Westlands
Oakman Insurance Agency
Family Medical Insurance in Kenya
Reliable medical cover for you and your family.
Oakman Insurance Agency helps individuals and families access medical insurance options with inpatient and outpatient protection, maternity, dental, optical, chronic-condition and emergency-related benefits, subject to the selected plan and policy terms.
Unexpected medical expenses can put significant pressure on a family's finances. Family medical insurance helps protect against eligible healthcare costs arising from illness, accidents, hospitalisation and other covered medical conditions.
We help families compare medical insurance options according to family size, ages, healthcare needs and budget. Depending on the selected option, cover can combine inpatient and outpatient benefits with maternity, dental, optical, chronic and pre-existing condition benefits, emergency evacuation, personal accident and last expense benefits.
What Does Family Medical Insurance Cover?
Family medical insurance can combine hospitalisation and day-to-day healthcare benefits under one medical insurance arrangement. Depending on the selected option, benefits can include inpatient treatment, outpatient care, maternity, dental, optical, chronic and pre-existing conditions, emergency evacuation, personal accident and last expense protection.
Inpatient cover helps protect the family against eligible costs when an insured person requires hospital admission. Depending on the selected limit, this may include hospital accommodation, doctors' fees, prescribed medicines, nursing, diagnostic investigations, surgery, chemotherapy, radiotherapy, physiotherapy, day-care surgery and eligible post-hospitalisation care.
Outpatient cover provides access to eligible treatment without hospital admission. Benefits can include GP and specialist consultations, prescribed medication, laboratory tests, pathology, X-rays, CT scans, MRI, ECG, physiotherapy and other eligible services.
Selected options provide maternity benefits ranging from approximately KES 50,000 to KES 250,000. Depending on the plan, this can include normal delivery, Caesarean section and eligible pregnancy-related complications. Waiting periods apply.
Selected plans provide benefits for eligible pre-existing and chronic conditions. Full disclosure is important. Waiting periods, underwriting and benefit limits apply.
Dental and optical benefits are available within outpatient limits on applicable options. Dental can include consultation, scaling, fillings, extraction and root canal treatment. Optical can include consultation, frames, glasses and contact lenses.
Eligible plans can include emergency road ambulance services within East Africa and, on higher options, emergency air evacuation. Pre-authorisation requirements apply.
Some plans provide overseas emergency treatment or medical referral subject to territorial restrictions, medical approval, pre-authorisation and applicable benefit limits.
Eligibility & Required Documents
Onboarding GuidelinesPrincipal Member
Eligible from 18 to 59 years at entry. New applicants above 50 years may require a medical examination report.
Child Dependants
Covered from term birth up to 25 years, subject to full dependency and schooling requirements.
Spouse Coverage
One legal spouse can be included as an eligible dependant subject to applicable policy rules.
Checklist of Required Documents
- Completed and signed family medical application form
- National ID or Passport copy for principal member and spouse
- Birth certificate or legal adoption documentation for child dependants
- KRA PIN certificate for the principal member
- Detailed medical history or examination report where requested by underwriters
- Existing medical cover or renewal records for waiting-period transfer consideration
Note on Verification: Additional documentation or health declarations may be requested during medical underwriting depending on age, elected benefit limits, or pre-existing conditions.
Waiting Periods & Policy Conditions
Coverage TimelinesMedical insurance policies in Kenya include specific waiting periods before certain benefits become admissible. Review key qualifying timelines below:
Maternity Cover
Maternity benefits are subject to a waiting period of up to 10 months from the policy effective date.
Pre-existing & Chronic Care
Specified waiting periods and sub-limits apply to declared pre-existing and chronic conditions.
Congenital Conditions
Treatment for congenital anomalies and birth complications is subject to qualifying terms and waiting times.
Psychiatric & Psychotherapy
Inpatient psychiatric care and therapy typically carry a 1-year qualifying waiting period.
Transplant & Reconstructive Surgery
Major surgical procedures such as organ transplants and reconstructive surgery carry extended qualifying periods.
Gynaecological, Eye & Dental Surgery
Elective gynaecological, ophthalmologic, and inpatient dental surgeries are subject to initial waiting periods.
Important Underwriting Terms:
• Claims incurred within an applicable waiting period are not admissible.
• Any waiting-period waiver is subject to full underwriting evaluation, submission of continuous prior cover transfer documentation, and formal written approval from the insurer.
• Claims incurred within an applicable waiting period are not admissible.
• Any waiting-period waiver is subject to full underwriting evaluation, submission of continuous prior cover transfer documentation, and formal written approval from the insurer.
