Eligibility:

Abale cover is for parents and extended family members (other than spouse and children – biological or adopted) of principal members under Standard cover

Waiting Period:

  • Three months waiting period for OPD visits and one-year waiting period for major operations and admissions.
BENEFIT CATEGORYBENEFITS (2024 – 2025)
External Hospitals– Not Covered.
Acute pharmacy medication– 85%* cover in UNIMED accredited service providers. Subject to the overall annual limit.
Chronic pharmacy medication– 85%* cover in UNIMED accredited service provider. Subject to the overall annual limit.
– UNIMED will allow a supply of drugs for a maximum of one month.
Minor Procedures– 100%* cover in Government, and CHAM hospitals. 85% cover in private hospitals. Subject to the overall annual limit.
Optical Benefits– 1 eye test every 24 months.
– Frames and Lenses – K100,000.00 once every 24 months.
– UNIMED pre-authorization required.
Maternity services: Antenatal, delivery and Postnatal– Not covered
General Dentistry: Cleaning, extraction, filling, denture placement– 85%* cover.
– Subject to the overall annual limit
– Check-up/Cleaning limited to once every 6 months.
Specialized Dentistry: Inlays, crowns, root implants and bridges.– Covered at a maximum of K250,000.00 per annum
– UNIMED pre-authorization required.
Specialized Dentistry: Orthodontics– Covered at a maximum of K500,000.00 per annum
– UNIMED pre-authorization required
Audiology– Hearing aids covered once every four years.
– Subject to a limit of MK500,000.00.
– UNIMED pre-authorisation required
Physiotherapy– 100% cover in Government and CHAM hospitals.
– 85% cover in private hospitals.
– UNIMED pre-authorisation required
Psychiatry– 100% * cover.
– Subject to the overall annual limit.
Medical Check-ups– 50% cover once per annum.
– UNIMED pre-authorization required.
Medical Examinations– Not covered
All hospital admissions and procedures– 100% cover in Government and CHAM hospitals, subject to the overall annual limit.
– 85%* cover in private hospitals subject to the overall annual limit.
– Cover limited to general wards for admissions and procedures in private hospitals.
– UNIMED pre-authorisation required.

Note:

* UNIMED offers 85% cover in selected private hospitals and 100% in CHAM and government hospitals. Please refer to the approved list of service providers.
Chronic conditions are diseases such as Diabetes, Hypertension and Peptic ulcers.
Please refer to UNIMED Exclusions.