Diamond Plan
DIAMOND PLAN
CENTRAL HEALTH MEDICAL AID
| SERVICE | COVERAGE |
| OUT – PATIENT BENEFITS | |
| GP & Specialist Consultation | Up to K 480,000.00 |
| Lab tests | Up to K 650,000.00 at all hospitals |
| Radiology | Up to K 480,000.00 at all hospitals |
| Occupational Health Services / Auxiliary | K 750,000.00 |
| Dentistry – Basic, Specialized and Orthodontics | Up to K 650,000.00 |
| Medicines, essential, generic | Up to K 450,000.00 |
| Maternity – Antenatal & Postnatal | Covered |
| Includes Obstetric Scans | |
| Optical – Lenses, Eye test, Frames | Up to K 250,000.00 |
| SERVICE | COVERAGE |
| IN-PATIENT BENEFITS | |
| Overall Limit | K 19,500,000.00 |
| Hospitalization | 100% subject to tariff General wards |
| Specialized subject to Pre-Authotrization | |
| Maternity – Child birth | 100% covered subject to Overall Limit and Pre-authorization |
| Specialized radiology | Up to K 2,300,000.00 (MRI Scans, CT Scans) |
| Take home drugs | Up to K 75,000.00 |
| External Medical Appliances | 100% covered subject to Overall Limit |
| Theatre costs – major procedures | 100% covered subject to Overall Limit |
| Psychiatric hospitalizations | 100% covered subject to Overall Limit |
| Opthalmology – procedures | 100% covered subject to Overall Limit |
| Ambulance Service | Up to K 3,100,000.00 |
| SERVICE | COVERAGE |
| CHRONIC DISEASE PROGRAM | |
| Oncology | Up to K 6,000,000.00 |
| Dialysis | Up to K 4,500,000.00 |
| Prescribed medicines | K 850,000.00 |
| Transplants | 100% covered subject to Overall Limit |
| SERVICE | COVERAGE |
| FOREGN TREATMENT | |
| Foreign referral – Patient and Guardian | 100% subject to tariff |
| 1 Economy class air ticket for guardian and upkeep up of K 800,000.00 | |
| Repatriation of remains | Up to K 2,000,000.00 |
| Air rescue / Cross border | 100% covered subject to Overall Limit |
| Emergency Outpatient Foreign Cover | K 300,000.00 – to be paid as a refund on production of receipts |
| FUNERAL BENEFIT | |
| Cash Pay Out | K300,000.00 |
| COVERAGE | PREMIUMS |
| MAIN MEMBER | K27,500.00 |