Combined Inpatient & Outpatient Premium Rates
Comprehensive annual pricing structured for individuals and young families
Example A: Single Person Schedule
Age Band: 19 – 29 Years| Inpatient Limit | Outpatient Limit | Calculation | Combined Annual Premium |
|---|---|---|---|
| KES 300,000 | KES 50,000 (Per Person) | 17,868 + 23,547 | KES 41,415 |
| KES 500,000 | KES 75,000 (Per Person) | 19,680 + 24,323 | KES 44,003 |
| KES 1,000,000 | KES 100,000 (Family-Shared) | 23,617 + 27,952 | KES 51,569 |
| KES 2,000,000 | KES 150,000 (Family-Shared) | 28,395 + 30,816 | KES 59,211 |
| KES 3,500,000 | KES 150,000 (Family-Shared) | 36,075 + 30,816 | KES 66,891 |
| KES 5,000,000 | KES 200,000 (Family-Shared) | 41,582 + 34,476 | KES 76,058 |
| KES 10,000,000 | KES 300,000 (Family-Shared) | 48,070 + 45,913 | KES 93,983 |
Note on Rates: Illustrative premiums based on a published rate schedule. Final premium is subject to current rates, underwriting, applicable levies and policy terms.
Example B: Young Family Schedule
Family Profile: M+2 (Husband 35, Spouse 30, Child 2)| Inpatient Limit | Outpatient Limit | Calculation | Combined Annual Premium |
|---|---|---|---|
| KES 300,000 | KES 50,000 (Per Person) | 49,574 + 31,740 + 31,740 + 22,653 | KES 135,707 |
| KES 500,000 | KES 75,000 (Per Person) | 56,995 + 32,787 + 32,787 + 23,400 | KES 145,969 |
| KES 1,000,000 | KES 100,000 (Family-Shared) | 68,396 + 79,523 | KES 147,919 |
| KES 2,000,000 | KES 150,000 (Family-Shared) | 82,236 + 98,085 | KES 180,321 |
| KES 3,500,000 | KES 150,000 (Family-Shared) | 104,172 + 98,085 | KES 202,257 |
| KES 5,000,000 | KES 200,000 (Family-Shared) | 120,075 + 98,085 | KES 218,160 |
| KES 10,000,000 | KES 300,000 (Family-Shared) | 135,518 + 130,623 | KES 266,141 |
Note on Rates: Illustrative premiums based on a published rate schedule. Final premium is subject to current rates, underwriting, applicable levies and policy terms.
Inpatient-Only Option
Family Profile: M+2 (Husband 35, Spouse 30, Child 2)A customer may choose inpatient-only medical insurance where the applicable plan permits. This focuses the premium on protection against major hospitalisation costs and can suit someone with a limited budget or existing access to outpatient care.
| Inpatient Limit | Illustrative Annual Premium – Family of Three |
|---|---|
| KES 300,000 | KES 49,574 |
| KES 500,000 | KES 56,995 |
| KES 1,000,000 | KES 68,396 |
| KES 2,000,000 | KES 82,236 |
| KES 3,500,000 | KES 104,172 |
| KES 5,000,000 | KES 120,075 |
| KES 10,000,000 | KES 135,518 |
Note on Rates: Illustrative premiums based on a published rate schedule for a family of three (35-year-old husband, 30-year-old spouse, and 2-year-old child). Final premium is subject to current rates, underwriting, applicable levies and policy terms.
Flexible Payment Options
Two-Installment ArrangementA two-installment arrangement may be available for eligible retail medical insurance arrangements, subject to the applicable insurer's payment terms. For instance, an annual premium of KES 147,919 would be approximately KES 73,959.50 per installment if split equally into two payments. Official quotations will display exact due dates and amounts.
Important Notice on Claims Eligibility: Retail products may be paid by installment before commencement or during the policy period, but claims are only admissible upon full premium settlement. Installments remain subject to insurer terms, and claims eligibility depends strictly on complete premium settlement and policy conditions.
Comprehensive Benefit Summary
Family Medical CoverExplore the full schedule of coverage features available under our family medical insurance plans, structured to protect against routine care, major hospitalisation, and emergencies.
