Registration and Benefits of Edu Afya: Comprehensive Medical Insurance Cover for Secondary School Students.
The Ministry of Education signed a contract with NHIF to provide medical insurance for all Public Secondary School Students for the duration of their Study.
Who is eligible?
- Any Student who is in a Public Secondary school.
- Registered by NHIF through the NEMIS database.
- Only the Student shall be covered.
How to Register
- Register the Student on Nemis Database.
- The data shall be shared by the Ministry of education to NHIF for registration.
- The student shall be physically present during bio-metric registration.
Note: Dependent /Parents shall not be covered.
Benefits Package and Nature of Service – WHAT IS COVERED
OUTPATIENT
General Out-patient Services:
Outpatient services are provided by or on the order of a clinician/ physician who is licensed as a general practitioner.
Specialized Out-patient Services:
Outpatient services are provided by or on the order of a physician who is licensed as a specialist or consultant and to whom a Member has been referred to by a general practitioner/Primary Care clinician where a member was registered.
This caters for all routine outpatient services as per Kenya’s essential package for health subject to policy terms and conditions.
Referral for specialized services which includes the following:
- Drug and Substance Abuse Rehabilitation Services
- Renal services and dialysis
- Specialized radiological diagnostic services
- Chronic ailment services such as Diabetes and Hypertension, Ultrasound. ECG.
- Cancer medical care and treatment services include radiotherapy services, chemotherapy services, or surgical intervention subject to preauthorization by the fund.
DENTAL COVER
This benefit caters for outpatient dental procedures, which include but not limited to:
- Extraction.
- Root canal.
- Dental X-ray Services.
- Accident-related inpatient Dental cases will be covered under the standard inpatient surgical benefits to the full inpatient limit.
OPTICAL COVER
This benefit caters for expenses related to eye treatment, including the cost of:
- Consultation.
- Eye testing.
- Prescription for ophthalmic treatment and prescription of eyeglasses.
- Accident-related inpatient optical cases will be covered under the standard inpatient benefits to the full inpatient limit.
Last Expense / Group LLife
This shall be paid to the declared dependents next to km upon a student’s demise.
INPATIENT Edu Afya: Medical Cover
Inpatient shall be on a referral basis from the selected outpatient Health Care Provider. This cover includes medical and surgical conditions which require admission.
It includes the following:
- Hospital accommodation charges
- Pre-hospitalization diagnostic services
- Doctor’s (physician, surgeon 8 anesthetists) fees.
- Nursing charges
- Drugs/medicines, dressings, and internal surgical appliances.
- Diagnostic, laboratory, or other medically necessary services
- Rehabilitation services
- Operating theater services
- Radiological diagnostic e.g. x-ray services, CT scan MRI, ECG
- In-patient physiotherapy.
Daycare surgery surgical procedures that do not require an overnight stay.
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Emergency Road Rescue
The Emergency Road Rescue Ambulance services for transportation and transfer of a sick member for treatment from a place of incident or facilities where adequate care is not available to the next available NHIF-accredited hospital or medical facility within the territorial limits of Kenya.
Emergency Air Rescue
The Emergency Air Rescue Services will be provided for the transportation and transfer of an injured member to an NHIF-accredited facility within the territorial limits of Kenya, where adequate medical care is available.
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Overseas Treatment
Treatment costs arising from a condition that warrants treatment overseas because the treatment is not available in Kenya will be covered subject to preauthorization from NHIF.
