The Britam Premier Milele Health Plan is a comprehensive private medical insurance cover designed to give individuals and families access to quality healthcare in Kenya and abroad. The plan provides lifetime cover through annual renewal and offers both inpatient and optional outpatient, maternity, dental and optical benefits.
This guide breaks down the benefits, coverage limits, eligibility rules, exclusions, and frequently asked questions to help you understand how the Premier Milele plan works.
Overview of the Premier Milele Health Plan
The Premier Milele plan gives members access to all hospitals, clinics and healthcare providers on the Britam medical panel. It is built to offer broad protection, including inpatient treatment, critical illness benefits, personal accident cover, evacuation, maternity, wellness checks and funeral benefits.
Key Highlights
- Lifetime cover subject to annual renewal
- Minimum premium of KES 11,099
- Free personal accident cover
- Critical illness cash benefit for 5M and 10M inpatient limits
- Annual wellness checkup from the 13th month
- Funeral cover within inpatient limits
- COVID-19 treatment covered
- Access to broad Britam hospital panel
Inpatient Cover Benefits
The inpatient benefit covers hospital admission and treatment for illness, accidents or surgery. Coverage includes:
- Hospital accommodation
- Doctors, surgeons, anesthetists, nursing care, drugs and dressings
- Theatre, ICU and HDU charges
- MRI, CT scan, pathology and diagnostic tests while admitted
- Daycare surgery under general anesthesia
- Home nursing care for up to 60 days subject to pre-authorization
- Lodger fee for accompanying parent for children up to 10 years
- Internal and external surgical implants
- Joint replacements and prostheses
- Emergency evacuation by road or air
- Emergency treatment while on holiday or business travel
- Overseas referral treatment through Britam approved Indian hospitals
- Accidental dental and optical treatment
- Newly diagnosed chronic conditions
- Pre-existing chronic conditions after a 12-month waiting period
- Psychiatric and mental wellness treatment
- Congenital conditions after a 12-month waiting period
- Last expense cover within inpatient limit
- Organ transplant after a two-year waiting period
Inpatient Sublimits by Plan Type
Plan limits available: 300,000, 500,000, 1,000,000, 2,000,000, 3,000,000, 5,000,000 and 10,000,000.
Examples of sublimits include:
- Newly diagnosed chronic conditions: from 150,000 up to 1,000,000
- Pre-existing chronic ailment and cancer treatment: from 100,000 up to 1,000,000
- Psychiatric treatment: from 50,000 up to 400,000
- Congenital conditions: from 50,000 up to 500,000
- Last expense: from 30,000 up to 150,000
- Non-accidental dental or optical: from 50,000 up to 200,000
- Annual wellness checkup: from 5,000 up to 30,000
- Personal accident benefit: from 40,000 up to 1,000,000
- Critical illness benefit for higher limits: up to 500,000
- COVID-19 hospitalization cover: from 100,000 up to 1,000,000
Room limits vary based on plan level, from general ward to private room with bath and basin.
Optional Benefits
Outpatient Cover
Outpatient limits range from KES 50,000 to 200,000.
Scope includes:
- Routine doctor consultations and specialist referrals
- Laboratory tests, X-rays, ultrasound, CT and MRI
- Physiotherapy
- Prescribed drugs and dressings
- Pre and post natal visits including two ultrasound scans
- HIV and AIDS treatment and prescribed ARVs
- Chronic and recurring conditions
- Vaccinations for children up to 18 months
- Psychiatric counselling
- Home based COVID-19 care up to KES 15,000
Co-pay of KES 1,500 applies at specific hospitals including Aga Khan, The Nairobi Hospital, Gertrude’s and others.
Maternity Cover
Maternity cover limits range from KES 80,000 to 300,000.
Dental Cover
Dental limits range from KES 10,000 to 40,000.
Optical Cover
Optical limits range from KES 10,000 to 40,000, including laser treatment.
Eligibility Rules
- Minimum entry age: from birth, after clinical discharge
- Maximum entry age: 75 years
- No maximum exit age
- Children covered up to 25 years with proof of schooling
- Senior citizens above 55 require medical tests from Britam-approved providers
- NHIF membership is compulsory
- Transfers from previous insurers allowed with proof of active cover
- Waiting periods waived only for equivalent benefits enjoyed previously
- Renewal depends on claim performance
Exclusions
The plan does not cover:
- Self-referral or self-prescribed treatment
- Infertility and impotence treatment
- Intentional self-injury, suicide, alcoholism or drug abuse
- Hazardous sports
- Cosmetic treatment unless accident-related
- Experimental treatment
- Weight management
- External appliances like crutches and wheelchairs
- Dental prostheses
- Alternative medicine unless referred
- Nutritional supplements
- Menopause or puberty related treatments
- Hearing aids
- Non-disclosure of pre-existing conditions
- Treatment outside approved panel
- Donor-related transplant costs
- Expenses above policy limits
Frequently Asked Questions
What are chronic or recurrent conditions?
Long-term illnesses that have no cure, may recur, require lifelong treatment or cause permanent disability.
What are pre-existing conditions?
Any illness or symptom that existed before joining the plan.
What are congenital conditions?
Medical conditions present at birth or caused by genetic factors.
What happens if I already had another cover?
Provide proof of benefits enjoyed. Waiting periods will be waived for equivalent benefits only. Accidents and acute illnesses are covered immediately.
What happens if I fail to disclose a condition?
Non-disclosure may lead to denial of cover for that condition or cancellation of the policy.
What documents do I need for treatment?
Carry your Britam medical card and national ID or passport.
How do I enroll a newborn?
Notify Britam immediately, submit birth notification and complete an application. Cover begins after confirmation and payment.
What do I receive after buying the Milele cover?
- Membership card
- Welcome letter
- Policy document
- List of hospitals and providers
Payment and Contact Information
Britam General Insurance Company (Kenya) Ltd
Britam Center, Upper Hill, Nairobi
Tel: 0709 165 000
Email: milele@britam.com
