Hospitals covered
CIC Insurance – Health Coverage Details
1. Insurance Overview
CIC Insurance Group is a major insurer in Kenya, offering various health insurance products—including family medical plans and cooperative (Sacco) health cover. Their health offers are designed to serve individuals, families, seniors, and cooperative groups with a balance of core inpatient cover and optional outpatient, maternity, dental, and optical benefits. CIC Kenya+2CIC Kenya+2
2. What CIC Covers Under Medical Plans
| Service Type | Coverage / Benefit |
|---|---|
| Inpatient (Hospitalisation) | Covered in most CIC plans (Afya Bora, Family Medisure, Seniors). Includes general ward, surgical fees, and hospital bed costs. CIC Kenya+2CIC Kenya+2 |
| Outpatient (GP & Specialist) | Covered under certain plans: e.g., CIC Afya Bora provides outpatient benefit up to a fixed limit. CIC Kenya |
| Maternity & Newborn Care | CIC Afya Bora covers antenatal care (with up to one ultrasound), post-natal care, and childbirth (normal or C-section). CIC Kenya |
| Laboratory & Diagnostics | Routine lab tests, X-ray, ultrasound are covered under Afya Bora. CIC Kenya |
| Chronic / Pre-existing Conditions | Covered in some plans: Afya Bora covers pre-existing, chronic, cancer up to a sub-limit; Seniors Mediplan also provides chronic cover. CIC Kenya+1 |
| Psychiatry / Mental Health | CIC Afya Bora includes psychiatry / psychotherapy services. CIC Kenya |
| Dental & Optical | Available in some plans (e.g., Family Medisure, CoopCare). Scribd+1 |
| Last Expense / Funeral | Some plans (CoopCare) include last-expense cover, paid on death. CIC Kenya |
| Home Nursing / Rehabilitation | For some senior covers (Seniors Mediplan), home nursing is included under inpatient benefits. KenGen SRS |
| Personal Accident | In some Medisure / Seniors plans, personal accident is part of benefits. Scribd |
| COVID-19 Treatment | Included under some plans (for example, Seniors Mediplan). CIC Kenya |
3. Coverage Limits
Afya Bora: In-patient limit is KSh 250,000 per family per year; outpatient limit is KSh 50,000 per family per year. CIC Kenya
Family Medisure: Depending on the tier, in-patient cover can go up to KSh 2,000,000 for the top plan. Scribd
Seniors Mediplan: In-patient and outpatient limits vary; e.g., inpatient up to KSh 5,000,000 in some structures. CIC Kenya
CoopCare (Cooperative plan): In-patient options go up to KSh 300,000, outpatient up to KSh 50,000, maternity up to KSh 25,000, dental & optical up to KSh 7,500. CIC Kenya+1
4. Pre-Authorization / Approval Requirements
In-patient stays (hospital admission) generally require prior authorization from CIC for many of its health plans. CIC Kenya
High-cost diagnostics or treatment (such as day surgery) may also need pre-approval depending on the plan.
5. Co-Pay / Co-Insurance
For Afya Bora, outpatient consultations have a co-pay: KSh 100 per visit. CIC Kenya
Other plans (e.g., Medisure) may have different cost-sharing structures depending on the tier and your policy schedule.
6. Waiting Periods
For Afya Bora: Pre-existing and chronic conditions have a 6-month waiting period. CIC Kenya
For other plans, waiting periods depend on product and underwriting; e.g., maternity benefits typically begin after a waiting period. (As common in standard health plans.)
7. How to Use CIC Cover at a Hospital
Present your CIC health insurance card and policy number when registering at the hospital.
Provide valid ID (e.g., national ID or passport) when checking in.
For planned admissions or maternity, inform CIC early / apply for pre-authorization.
Once treated, the hospital bills CIC (in-network) or you submit the claim as per your policy.
8. Required Documents
CIC Insurance policy card or proof of membership.
National ID or passport for principal and dependents.
Pre-authorization request or letter (if required for inpatient).
Maternity: any enrollment documentation as required by your plan.
9. Exclusions
Common exclusions for CIC health plans (especially Afya Bora) include:
Infertility treatments. CIC Kenya
Alternative medicine (e.g., herbal medicine, chiropractic, homeopathy). CIC Kenya
Experimental or unapproved medical treatments. CIC Kenya
External surgical appliances (e.g., wheelchairs, hearing aids) are not covered. CIC Kenya
Optical and dental treatment if not resulting from an accident (or depending on plan). CIC Kenya+1
10. Value-Added / Unique Features
CoopCare Program: A medical cover tailored for cooperative (Sacco) members with affordable premiums, offering inpatient, outpatient, maternity, dental, optical, and last expense benefits. CIC Kenya
Seniors Mediplan: Designed for older members (60–80 years), it includes inpatient, outpatient, dental, optical, chronic conditions, home nursing, and even geriatric assessments. CIC Kenya
Flexible Benefit Options: For Medisure and other plans, there are different tiers (essential, standard, comprehensive, superior) depending on cover limits and included benefits. Scribd
11. Hospital & Insurer Contact Details
CIC Insurance General Inquiries / Claims: Use contact details listed on their website or on your policy document. (CIC HQ phone: +254 20 282 3000) CIC Kenya
CoopCare Inquiry: For cooperative-based health cover questions, contact CIC via their Cooperatives Solutions team. CIC Kenya
12. Disclaimer
This summary is based on publicly available CIC Insurance product documents (Afya Bora, Medisure, CoopCare, Seniors). Coverage, limits, waiting periods, and benefits may vary depending on the exact policy or plan you have. Always check your policy schedule or speak with CIC directly before seeking treatment.