Britam Insurance – Health Coverage Details

1. Insurance Overview

Britam Insurance offers several health insurance plans for individuals, families, and groups — including budget-friendly and comprehensive options. Their plans aim to provide flexible coverage across inpatient and outpatient care, plus additional services such as wellness, critical-illness cover, and last-expense / funeral benefits.

2. What Britam Covers Under Its Medical Plans

3. Coverage Limits & Plan Tiers

• Britam offers multiple plan tiers under e.g. the “Milele / Premier / Advantage” structure. Inpatient coverage limits vary from KES 300,000 up to KES 10,000,000 depending on the plan selected. 

• Outpatient benefit limits (when included) often range from KES 50,000 to 200,000 annually (varies by plan).

• Dental and optical (non-accident) sub-limits: e.g. up to KES 10,000 to 40,000 depending on plan.

• Critical-illness, last-expense, personal accident, and wellness-check benefit limits vary by plan/sub-limit structure. 

4. Pre-Authorization / Approval Requirements

• Planned hospital admissions, surgeries, or complex treatments generally require pre-authorization from Britam, especially under comprehensive plans. 

• For non-emergency procedures, pre-approval helps ensure coverage of theatre, diagnostics, and specialist services. 

5. Co-Pay / Co-Insurance & Waiting Periods

• Some plans may have co-payments or exclusions for outpatient or non-emergency services (especially under lower-tier plans).

• Waiting periods apply: e.g. for maternity, non-accident surgeries, pre-existing conditions — duration depends on plan.

6. How to Use Britam Cover at a Hospital

1. Present your Britam health insurance card / policy number and photo ID at hospital registration / reception.

2. Verify that the hospital is on Britam’s panel (for cashless / credit-facility).

3. For planned admissions / surgeries / maternity: request pre-authorization from Britam.

4. After treatment, hospital bills are sent directly to Britam (if within the network and pre-authorized) or you submit a claim as per your policy terms.

7. Required Documents (Commonly Requested)

• Britam membership card / policy number

• Valid government-issued ID for insured persons and dependants

• For admissions: pre-authorization forms (if required), referral letters (where applicable)

• For maternity: prenatal clinic records / pregnancy declaration (depending on plan)

• For specialised treatments / diagnosis: doctor’s referral, prescription, or consultant letter

8. Exclusions & Common Limitations

Britam’s plans typically exclude or limit:

• Purely elective or cosmetic procedures (unless accidental)

• Self-prescribed treatment or unapproved alternative medicine

• Dental prosthetics, hearing aids, elective dental/optical upgrades (unless part of accident)

• Hazardous sports or activities, and treatments arising from self-harm or illegal acts

• Treatments outside Britam’s approved provider network (unless agreed otherwise)

• Some sub-limits and benefit caps apply for chronic/pre-existing conditions, dental/optical services, last-expense benefits etc. 

9. Value-Added / Unique Features

• Personal Accident Cover & Critical Illness Cash Benefits: Some Britam plans include accidental death/disablement protection and lump-sum benefit on diagnosis of critical illnesses.

• Annual Wellness Checkups & Preventive Care: Offered under select plans to promote early detection and health maintenance.

• Telemedicine, Online Pharmacy & Medicine Delivery: For convenience and ease of access, especially for minor ailments or repeat prescriptions.

• Funeral / Last Expense Cover: Some plans include benefit to assist with funeral expenses / last expenses for insured members or dependants. 

10. Disclaimer

This summary is based on publicly available information about Britam’s health insurance plans (e.g., Milele, Premier, Advantage, Bima ya Mwananchi, etc.). Actual benefits, limits, exclusions, waiting periods, and network access may vary based on the specific plan and policy you select. Always verify your policy schedule or contact Britam directly before relying on coverage.