| Benefit | Illustrative Limit | Customer-Facing Description |
|---|---|---|
| Inpatient | KES 300,000–10,000,000 | Hospitalisation, professional fees, prescribed medicines, diagnostics, surgery and eligible inpatient treatment. |
| Outpatient | KES 50,000–300,000 | Consultations, prescribed medication, diagnostics, radiology, laboratory services and eligible routine care. |
| Maternity | KES 50,000–250,000 | Normal delivery, Caesarean section and eligible pregnancy complications, subject to waiting periods. |
| Optical | KES 5,000–30,000 | Optical consultation, frames, glasses and contact lenses within applicable limits. |
| Dental | KES 5,000–30,000 | Dental consultation, scaling, fillings, extraction and root canal treatment within outpatient cover. |
| Pre-existing/chronic | Varies by plan | Eligible conditions subject to disclosure, underwriting, waiting periods and benefit limits. |
| Congenital/neonatal | Approx. KES 50,000–500,000 | Specified congenital and neonatal complications subject to eligibility and waiting periods. |
| Psychiatric/psychotherapy | Approx. KES 150,000–750,000 | Eligible inpatient psychiatric treatment after the qualifying period. |
| Personal accident | KES 100,000–1,000,000 | Principal member accidental death benefit, subject to terms. |
| Last expense | KES 50,000–150,000 | Family benefit following death from a covered condition, subject to policy terms. |
| Hospital cash | Approx. KES 500–8,000/night | Fixed cash benefit for eligible hospitalisation where applicable. |
| Post-hospitalisation | Approx. KES 15,000–50,000 | Eligible follow-up expenses within the specified post-discharge period. |
| Home nursing | Up to 90 days | Post-discharge nursing where medically recommended and pre-authorised. |
| Road ambulance | Fully covered | Emergency road evacuation within East Africa, subject to pre-authorisation. |
| Air evacuation | Selected higher plans | Emergency air evacuation within East Africa, subject to pre-authorisation. |
| Overseas emergency | Reimbursement limits | Emergency illness/injury while travelling, subject to territorial restrictions. |
| Overseas referral | Subject to limit | Referral where required treatment is unavailable locally, subject to approval. |
| Organ transplant | Approx. KES 100,000–1,000,000 | Eligible transplant services subject to pre-authorisation and qualifying period. |
| Reconstructive surgery | Approx. KES 50,000–750,000 | Eligible illness-related reconstructive surgery, subject to waiting period. |
| Gynaecological surgery | Approx. KES 150,000–500,000 | Eligible surgery after applicable waiting period. |
| External medical aids | Approx. KES 30,000–50,000 | Prescription-based aids such as wheelchairs, crutches and walking frames. |
| Prosthetic devices | Approx. KES 150,000–500,000 | Eligible prosthetic devices subject to medical recommendation and conditions. |
| Ophthalmologic surgery | Approx. KES 50,000–200,000 | Pre-authorised non-accidental ophthalmologic surgery. |
| Dental surgery | Approx. KES 50,000–200,000 | Eligible inpatient dental surgery subject to pre-authorisation. |
| Day-care surgery | Within inpatient limit | Eligible minor surgical treatment not requiring overnight admission. |
| Health check-up | Approx. KES 5,000–15,000 | Wellness/health screening subject to qualifying conditions. |
| Terrorism | Fully covered | Medical expenses for an insured person who is an innocent victim, subject to policy terms. |
Note on Benefits & Payments: Benefit limits, features, and installment availability are subject to the specific insurer's policy terms, underwriting guidelines, and final quotation schedules.
Key Policy Exclusions & Limitations
Policy TermsTo maintain clarity and transparency, please note that family medical insurance plans standardly exclude or limit coverage for the following conditions and treatments:
Cosmetic surgery unless specifically covered under applicable policy terms
Weight-management treatments, obesity surgery, and slimming drugs
Participation in hazardous sports or professional racing where excluded
Family planning, contraception, and infertility-related treatments
Treatment rendered by unregistered medical practitioners or herbalists
Self-referred or self-prescribed treatment without medical practitioner referral
Certain non-medical alternative treatments and experimental therapies
Alcohol/drug-related conditions and intentional self-injury where excluded
Medical expenses resulting from war, invasion, or related global hostilities
Active participation in certain riot, strike, or civil commotion risks
Expenses recoverable under another insurance arrangement, WIBA, or statutory scheme
Non-prescription sunglasses, designer frames, or specified optical exclusions
Important Warning on Disclosure: Claims arising from non-disclosure, concealment, or misrepresentation of material medical facts at application will lead to claim repudiation and potential policy cancellation.
Frequently Asked Questions
Family Health Insurance FAQIt is medical insurance structured to cover a principal member and eligible dependants, subject to selected benefits, limits, waiting periods, provider network and policy terms.
The premium depends on the principal member's age, family size and selected inpatient/outpatient limits. Use the illustrative examples on this page and request a current quotation.
A family of three can have different premiums depending on ages and benefits. A 35-year-old husband, 30-year-old spouse and 2-year-old child can use the M+2 examples on this page as an illustration; final pricing requires a quotation.
Yes, where the applicable plan permits. Inpatient-only cover focuses the premium on major hospitalisation risks.
Yes. Applicable options combine inpatient and outpatient benefits. Outpatient may be family-shared on higher options and per-person on certain lower options.
A two-installment arrangement may be available for eligible retail medical arrangements, subject to insurer payment terms. Claims eligibility remains subject to premium settlement and policy conditions.
Selected plans provide maternity benefits. Illustrative limits range from KES 50,000 to KES 250,000, subject to waiting periods and policy terms.
Some plans provide benefits for eligible pre-existing and chronic conditions, subject to disclosure, underwriting, waiting periods and benefit limits.
Selected plans include dental benefits within outpatient cover, with limits varying by option.
Selected plans include optical benefits within outpatient cover, subject to the applicable limit and conditions.
The approved provider network depends on the selected plan. Confirm your preferred hospital or clinic before purchasing.
Provide the ages of the principal member, spouse and children, indicate inpatient-only or inpatient plus outpatient, and state your preferred inpatient limit.
Request a Family Medical Insurance Quote
Your family's healthcare needs are different from everyone else's. Compare the inpatient limit, outpatient limit, maternity benefits, hospital network, waiting periods, exclusions and additional benefits before selecting a plan.
