly defined. Below are the annual premium rates:
Inpatient Premiums (Per Person)
- KES 500,000 Limit: KES 116,352
- KES 1,000,000 Limit: KES 132,299
- KES 3,000,000 Limit: KES 178,535
- KES 5,000,000 Limit: KES 206,231
- KES 10,000,000 Limit: KES 229,049
Outpatient Premiums (Per Person)
- KES 100,000 Limit: KES 94,968
- KES 150,000 Limit: KES 101,270
- KES 200,000 Limit: KES 107,534
Dental and Optical Premiums (Per Person)
- Dental (KES 20,000): KES 16,176
- Optical (KES 20,000): KES 16,176
Note: All premiums include a 0.45% levy and KES 40 stamp duty. Outpatient cover requires inpatient cover, and dental/optical benefits must be purchased together. The outpatient limit is tied to the inpatient limit, as outlined in the rules of selection.
Eligibility and Application Process
To enroll in the Afya Imara Seniors Cover, individuals must meet the following criteria:
- Age: 65 to 80 years (age next birthday). Existing members can renew for life, subject to Old Mutual’s review.
- Dependents: Only one legal spouse is eligible. Dependents under 65 years are covered under other Afya Imara plans (e.g., Afya Imara, Afya Imara County, or Afya Imara Junior).
- Medical Report: All applicants must submit a medical report from a designated Old Mutual panel provider. Coverage is subject to written acceptance by Old Mutual after review.
- NHIF Integration: Where applicable, hospital bills are settled net of NHIF benefits, per NHIF guidelines.
How to Sign Up
- Visit a Branch: Contact any Old Mutual branch or an authorized agent/broker.
- Phone: Call +254 (0) 711 065 100 or +254 (20) 2850 000.
- Email: Reach out to medicalretailretention@oldmutual.co.ke.
- Website: Visit oldmutual.co.ke for more details or to request proposal forms.
Applicants must complete an application form, attach relevant documents, and provide proof of payment. Medical cards are issued to all members for seamless access to healthcare providers.
Exclusions Under Afya Imara Seniors Cover
While the cover is comprehensive, certain treatments and conditions are excluded to maintain affordability and clarity. Key exclusions include:
- Cosmetic and Elective Procedures: Cosmetic surgery (unless accident-related), weight management treatments, and beauty treatments in nature cure clinics or health spas.
- High-Risk Activities: Injuries from professional or hazardous sports (e.g., bungee jumping, paragliding).
- Non-Medical Treatments: Alternative treatments (e.g., chiropractic, acupuncture, herbalism) and self-prescribed treatments.
- Other Insurance Coverage: Expenses recoverable under NHIF, GPA, WIBA, or other insurance plans.
- Specialized Equipment: Diagnostic devices like glucometers or BP machines.
- Maternity: Maternity and related complications are not covered.
- Experimental or Unapproved Treatments: Includes treatments for infertility, drug addiction, or those involving nuclear contamination.
For a complete list, refer to the official policy document available on Old Mutual’s website.
Why Choose Afya Imara Seniors Cover?
The Afya Imara Seniors Cover stands out in Kenya’s insurance market for several reasons:
- Tailored for Seniors: Specifically designed for individuals aged 65–80, addressing age-related health concerns like chronic illnesses and critical conditions.
- Critical Illness Benefit: A unique KES 750,000 cash payout upon first diagnosis of critical illnesses (e.g., cancer, stroke, heart attack), bridging treatment cost gaps.
- Flexible Payment Options: Installment plans through IPF make premiums manageable for seniors and their families.
- Extensive Hospital Network: Access to top private and mission hospitals across East Africa, with overseas referrals for specialized care.
- No-Claim Discounts: Policyholders who don’t file claims can benefit from reduced premiums starting from the third year.
Comparing Afya Imara Seniors with Other Plans
When choosing medical insurance for elderly parents in Kenya, it’s worth comparing Afya Imara Seniors with alternatives like Jubilee Afya Senior Plan, Britam Afya Milele, or CIC Senior Citizen Cover. Here’s how it stacks up:
- Jubilee Afya Senior Plan: Covers seniors up to 79 years with no strict age limit post-enrollment. Includes funeral benefits and chronic illness coverage but may have higher premiums for similar limits.
- Britam Afya Milele: Focuses on chronic conditions like cancer and dialysis, with access to top hospitals like Nairobi Hospital and Aga Khan. Premiums may vary based on coverage level.
- CIC Senior Citizen Cover: Offers cashless treatment at private hospitals and includes specialist consultations, but age restrictions may apply.
Afya Imara Seniors is competitive due to its lifetime renewal option, critical illness cash benefit, and no-excess inpatient cover, making it a cost-effective choice for comprehensive care.
Tips for Choosing Senior Medical Insurance in Kenya
Selecting the right health cover for elderly parents requires careful consideration. Here are practical tips to guide your decision:
- Assess Health Needs: Consider pre-existing conditions, chronic illnesses, or frequent medical requirements (e.g., dialysis, cancer treatment).
- Compare Premiums and Benefits: Evaluate inpatient and outpatient limits, co-pays, and additional benefits like dental or optical care.
- Check Hospital Networks: Ensure the plan includes access to preferred hospitals, such as Aga Khan, Nairobi Hospital, or MP Shah.
- Understand Waiting Periods: Chronic conditions often have a 1-year waiting period, so plan enrollment accordingly.
- Explore Diaspora Options: For Kenyans abroad, Afya Imara Seniors and similar plans allow premium payments from overseas for parents in Kenya.
The Old Mutual Afya Imara Seniors Cover is a robust and affordable medical insurance solution for Kenya’s elderly, offering comprehensive inpatient and outpatient benefits, lifetime coverage, and access to a wide hospital network. With flexible premium options, critical illness benefits, and no-excess inpatient cover, it addresses the unique healthcare needs of seniors aged 65 to 80. Whether you’re seeking affordable senior healthcare in Kenya or a plan that covers chronic conditions and emergencies, Afya Imara Seniors is a strong contender.
For more details or to enroll, visit oldmutual.co.ke, contact Old Mutual at +254 (0) 711 065 100, or email medicalretailretention@oldmutual.co.ke. Secure your loved ones’ health today and ensure peace of mind for the future.
