Hospitals covered
Old Mutual Insurance – Health Coverage Details
1. Insurance Overview
Old Mutual (Kenya) provides a range of medical insurance plans under its Afya Imara brand, tailored for individuals, families, and senior citizens. These plans combine inpatient care, outpatient services, and additional benefits like optical, dental, and critical illness protection. Business Now+2MoneyVersations+2
2. What Old Mutual Covers Under Its Health Plans
| Service Type | Coverage / Benefit |
|---|---|
| Inpatient (Hospitalisation) | Hospital stays (ward, surgery, ICU) are covered up to different benefit limits. KenGen S RBS+2Step by Step Insurance+2 |
| Outpatient (GP & Specialist) | Optional outpatient cover is available depending on the plan. Includes consultations, diagnostics, and prescribed medicines. Step by Step Insurance+1 |
| Maternity & Newborn Care | Covers antenatal, delivery (normal and C-section), and post-natal care under certain plan options. Step by Step Insurance |
| Laboratory & Diagnostics | Lab tests, X-rays, and other diagnostic services are supported under inpatient and (where added) outpatient benefits. Step by Step Insurance |
| Chronic / Pre-existing Conditions | Conditions like HIV/AIDS, congenital diseases, and chronic illnesses are covered, typically after a waiting period. Step by Step Insurance |
| Dental & Optical | These are optional add-ons in some plans. MoneyVersations+1 |
| Emergency / Evacuation | Some plans offer road and air ambulance evacuation, especially in more comprehensive tiers. Step by Step Insurance |
| Post-Hospitalisation Care | After discharge, follow-up outpatient care is covered (e.g., diagnostics, dressings, physiotherapy) for a limited period. KenGen S RBS |
| Critical Illness Cash Benefit | On first diagnosis of critical illnesses like cancer, stroke, heart attack, kidney failure or paralysis, Old Mutual pays a lump sum (e.g., KES 750,000). Business Now |
| COVID-19 Treatment | Some plans (e.g., Afya Imara Seniors) include COVID-19 treatment for moderate and critical cases. HapaKenya |
3. Coverage Limits
For the Afya Imara Seniors plan, inpatient limits range from KES 500,000 to KES 10,000,000. Business Radar+1
Outpatient optional cover for the Seniors plan ranges from KES 50,000 to KES 200,000. Business Radar
For Afya Imara County Cover (another Old Mutual plan), different inpatient options are available (e.g., KES 100,000; 250,000; 500,000; 1,000,000) with corresponding outpatient limits. Step by Step Insurance
4. Pre-Authorization / Approval Requirements
Hospital admissions and some major procedures require pre-authorization from Old Mutual. KenGen S RBS+1
Post-hospitalization follow-up costs (e.g., diagnostics and physiotherapy) must be claimed within a short window after discharge. KenGen S RBS
5. Co-Pay / Co-Insurance
For some outpatient plans, there is a co-pay (for example, under the Afya Imara Seniors plan). According to sources, co-pay per outpatient visit is about KES 1,000–2,000 depending on provider. Business Radar
Inpatient excess/co-pay details may depend on the specific tier of the plan.
6. Waiting Periods
For the Afya Imara Seniors plan: 28 days waiting for general illness, 60 days for surgical conditions. Scribd+1
Chronic and pre-existing conditions generally have a 1-year waiting period for full cover in some plans. Step by Step Insurance
7. How to Use Old Mutual Cover at a Hospital
Present your Old Mutual Afya Imara insurance card and policy number on hospital registration.
Provide valid ID (e.g., national ID) when checking in.
If admitted, have the hospital request pre-authorization from Old Mutual (if required for your plan).
After treatment, hospital bills may be submitted to Old Mutual directly (if in-network) or you may submit claims, depending on plan setup.
8. Required Documents
Old Mutual medical insurance card or membership proof.
Valid government-issued ID (for principal and dependents).
Pre-authorization form / letter (for inpatient admissions).
Documents for critical illness claim (if claiming the lump-sum benefit).
9. Exclusions
Some common exclusions or limits:
Cosmetic or elective surgery (unless due to an accident) is typically excluded. KenGen S RBS
Experimental or unapproved treatments may not be covered.
Members must use Old Mutual’s approved panel of hospitals for certain benefits. Scribd+1
Some plans may exclude certain services outside pre-defined benefit limits or network terms.
10. Value-Added / Unique Features
Critical Illness Cash Benefit: Lump sum on first diagnosis of major illness (e.g., cancer, stroke). Business Now
Post-Hospitalization Benefit: Covers follow-up outpatient care (diagnosis, drugs, dressings) within a limited timeframe. KenGen S RBS
Flexible Cover Options: Plans with different inpatient and outpatient tiers (e.g., for senior citizens, county-level cover). Step by Step Insurance
Evacuation (Medical Transport): Road and air evacuation included in some plans for emergencies. Step by Step Insurance
11. Hospital & Insurer Contact Details
Old Mutual / UAP-Old Mutual Customer Care: Depends on your policy – check your policy document or insurer website for claims and pre-authorization contacts.
Critical Illness Claims: Use the Old Mutual life or health business contact (as per policy).
12. Disclaimer
This information is based on publicly available Old Mutual (Kenya) health insurance product details (Afya Imara, Seniors, County). Actual benefits, waiting periods, and limits depend on your specific policy or plan waiting-period schedule. Always confirm your coverage details directly with Old Mutual or via your policy contract before seeking care.