STANDARD-EX

BENEFIT CATEGORY	BENEFITS (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	– 100% cover in Government, and CHAM hospitals. – 85%* cover in private hospitals. – Benefit subject to the overall annual limit. – Covered once every 3 years. – UNIMED pre-authorization required.
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	-Subject to an annual limit of K50,000.00. – For Education purposes only. – UNIMED pre-authorization required
All hospital admissions and procedures	– 100% cover in Government hospitals 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. – NIMED 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.