Outpatient coverage:

Includes unlimited outpatient consultations at any one of our partner provider facilities (Exhibit D) located throughout Kenya.  These consultations can take place on an as-needed or scheduled basis  without any claims or additional copays or fees at all. 

The following is covered::

  • Access to a Doctor whenever needed
  • Specialist Referral
  • All prescribed tests and diagnostics
  • All prescribed medications - guaranteed for quality
  • Emergency Room Care
  • Plans offer coverage for many  pre-existing conditions up to 100,000 KES
  • Common pre-existing  conditions covered include but are not exclusive to: Hypertension, Diabetes, Asthma, Peptic Ulcer Disease, Chronic Skin and Eye Conditions
  • Additional pre-existing conditions are covered as long as they are not explicitly excluded

Inpatient Coverage:

Covers hospitalization and major procedures, including surgery, at any of our partner hospitals or their affiliates (Exhibit D, Section 2)

  • Antara Health Plans offer KES 1,000,000 Inpatient coverage
  • KES 500,000 sub-limit at intensive care unit (ICU)
  • Includes the following:
  • All needed medications
  • X-Rays, CT Scans, and Laboratory Examinations
  • Operating Theatre, Surgical Treatment and all bills associated with surgery

Comprehensive Coverage plans are for 1 year of coverage.

Individual Plans Vs Family Plans:

Comprehensive Care Plans can be purchased for a group of individuals at favorable rates. Those covered under family plans receive Outpatient coverage as needed, BUT must share the Inpatient Coverage between them of between 100,000 KES and 1,000,000 KES, depending on plan purchase. Please note that Family Plans do NOT include coverage for preexisting conditions. 

Many pre-existing conditions –– such as diabetes, hypertension, and asthma –– ARE included in our Individual Comprehensive Coverage Plans up to $1000.00 (typical investigations and drug treatments generally do not cost more than $500). 

The Antara Health Navigator 

Every single person covered by Antara Health with be assigned a Health Navigator. A Health Navigator is a qualified health professional employed by Antara Health to benefit everyone we cover. 

Our Health Navigators typically have a background in both nursing and claims administration so that they understand both the clinical and logistical sides of delivering care. 

Health Navigators serve as a point of first contact for all our members. They will be there to answer questions, provide information on wellness resources, follow up about care received, and help address any issues that may arise. 

What IS Covered

At Antara Health we want to be up front about what our Comprehensive Care Plans do and do not cover. While Antara Health coverage offers great coverage at excellent value, not everything, including some pre-existing conditions, will be covered by our Comprehensive Plans.

What IS covered: Outpatient Benefits

  • Unlimited Consultations with an Avenue Healthcare doctor at any of our clinics
  • Unlimited Specialist Consultations on referral from our doctors
  • All needed drugs and dressings
  • X-rays, CT Scans, Ultrasound and Laboratory Examinations
  • Special Procedures (e.g. suturing, plaster of Paris (POP))
  • Many pre-existing conditions, including but not exclusive to: Diabetes, Hypertension, Asthma, peptic Ulcer Disease and more

Outpatient services are available within 24 hours of enrolment from any of our facilities in the Partner Provider Facilities List (Exhibit D).

What IS covered: Inpatient Benefits

  • Inpatient care  to the selected limit
  • All needed drugs and dressings
  • X-Rays, CT Scans, and Laboratory Examinations
  • Operating Theatre, Surgical Treatment and all bills associated with surgery

Additional benefit of costs of emergency admission for the first 48 hours in any NHIF approved hospital outside Nairobi. Avenue Hospital must be informed of any such admission within the first 24 hours.

For non-emergency admissions, there is a 60-day waiting period.

What Is NOT Covered

At Antara Health we want to be upfront about what our Comprehensive Care Plans do and do not cover. While Antara Health coverage offers great coverage at excellent value, not everything, including some preexisting conditions, will be currently covered by our Comprehensive Plans.

What is NOT Covered Outpatient Exclusions:

  • We do not yet provide coverage for people over 65 years of age
  • Pre-existing 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 gynaecological surgery
  • Dentistry (except in the case of severe accidental damage.
  • Magnetic Resonance Imaging (MRI)*
  • Medical equipment
  • Prosthetic devices
  • Hearing aids

What is NOT Covered Inpatient Exclusions: 

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

* The good news is that NHIF covers much of what our plans do not - such as dialysis, chemotherapy, and MRIs. Antara Health makes it easy to sign up for NHIF coverage and our Health Navigators help our beneficiaries maximize the benefits available under NHIF.

An important note

Although we partner with high quality providers, we are not a clinical service provider and the medical care your loved ones received will be provided by our clinical service partners.  So, even though we curate our partners very carefully, we can not be responsible for the care they provide.  We are responsible for coordinating that care and would like to hear about any issues or concerns that you may have, but ultimately, our partners are responsible for the medical care they provide.

We also want you to know that Antara Health is a growing company. As we expand we will be improving our coverage and our benefits. We are constantly working to deliver the best possible care to everyone we cover and maximize value to all our customers.

To that end, we have a strong commitment to listening to our customers. If you have questions, we want to answer them. If you’re dealing with a specific health situation and are unsure if we’re for you, then please get in touch and we’ll be happy to see how we can help.  

Did this answer your question?