The Advantage Milele Health Plan is a comprehensive private medical insurance cover in Kenya designed to support individuals and families seeking wide inpatient and outpatient protection. It targets customers who require lifetime medical coverage subject to annual renewal, extensive chronic illness support and access to a broad hospital network.
This guide breaks down all the key benefits, sublimits, eligibility rules and exclusions to help you compare and understand the plan from a policyholder perspective.
Key Benefits of the Advantage Milele Health Plan
- Lifetime medical cover renewed annually
- Full coverage of pre-existing, chronic and congenital conditions up to the chosen inpatient limit
- Access to doctors, hospitals and clinics within the Britam provider panel
- Critical illness cash benefits available for high inpatient limits
- Funeral cover included
- Free personal accident cover
- COVID 19 treatment
- Annual wellness checkup after renewal
- Minimum annual premium of KSh 17,332
Optional additions include outpatient, maternity, dental and optical benefits.
Advantage Milele Plan — Key Coverage Limits by Plan Type
| Plan Type (Inpatient Limit) | New Chronic Limit | Dental (non-accident) | Optical (non-accident) | Last Expense | Wellness Checkup |
|---|---|---|---|---|---|
| KSh 300,000 | KSh 150,000 | KSh 50,000 | KSh 50,000 | KSh 30,000 | KSh 5,000 |
| KSh 500,000 | KSh 200,000 | KSh 75,000 | KSh 75,000 | KSh 50,000 | KSh 7,500 |
| KSh 1,000,000 | KSh 350,000 | KSh 100,000 | KSh 100,000 | KSh 75,000 | KSh 10,000 |
| KSh 2,000,000 | KSh 500,000 | KSh 125,000 | KSh 100,000 | KSh 100,000 | KSh 12,500 |
| KSh 3,000,000 | KSh 750,000 | KSh 150,000 | KSh 100,000 | KSh 100,000 | KSh 15,000 |
| KSh 5,000,000 | KSh 1,000,000 | KSh 200,000 | KSh 150,000 | KSh 100,000 | KSh 20,000 |
| KSh 10,000,000 | KSh 1,000,000 | KSh 200,000 | KSh 200,000 | KSh 150,000 | KSh 30,000 |
What the Inpatient Cover Includes
The inpatient component offers the following benefits:
- Doctors, physician and surgeon fees
- Anaesthetist charges
- Nursing care, drugs and dressings
- Surgical appliances and internal prostheses
- Theatre, ICU and HDU charges
- MRI, CT scans, pathology and diagnostic tests while admitted
- Daycare surgery requiring general anaesthesia
- Home nursing care with pre-authorization
- Lodger benefits for parents of children up to ten years
- Internal and external surgical implants and joint replacements excluding dental fixtures
- Emergency evacuation by road or air leading to admission
- Overseas treatment referrals within the Britam India panel
- COVID 19 treatment
- Accidental optical and dental treatment
Inpatient Sublimits by Plan Type
The plan is offered in tiers ranging from KSh 300,000 to KSh 10,000,000 in overall annual inpatient limits. The following sublimits apply:
Newly Diagnosed Chronic Conditions (excluding cancer and HIV)
- KSh 150,000 to KSh 1,000,000 depending on plan type
- Conditions diagnosed within six months of cover start may be treated as pre-existing
Pre-existing Chronic Ailments
- Covered to the full inpatient limit
HIV and Cancer Treatment
- Covered to the full inpatient limit
- Radiotherapy and chemotherapy require a twelve month waiting period
Psychiatric and Mental Wellness Treatment
- Covered to the full inpatient limit
Congenital Ailments
- Covered to the full limit
- Waiting period of twelve months waived if the mother was covered under maternity
Post Hospitalisation Treatment
- Up to thirty days after discharge on reimbursement
- Limited to between KSh 10,000 and KSh 50,000 depending on plan
Last Expense Within Inpatient Limits
- KSh 30,000 to KSh 150,000
Organ Transplant
- Covered within chronic illness sublimit
- Two year waiting period
Non Accidental Dental Treatment
- KSh 50,000 to KSh 200,000
Non Accidental Optical Treatment
- KSh 50,000 to KSh 200,000
Annual Wellness Checkup
- KSh 5,000 to KSh 30,000 starting from month thirteen
Additional Inpatient Benefits
Personal Accident Cover
- KSh 40,000 to KSh 1,000,000 depending on the plan
Critical Illness Cover
- Available for limits of KSh 5 million and KSh 10 million
- Two year waiting period
Hospital Accommodation
- General ward for lower limits
- Private rooms with varying caps for higher limits
COVID 19 Hospitalisation
- Covered across plan types
Alternate Cashback Benefit
A reimbursement option is available when an insured person receives adequate in-hospital treatment that is not billed to the insurer. This benefit requires:
- A completed claim form
- Doctor signature and stamp
- Hospital invoice or discharge summary
Maternity Cover
Maternity benefits are offered as a standalone option. Limits range from KSh 80,000 to KSh 300,000 depending on the selected plan.
Outpatient, Dental and Optical Options
Outpatient limits range from KSh 50,000 to KSh 200,000. Dental and optical optional limits range from KSh 10,000 to KSh 40,000.
Outpatient Scope of Cover
- Routine consultations and specialist referrals
- Diagnostic tests including X-rays, scans and ECG
- Pre-natal and post-natal services including two ultrasound scans
- Physiotherapy
- Prescribed drugs and dressings
- Chronic and recurring conditions including congenital issues
- HIV related treatment and ARVs
- Vaccinations for children up to one and a half years
- Psychiatric counselling
- Home based COVID 19 care up to KSh 15,000
Outpatient co-pay applies at select major hospitals.
Eligibility Rules
- Newborns can join after birth with a birth notification and application form
- Maximum entry age is 75 years
- No maximum exit age
- Senior citizens above 55 require a medical test
- Children between 18 and 25 years must provide proof of schooling
- Applicants must have NHIF
- Transfers from other insurers require proof of previous cover
- Waiting periods may be waived for benefits enjoyed previously
- Renewal is subject to performance of the cover
Key Exclusions
The plan does not cover:
- Self referred or self prescribed treatment
- Infertility and impotence
- Intentional self injury, suicide, substance abuse
- Hazardous sports
- Cosmetic treatment except where caused by accidental injury
- Experimental treatment
- Weight management
- Diagnostic equipment such as glucometers or BP machines
- External surgical appliances such as crutches and wheelchairs
- Dental prosthesis and cosmetic dental work
- Alternative medicine unless referred by a general practitioner
- Treatment recoverable from other sources
- Treatment outside the approved provider panel
- Nutritional supplements unless part of treatment
- Menopause and puberty related treatment
- Undisclosed pre existing or chronic conditions
- Costs related to donor transplants
Frequently Asked Questions
What is a chronic or recurrent condition?
A condition that has no cure, recurs, causes permanent disability or needs long term monitoring or supervision.
What is a pre existing condition?
A condition for which one has had symptoms or treatment before joining the policy.
What are congenital conditions?
Health conditions present at birth or caused by genetic factors.
What happens if I was insured by another provider?
Waiting periods can be waived for benefits previously enjoyed if proof is provided.
What is the effect of non-disclosure?
The cover will exclude the undisclosed conditions and may lead to cancellation.
What do I need to access services?
Carry your medical card and national ID or passport.
How do I enroll a newborn?
Notify the insurer immediately after birth, submit birth notification and application form, and wait for acceptance.
What documents do new customers receive?
A membership card, policy document, welcome letter and provider list.
