Hospitals covered
Counties
Nairobi Nakuru
Kisumu Eldoret
Mombasa
Madison Insurance – Health Coverage Details
1. Insurance Overview
Madison Insurance’s BetterLife plan is designed for individuals, families, and small businesses, offering flexible health coverage with a wide panel of healthcare providers and value-added benefits for everyday medical needs and serious care.
2. What Madison Covers
| Service Type | Coverage / Benefit |
|---|---|
| Inpatient (Hospitalisation) | Covered, with different limit options (up to KSh 5,000,000 in some plans). |
| Outpatient (GP & Specialist) | Covered – includes consultations, lab tests, and diagnostics. |
| Maternity & Newborn | Maternity care (including pre-/post-natal) is included within inpatient; ultrasounds and pre-natal visits covered in outpatient. |
| Diagnostic Tests | Lab tests, pathology, and imaging (within outpatient/inpatient limits) are covered. |
| Dental & Optical | These are part of the outpatient benefit under BetterLife plans. |
| Chronic / Pre-existing Conditions | Covered, but subject to waiting periods. |
| COVID-19 Treatment | Exclusive COVID-19 inpatient cover (limit depends on plan). |
| Wellness / Value-Added | 24/7 careline, flexible coverage, and health check options. |
3. Coverage Limits
Inpatient limit: range depending on the plan, up to KSh 5,000,000 in some BetterLife plans.
Outpatient limit: plan-dependent (BetterLife allows different annual outpatient limits).
Maternity, dental, and optical benefits also have sub-limits as part of the outpatient or inpatient components.
4. Pre-Authorization / Approval Requirements
Hospital admissions (inpatient) may require pre-authorization or prior approval.
Major procedures or maternity stays may need approval as per policy schedule (check with Madison).
5. Co-Pay / Co-Insurance
Depending on the specific BetterLife plan, there may be co-pay or co-insurance for outpatient services.
Premiums and co-pay details depend on the plan selected (Premier, Executive, Budget).
6. Waiting Periods
According to Madison’s BetterLife policy:
No waiting period for accidents.
30 days for outpatient illnesses and non-chronic inpatient admissions.
10 months for maternity (normal or complications).
1 year for chronic, congenital illnesses, and certain surgeries (fibroids, hernia repair etc.).
2 years for cancer treatment and organ transplants.
7. How to Use Madison Cover at a Hospital
Present your Madison BetterLife insurance card or policy number during hospital registration.
Provide valid identification (e.g., national ID).
For inpatient admissions or maternity cases, notify Madison early or request pre-authorization if required by your plan.
The hospital bills Madison directly (if in-network), or you submit your claims/documentation as required by your policy.
8. Required Documents
Medical application form (filled out when enrolling).
National ID / Passport for principal and spouse (if any).
Birth certificates for dependents under 18, and proof of schooling for dependents 19–25 (if applicable).
Proof of premium payment / renewal documentation.
9. Exclusions
Treatments for extreme sports, war, or civil unrest.
Chiropractors, herbalists, acupuncturists are not covered.
Optical laser surgery (unless stated) has waiting periods.
Organ transplant and cancer have long waiting periods (2 years) before benefits apply.
10. SME / Group Plan Unique Features
The SME BetterLife plan offers flexible benefit structures for small businesses.
Includes 24/7 medical emergency assistance.
Parent accommodation when a child is hospitalised under the SME plan.
After-care and home nursing are available post-hospitalisation.
Ambulance services (private) coverage for SME plan.
11. Contact / Support
Madison Healthcare 24/7 Care Line: 0709-922 555 Madison Group Limited
Application / Enrollment can be done via their BetterLife web form. Madison Group Limited
12. Disclaimer
This summary is based on publicly available Madison BetterLife policy brochures and benefit summaries. Actual coverage, benefits, and limits depend on your specific plan and policy schedule. Always review your policy document or speak with Madison directly to confirm all terms before seeking treatment.