JCare Johari is sold as a combined inpatient and outpatient cover. You cannot purchase the two separately.
There are two cover options:
Plan A
- Inpatient: 200,000
- Outpatient: 40,000
Plan B
- Inpatient: 400,000
- Outpatient: 50,000
Key Inpatient Benefits
Hospitalization
- Covers general ward bed
- NHIF rebate applies to bed costs
COVID-19 hospitalization
- Up to 200,000 per family
Newly diagnosed chronic conditions
- Plan A: 50,000
- Plan B: 100,000
External aids (hearing aids and tests)
- 20,000 for both plans
Pre-existing and chronic conditions after one-year waiting period
- Plan A: 100,000
- Plan B: 200,000
These include:
- Cancer
- HIV and related treatment
- Congenital conditions
- Organ transplant
- Psychiatric conditions
- Gynaecological conditions
- Hernias, thyroidectomy, tonsillectomy and similar procedures
Day surgery
- Covered
Accident-related dental surgery
- Covered
Non-accident dental surgery (after one year)
- Plan A: 25,000
- Plan B: 40,000
Non-accident eye treatment (after one year)
- Plan A: 25,000
- Plan B: 40,000
Maternity (after one year)
- Plan A: 40,000
- Plan B: 50,000
- Covers normal delivery, C-section and complications
- Antenatal and postnatal outpatient costs are not covered
Medication after discharge
- Up to 14 days
Local road ambulance
- Covered
Occupational and speech therapy
- Up to 6 months within cover period
- Requires pre-authorization
Pain management
- Covered under pre-existing and chronic sub-limits
Last expense
- Plan A: 20,000
- Plan B: 25,000
Personal accident cover (principal member only)
- 100,000
Outpatient Benefits
COVID-19 testing
- 15,000 per family
Chronic and pre-existing conditions (after one year)
- Covered within outpatient limit
GP consultations
- Covered on approved provider panel
Specialist consultations (on referral)
- Covered within outpatient limit
Pathology, X-ray and basic diagnostic tests
- Covered on pre-authorization
Prescription drugs (up to 14 days)
- Covered
Annual medical check-up (main member and spouse)
- 10,000
Family planning
- IUCD and Norplant only
- 2,500
Routine pre-natal and post-natal outpatient care (after one year)
- Covered within outpatient limit
Routine baby immunisations (KEPI)
- Covered for children up to 1.5 years
Occupational and speech therapy
- Covered on pre-authorization
Pain management
- Covered under outpatient limit
Waiting Periods
- General illness: 30 days
- Accidents: No waiting period
- Chronic, pre-existing, maternity, gynaecological, non-accident dental and non-accident eye treatments: 1 year
- Newly diagnosed chronic conditions: 3 months
Who Is Eligible?
- Main member and spouse: 18 to 60 years (cover extends to 65 years once enrolled)
- Children: 0 days to 18 years
- Dependent children up to 25 years with proof of schooling
What Is Not Covered (Key Exclusions)
These are common exclusions across most low-cost medical insurance products in Kenya:
- Menopause, hormone replacement therapy and puberty-related treatment
- Genetic testing and genetic disorders
- Cosmetic surgery unless caused by an accident
- General wellness checks beyond the included annual check-up
- Vitamins, supplements and nutritional products
- Non-panel hospitals
- Reimbursement for bills paid out-of-pocket
- Herbal, acupuncture and alternative treatments
- Optical glasses and contact lenses
- Dental procedures such as cleanings, fillings and extractions
- Obesity treatment and weight loss surgeries
- Alcohol and drug-related conditions
- Fertility treatment
- Epidemics or pandemics except COVID-19 within specific limits
- Injuries from hazardous sports and racing activities
How Much the JCare Johari Plan Costs
Below are family premium estimates per year (excluding 0.45 percent training levy and 40 shillings stamp duty).
Plan A (IP 200,000 + OP 40,000)
- Member only: 25,564
- Member + 1: 35,749
- Member + 2: 45,936
- Member + 3: 56,121
- Member + 4: 66,307
- Member + 5: 76,492
Plan B (IP 400,000 + OP 50,000)
- Member only: 30,687
- Member + 1: 42,922
- Member + 2: 55,157
- Member + 3: 67,391
- Member + 4: 79,626
- Member + 5: 91,861
Answers to Common Questions
1. Can you buy inpatient only?
No. JCare Johari sells inpatient and outpatient as a single combined package.
2. Can you visit any hospital?
No. You must use the provider panel.
3. Does the cover allow refunds if you pay cash?
No. Reimbursement is not allowed.
4. Does it cover major chronic illnesses such as cancer?
Yes, but only up to the chronic sub-limits after the one-year waiting period.
5. Does it cover maternity?
Yes, after one year, but within low limits suitable for basic maternity support.
Who This Plan Suits Best
JCare Johari fits individuals or young families looking for:
- An affordable entry-level medical insurance option
- Coverage for common illnesses and basic emergencies
- Basic maternity support
- A plan with low premiums and defined limits
It is not suitable for high-cost treatment needs such as advanced surgeries, expensive chronic management or international hospital access.
