Plan Details

This is a breakdown of what is and what is not covered under our current plans

OUTPATIENT

What IS COVERED ​

  • For Individual Comprehensive Plans:

    • Pre-existing diabetes, asthma, hypertension, peptic ulcer disease and chronic eye conditions are INCLUDED but there are limits to the coverage we can provide for chronic conditions.  All plans cover $1,000 of chronic disease outpatient coverage.

  • Unlimited Consultations with an Avenue Healthcare doctor at any of our clinics

  • Unlimited Specialist Consultations on referral from Avenue doctors

  • All needed drugs and dressings

  • X-rays, CT Scans, Ultrasound and Laboratory Examinations

  • Special Procedures (e.g. suturing, POP)

Outpatient services are available within 24 hours of enrollment from any of our facilities in Nairobi, Thika, Mombasa, Kisumu,Nakuru and Eldoret.

OUTPATIENT​

What IS NOT COVERED 

  • We do not yet provide comprehensive coverage for people over 65 years of age, but we do provide our exclusive Senior Care Packages.
    Just
    click here to learn more.

  • Pre-exisiting cancers or kidney diseases

  • Congenital and genetic disorders

  • HIV related conditions

  • Drug/alcohol dependency

  • No coverage for cosmetic surgery (except in the case of accidental disfigurement)

  • Family planning or pregnancy care (for this we have a separate plan)

  • Non-emergency gynecological surgery

  • Dentistry (except in the case of severe accidental damage)

  • MRI

  • Medical equipment

  • Prosthetic device

  • Hearing aids

The good news is that NHIF will help cover much of what our coverage will not. 

If your loved ones have complicated conditions, contact us and we will try to help figure out the best way to get them covered.

INPATIENT

What IS COVERED

  • Inpatient coverage up to $10,000 USD (KES 1,000,000)

  • All needed drugs and dressings

  • X-Rays. CT Scans and Laboratory Examinations

  • Operating Theatre, Surgical Treatment and all bill's associated with surgery

Advantage, Privilege and Premier card holders have an additional benefit of costs of emergency admission for the first 48 hours in any NHIF approved hospital outside Nairobi. Avenue must be informed of any such admission within the first 24 hours.

Please note that for non-emergency admissions, there is a 60-day waiting period.

INPATIENT

What IS NOT COVERED 

  • Hospital admission in the first 60 days of membership, EXCEPT for accidental injury admissions

  • ICU care*

  • HDU care

 

*ICU can be purchased at an additional cost. Please contact us if you would like to add ICU cover. 

The good news is that NHIF will cover much of what our coverage will not and our team will help you maximize NHIF benefits.

If your loved ones have complicated conditions, contact us and we will try to help figure out the best way to get them covered.

If you want to learn more about our plans click here and we can find time to speak

Contact Information

Tel:

+1 917 2677454 ​ (US)

+254 711 082 828 (Kenya)

‭+44 20 3998 2448 (UK) 

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