Medical Insurance Cover 2022

SERVICES STUDENT YANKHO THANDIZO THANDIZO PLUS UMOYO UFULU UFULU FOREIGN BENEFIT MTENDERE MAKOLO
Overall Annual Limit MK1,481,200.00 MK500,00 MK4,000,000.00 MK5,750,000.00 MK11,500,000.00 MK15,870,000.00 MK15,870,000.00 MK20,700,000.00 MK9,642,750.00
Premium per month MK3,700.00 MK3,000.00 MK5,850.00 MK10,450.00 MK15,750.00 MK27,200.00 MK45,500.00 MK69,000.00 MK50,600.00
GP Consultations 100% up to annual maximum benefit limit 100% up to annual maximum benefit limit 100% up to MK50,000.00 Limit per annum 100% up to MK60,000.00 Limit per annum 100& up to MK150,000.00 Limit per annum 100% up to MK200,000.00 Limit per annum 100% up to MK200,000.00 Limit per annum
Specialist Consultation(Referal
and 6 months waiting
period required)
Nil Nil 100% up to MK50,000.00 Limit per annum,
subject to Referal and 6 months wait period
100% up to MK80,000.00 Limit per annum,
subject to Referal and 6 months wait period
100% up to MK200,000.00 Limit per annum,
subject to Referal and 6 months wait period
100% up to MK300,000.00 Limit per annum,
subject to Referal and 6 months wait period
100% up to MK300,000.00 Limit per annum,
subject to Referal and 6 months wait period
100% up to Overall Annual limit 100% up to MK200,000.00 Limit per annum,
subject to Referal and 6 months wait period
Maternity - Normal delivery
(Antenatal, Postnatal)
Nil 100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to Overall Annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to Overall Annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to Overall Annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to Overall Annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
100% Subject to Overall Annual limit and
12 months wait period, limited to 5 antenatal
and 2 postnatal visits. One
birth every 2 years
Nil
Caesarian Section Nil 70% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
100% Subject to overall annual limit and
12 months wait period, limited to 5 antenatal
Nil
Major Procedures 100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit 100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit, 6 months
waiting period
100% Up to maximum annual limit, 6 months
waiting period
70% maximum annual limit, MK1,500,000.00
6 months waiting period
Pathology 100% up to limit of MK20,000.00 per annum 100% up to limit of MK20,000.00 per annum 100% up to limit of MK60,000.00 per annum 100% up to limit of MK100,000.00 per annum 100% up to limit of MK150,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK400,000.00 per annum 100% up to limit of MK150,000.00 per annum
Radiology 100% up to limit of MK20,000.00 per annum 100% up to limit of MK20,000.00 per annum 100% up to limit of MK60,000.00 per annum 100% up to limit of MK100,000.00 per annum 100% up to limit of MK150,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK400,000.00 per annum 100% up to limit of MK150,000.00 per annum
Specialised Radiology Nil Nil annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
100% Up to limit of MK1,000,000.00 per
annum and pre authorisation required
100% Up to limit of MK500,000.00 per
annum 6 months wait period and
pre authorisation required
General Dentistry 100% up to limit of MK40,000.00 per annum 100% up to limit of MK35,000.00 per annum 100% up to limit of MK60,000.00 per annum 100% up to limit of MK80,000.00 per annum 100% up to limit of MK150,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK250,000.00 per annum 100% up to limit of MK350,000.00 per annum 100% up to limit of MK150,000.00 per annum
Specialised Dentistry Nil Nil annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
annum, 6 months wait period and pre-
authorisation required
100% Up to limit of MK500,000.00 per
annum and pre authorisation required
100% Up to limit of MK250,000.00 per
annum 6 months wait period and
pre authorisation required
Chronic Generic Drugs 100% Up to limit of MK70,000 per annum 100% Up to limit of MK50,000.00 per annum 100% Up to MK100,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK150,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK500,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK750,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK750,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK1,000,000.00 Limit per annum,
subject to 12 month wait period
100% Up to MK500,000.00 Limit per annum,
subject to 12 month wait period
Chronic Branded Drugs Nil Nil 70% Up to chronic limit above 70% Up to chronic limit above 70% Up to chronic limit above 70% Up to chronic limit above 70% Up to chronic limit above 70% Up to chronic limit above 70% Up to chronic limit above
Acute Medicines(NBD,NGD,OTCS,VAC) 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit 100% Subject to Overall Annual limit
Optical-Frames and Lenses
(once every two years)
