Will I be covered for any pre-existing illnesses or conditions which I have prior to joining the appropriate medical scheme which you have recommended?

Pre-existing conditions on the whole tend to be rejected from cover typically for the first two years of your policy. These conditions can be brought back onto cover, if they have not been treated, or no symptoms have arisen for two years after taking out health insurance*

*Subject to terms and conditions.

Is there a maximum amount that I can claim during the policy term?

This depends on the annual maximum limit on your policy. You should note that certain treatments will have their own sub-limits.

Are my Claims Cashless?

Most insurers have a direct settlement list.

This will depend on the type of treatment you require, for instance:


You will be required to produce your membership card to the hospital.
Depending on the type of settlement agreement in place between the hospital and the insurer, you will either have to settle the bill and claim back the money or the insurer will settle directly with the hospital. (Most hospitals in the Kenyan region we deal with

This usually enables you to be admitted without having to pay a sum of money upfront. A direct settlement agreement is required between the medical insurance company and the hospital.

If you were to attend a hospital that does not have a direct settlement agreement in place, you will be required pay for the treatment upfront and then claim at a later date.

Out-patient claims

Out patient claims will usually require you to pay the healthcare facility upfront and complete a claim form within the next 6 months to either Goldstar or directly to the insurance provider. The claim form requires a signed medical report from the doctor and any relevant receipts which relate the appointment.

Can I use any hospital or Doctor/Medical practitioner?

You are able to use any hospital or doctor/medical practitioner as long as they can provide a satisfactory service.

If I want health insurance will I need to undergo a medical examination?

Some insurers may require a medical exam if you want your pre-existing covered.

Is there a waiting period before I am covered?

Usually insurance companies will begin your cover from the date they receive your application form. It certain circumstances they may be a waiting period such as cover for pregnancy. You can always ask one of our advisors for more details.

Do you charge for your services?

No, we are paid by your insurance provider, which does not affect your premium.

Is it possible to get better rates direct from an insurance company?

No, and in Kenya you are not allowed to go straight to insurers, so why not let us do all the work for you?