Hospitals covered
Madison Insurance – Health Coverage Details
1. Insurance Overview
Madison Insurance’s BetterLife plan is designed for individuals, families, and small businesses, offering flexible health coverage with a wide panel of healthcare providers and value-added benefits for everyday medical needs and serious care.
2. What Madison Covers
| Service Type | Coverage / Benefit |
|---|---|
| Inpatient (Hospitalisation) | Covered, with different limit options (up to KSh 5,000,000 in some plans). |
| Outpatient (GP & Specialist) | Covered – includes consultations, lab tests, and diagnostics. |
| Maternity & Newborn | Maternity care (including pre-/post-natal) is included within inpatient; ultrasounds and pre-natal visits covered in outpatient. Madison Group Limited |
| Diagnostic Tests | Lab tests, pathology, and imaging (within outpatient/inpatient limits) are covered. Madison Group Limited |
| Dental & Optical | These are part of the outpatient benefit under BetterLife plans. Madison Group Limited |
| Chronic / Pre-existing Conditions | Covered, but subject to waiting periods. Madison Group Limited |
| COVID-19 Treatment | Exclusive COVID-19 inpatient cover (limit depends on plan). Madison Group Limited |
| Wellness / Value-Added | 24/7 careline, flexible coverage, and health check options. Madison Group Limited |
3. Coverage Limits
Inpatient limit: range depending on the plan, up to KSh 5,000,000 in some BetterLife plans. Madison Group Limited
Outpatient limit: plan-dependent (BetterLife allows different annual outpatient limits). Madison Group Limited
Maternity, dental, and optical benefits also have sub-limits as part of the outpatient or inpatient components. The Star
4. Pre-Authorization / Approval Requirements
Hospital admissions (inpatient) may require pre-authorization or prior approval.
Major procedures or maternity stays may need approval as per policy schedule (check with Madison).
5. Co-Pay / Co-Insurance
Depending on the specific BetterLife plan, there may be co-pay or co-insurance for outpatient services.
Premiums and co-pay details depend on the plan selected (Premier, Executive, Budget). Madison Group Limited
6. Waiting Periods
According to Madison’s BetterLife policy:
No waiting period for accidents. Madison Group Limited
30 days for outpatient illnesses and non-chronic inpatient admissions. Madison Group Limited+1
10 months for maternity (normal or complications). Madison Group Limited
1 year for chronic, congenital illnesses, and certain surgeries (fibroids, hernia repair etc.). Madison Group Limited
2 years for cancer treatment and organ transplants. Madison Group Limited
7. How to Use Madison Cover at a Hospital
Present your Madison BetterLife insurance card or policy number during hospital registration.
Provide valid identification (e.g., national ID).
For inpatient admissions or maternity cases, notify Madison early or request pre-authorization if required by your plan.
The hospital bills Madison directly (if in-network), or you submit your claims/documentation as required by your policy.
8. Required Documents
Medical application form (filled out when enrolling). Madison Group Limited
National ID / Passport for principal and spouse (if any). Madison Group Limited
Birth certificates for dependents under 18, and proof of schooling for dependents 19–25 (if applicable). Madison Group Limited
Proof of premium payment / renewal documentation.
9. Exclusions
Treatments for extreme sports, war, or civil unrest. Madison Group Limited
Chiropractors, herbalists, acupuncturists are not covered. Madison Group Limited
Optical laser surgery (unless stated) has waiting periods. Madison Group Limited
Organ transplant and cancer have long waiting periods (2 years) before benefits apply. Madison Group Limited
10. SME / Group Plan Unique Features
The SME BetterLife plan offers flexible benefit structures for small businesses. Madison Group Limited+1
Includes 24/7 medical emergency assistance. The Star
Parent accommodation when a child is hospitalised under the SME plan. The Star
After-care and home nursing are available post-hospitalisation. The Star
Ambulance services (private) coverage for SME plan. The Star
11. Contact / Support
Madison Healthcare 24/7 Care Line: 0709-922 555 Madison Group Limited
Application / Enrollment can be done via their BetterLife web form. Madison Group Limited
12. Disclaimer
This summary is based on publicly available Madison BetterLife policy brochures and benefit summaries. Actual coverage, benefits, and limits depend on your specific plan and policy schedule. Always review your policy document or speak with Madison directly to confirm all terms before seeking treatment.