Nil 100% Up to MK20,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK40,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK60,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK80,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK140,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK140,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK250,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
100% Up to MK80,000.00 Limit per annum,
subject to pre authorisation and 12
month wait period
Eye Test 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit 100% Subject to annual optical limit
Hospitalisation(Medical and Surgical Wards) 100% Up to Annual Maximum benefit limit 100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
100% Subject to 6 month wait period and
Overall Annual limit, pre authorisation required
Oncology Treatment Nil Nil 100% Up to MK500,000.00 limit per annum
subject to 12 month wait period
100% Up to MK600,000.00 limit per annum
subject to 12 month wait period
100% Up to MK2,500,000.00 limit per annum
subject to 12 month wait period
100% Up to MK3,000,000.00 limit per annum
subject to 12 month wait period
100% Up to MK3,000,000.00 limit per annum
subject to 12 month wait period
100% Up to MK4,000,000.00 limit per annum
subject to 12 month wait period
100% Up to MK2,500,000.00 limit per annum
subject to 12 month wait period
Foreign Treatment(world wide) Nil Nil Nil Nil Nil Nil Limit per annum subject to 12 month wait
period and pre authorisation
Limit per annum subject to 12 month wait
period(Worldwide)
Nil
Emergency Air Evacuation Nil Nil Nil Nil Nil Nil Limit per annum subject to 12 month wait
period and pre authorisation
100% Up to foreign treatment limit Nil
Emergency Road Evacuation Nil Nil Nil 100% Up to MK200,000.00 limit per annum subject to pre authorisation 100% Up to MK300,000.00 limit per annum subject to pre authorisation 100% Up to MK400,000.00 limit per annum subject to pre authorisation 100% Up to MK400,000.00 limit per annum subject to pre authorisation 100% Up to MK500,000.00 limit per annum subject to pre authorisation 100% Up to MK300,000.00 limit per annum subject to pre authorisation
Funeral Benefit MK60,000.00 MK50,000.00, subject to 2 years wait period MK60,000.00, subject to 2 years wait period MK80,000.00, subject to 2 years wait period MK150,000.00, subject to 2 years wait period MK300,000.00, subject to 2 years wait period MK300,000.00, subject to 2 years wait period MK300,000.00, subject to 2 years wait period MK150,000.00, subject to 2 years wait period
Blood Transfusion 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit 100% Up to maximum annual limit
Dialysis Nil Nil Nil Nil Annum, subject to pre authorisation and
12 month wait period
Annum, subject to pre authorisation and
12 month waith period
Annum, subject to pre authorisation and
12 month waith period
Annum, subject to pre authorisation and
12 month waith period
Annum, subject to pre authorisation and
12 month waith period
Hearing Aids(Once evry 5 years) Nil Nil Nil 100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
100% Up to MK75,000.00 limit per annum
subject to pre authorisation and 12
month wait period
Organ Transplant Nil Nil Nil Nil Nil Nil Nil 100% Up to foreign treatment limit above Nil
Orthopaedic Procedures Nil Nil Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period Subject to pre authorisation and 6 month wait period
Orthopaedic Appliances
(Clutches, prothesis)
Nil Nil 100% Up to MK50,000.00 limit per annum
subject to 6 month wait period
100% Up to MK70,000.00 limit per annum
subject to 6 month wait period
100% Up to MK100,000.00 limit per annum
subject to 6 month wait period
100% Up to MK200,000.00 limit per annum
subject to 6 month wait period
100% Up to MK300,000.00 limit per annum
subject to 6 month wait period
100% Up to MK350,000.00 limit per annum
subject to 6 month wait period
100% Up to MK100,000.00 limit per annum
subject to 6 month wait period
COVID-19 Nil Nil Nil Nil Nil 100% Up to MK2,500,000 limit per annum
subject to pre authorisation, Govt
approved centres only
Nil 100% Up to MK2,500,000 limit per annum
subject to pre authorisation, Govt
approved centres only
100% Up to MK2,500,000 limit per annum
subject to pre authorisation, Govt
approved centres only

  1. Pre-natal vitamins and geriatric vitamins; Vitamin B tablets and ampoules if prescribed for neurological disorders e.g., neurobion; Calcium supplements when prescribed specifically for the treatment of osteoporosis.
  2. Contact lens preparation.
  3. All demand prescriptions and treatment.
  4. Expenses for which a third party is liable including expenses associated with occupational injuries and diseases, motor vehicle accidents covered by other forms of insurance, provided that the medical services covered by other forms of insurance, provided that the SCHEME may provide benefits until the third party’s liability has been established at which stage the expenditure shall be recoup from the third party or the member as the case may be.
  5. Injury arising from any form of public disorder.